Venereal Diseases in Midwifery Practice

Kai Tiaki : the journal of the nurses of New Zealand, Volume XV, Issue 3, 1 July 1922, Page 107

Venereal Diseases in Midwifery Practice

Gonorrhcea and syphilis are the two varieties which it is necessary to recognise. They both affect mother and child, and are both contagious diseases. Gonorrhoea. 1. In the Mother. — This disease sets up an inflammation in the vagina, igiving rise to a thick yellow, purulent discharge. Frequently the urethra and bladder become infected, and cystitis is set up, causing frequent and painful urination. Not infrequently an abscess forms in the vulva. The infection is apt to travel up through the uterus into the Fallopian tubes, and set up inflammation and abscess formation there; it sometimes gives rise to peritonitis. This disease sometimes gives rise to puerperal septicEemia, which however is not usually of a severe variety. Sometimes the organism gets into the system and sets up an inflammation of the various joints, resembling rheumatism, and sometimes abscesses. 2. In the Child. — The child is usually infected during birth and develops that form of inflammation of the eye called opthalmia neonatorum. Cases have bceii recorded in which the child was born with opthalmia, but usually it is not until the second day after birth that the eyelids become red and swollen, and pus exudes from between the lids. On the other hand, the child may not be infected until some days after birth. That form of infection would be a distinct reflection on the nurse. Syphilis. This disease is of two kinds — acquired and congenital. Whilst gonorrhoea in a large proportion of cases remains a local disease, syphilis is characteristically a blood disease. 1. In the Mother. — The disease is usually described as occurring in three stages: Primary, Secondary and Tertiary. Primary Syphilis. — Inoculation is followed in about four weeks by the first local manifestation of syphilis, the prim-

ary sore or chancre. The most common site is the labia, either majora or minora, but it may occur in other parts of the genital organs, or on the lips, or, especially in the case of doctors and midwives, on the fingers. Sometimes the initial lesion is so slight that it is overlooked. Usually the primary sore is single, but sometimes, as in the case of the labia, adjacent surfaces are affected. It begins as a small sharply rounded excoriated spot of dull red colour, and looks like an erosion, but is usually painless. During pregnancy it may assume larger proportions than under ordinary circumstances. The discharge is serous and scanty if the ulcer is protected, but it becomes purulent if irritated. The sore is associated with enlarged glands in the groin. Secondary Syphilis. — From the appearance of the primary sore to the appearance of secondary symptoms generally six weeks elapse. During this period the chancre is likely to be healed, and the poison is being dissimulated throughout the system. Instead of poison one should say rather the syphilis microbe and the products of its activity. This stage is usually ushered in by a feverish attack lasting three or four days. Various rashes on the skin occur pretty generally over the body. The spots come out slowly in crops, are of a coppery or raw-ham appearance, and are not itchy. There is general enlargement of the lymphatic glands. The hair tends to fall out and sometimes in considerable quantities, leaving bald patches. A sore throat is a common symptom, and white patches appear in the throat and inner surface of lips. At this stage the disease is very contagious, and the patient must have her oavu spoons, cups, etc. Inflammation of the eyes, iritis, is a serious complication at this stage. One condition often found about the labia, the arms and perineum must be especially mentioned, and that is wart-like excrescence called condylomata; occas-

ionally these form large cauliflower-like excrescences. The presence of these condylomata may be the first indication to the midwife that the patient is syphilitic. The placenta is also the site of syphilitic disease, which may result in the death of the foetus. In many patients no history of a rash can be elicited, and the first intimation of the existence of the disease is afforded by the birth of a premature or macerated foetus. The syphilitic placenta is large and pale, and often presents a dull greasy appearance; it sometimes shows yellow or white firm patches. Tertiary Syphilis.— The symptoms of tertiary syphilis usually appear during the third or fourth year after infection. Under suitable treatment the patient should be cured in the secondary stage, but patients often neglect treatment and fail to persevere with it, with the result that syphilis passes into a chronic condition called tertiary. Almost all he organs of the body are liable to be affected by tertiary syphilis, either with chronic inflammatory changes or with the formation of tumours called gummata. Bones and joints become chronically inflamed, tumours occur in the brain; degeneration of brain and spinal cord is also of common occurrence, giving rise to various forms of paralysis. Deafness and blindness as well as disease of the heart and arteries are liable to result from tertiary syphilis. Various skin diseases are apt to appear during this stage and may be the only sign of the disease.

But there may be no symptoms for several years, during' which the patient appears quite well, but the blood gives a positive Wasscrman test, a sure indication that the disease is still present. In the tertiary stage the nurse need have no fear of contagion. 2. In the Child. — Syphilis is the most frequent cause of foetal death in the later months of pregnancy. The mother may be suffering from the disease at the time of conception, or may contract it during the course of pregnancy, but in either event transmission to the foetus occurs through the placenta. Usually it leads to the premature expulsion of a macerated premature foetus. Less commonly the child is born alive showing distinct manifestations of the disease, while in other cases they do not appear until a later period. The appearance of the syphilitic foetus varies materially, according as it is born alive or dead. In either instance it is markedly undersized, and the subcutaneous fat is poorly developed or entirely lacking. In the living child the skin usually presents a dry, drawn apearance, and has a peculiar gray'sh hue. It is very brittle and readily cracks at the flexures of the joints. The skin covering the soles of the feet and the palms of the hands is often thickened and glistening, like the hands of a washerwoman. In other cases characteristic vesicles are noted in the same locations. If intra-uterine death has occurred the sk-n peels off at the slightest touch.