Venereal Disease in Relation to Motherhood and Infancy

Kai Tiaki : the journal of the nurses of New Zealand, Volume XV, Issue 3, 1 July 1922, Page 123

Venereal Disease in Relation to Motherhood and Infancy

In her lecture on "Venereal Disease in the Mother and Child/' on January 30, at Carnegie House, 117 Piccadilly, W.I, Mrs. Seharlieb, C.8.E., M.D, .M.S.', J.P. ? gave her large audience of women a graphic yet simple and clear account of the symptoms, progress and effects of syphilis and gonorrhoea in the case of women and children. The lecture Avas followed with close attention. The lecturer said that of these two diseases, syphilis, whether congenital or acquired, has the greatest effect on the national health, hut gonorrhoea is equally dangerous to the individual. Venereal diseases are not infectious in the same way as is scarlet fever, but are communicated through contact of a diseased with a healthy mucous membrane, or by the germ being carried on an open sore. Sexual intercourse is the usual, but not the only, mode of infection. It can be conveyed in other ways. For instance, doctors, nurses and midwives may contract these diseases by carelessly handling the sick without wearing rubber gloves. They may also be conveyed by the use of imperfectly-washed cups, glasses, spoons, etc., that have been used by the syphilitic persons; by kissing", or through careless use of the telephone, Avhistles and other Avind instruments. This ''syphilis of the innocent," as it has been called, may be also contracted by healthy wives through infected husbands, sometimes by husbands through their wives; and by unborn infants thnnigh their mothers. A heavy percentage of miscarriages is caused by this infection having been conveyed to the pregnant woman. The germ of syphilis (spirocheeta pallida) is a micro-organism like a corkscrew in shape when viewed through the microscope. It was called by Sir William Osier the "worm that never dies." It is not a worm, and happily it can be destroyed by long and painstaking treatment, Avithout which it goes on in human tissues for an indefinite number of years. Apparent recovery is possible, although the disease may be latent, and

symptoms may recur forty and fifty years after infection in early youth. EFFECT ON THE PREGNANT MOTHER. A healthy woman may be infected during intercourse, she having received the fertile seed and the germ of disease at one and the same time. The processes of life are considerably quickened in pregnancy, the vulva, labia, vestibule and cervix all being* specially softened. She does not at once notice symptoms of the disease, and may only receive the first intimation of disaster when she begins to develop skin rashes, mucous tubercles, also savo! len iglands in the axillse or groins. After a time she may lose her hair, eyelashes and eyebrows, and complains of sore throat. On examination, a large ulcerated surface that heals very slowly is seen in the throat. EFFECT ON THE CHILD. Whether the woman were already syphilitic or whether she acquired the disease at the time of fertilisation, the disease affects the foetus, and its most frequent fate is abortion, miscarriage, a premature or a still-birth. Some syphilised babies, hoAvever, are born alive, and not all of them slioav signs of the disease at birth. "When they are six, seven or eight Aveeks old, they develop " snuffles." This trouble is caused by an inflammation of the mucous membrane lining 1 the nose. The child cannot suck; because it is unable to breathe through a closed nose ; it must be fed with a spoon. There is also a thick yellow nasal discharge, often blood-stained. Sometimes the cartilages and the small bones of the nose may necrose, and the "bridge" falls in, causing the condition knoAvn as " saddle-nose." There may be linear scars of mucous tubercles round the mouth. The child suffers from skinrashes of many different forms — among them pemphigus on the palms and soles. The completion is unhealthy, the colour of cafe au lait. In appearance the baby is Avizened and lantern-jaAved, with a typical "old man" face— familiar to hospital

nurses as a " waster " or a "marasmic" baby. The only drug that seems to benefit those infants is "grey powder/' in small doses. All syphilitic babies do not die, but much trouble is in store for those that survive. At about six months old a certain number die of meningitis, not caused by tubercle, but by the germ of syphilis. Somo survive longer, and appear to improve, as the disease is marked, characteristically, by "lucid intervals," but about the time of the second dentition a neAv crop of troubles appears. Now the teeth are affected, and the child develops the kind known as "notched and jagged," or "Hutchison's" teeth. They are knobbed at first, until by degrees the knobs wear off, and then the margin becomes crescentic. The surface of the teeth is often : ' pitted ' ' and striated in appearance. Blindness at this age is likely to occur in bad cases, through interstitial keratitis (a chronic inflammation of the cornea), also deafness, the nerve of hearing becoming diseased and finally destroyed. In adolescence — always a difficult time of life, when growth, development and education all make strenuous demands on the child at the same time — syphilis again gets the upper hand. In the syphilitic adolescent, the stress of the disease falls on the nervous system, the mind ceases to develop, it retrogrades, and extreme cases reach the condition known as infantilism. The finer mental attributes fail first — judgment, memory, interest, The boy shows no ambition in work or in games. The girl has 310 care for her appearance. The finer movements become impaired, and there is, first, lack of power in drawing, writing, dancing ; then inability to walk, stand or sit. The patient becomes quite helpless and bedridden as the loss of power becomes general; affecting every organ and function of the body. This terrible condition is what is known as G.P.I. — "General Paralysis of the Insane" — which is the final development. "When this point is reached the ruin is complete, and life is rarely prolong-on beyond 18 months or two years — if the

patient is adolescent, In the case of older persons, both men and women, general paralytics have intervals when they are better, and may go on for years before the end comes. All this syphilis will do for the pregnant woman and her child, unless the diease Is put under salvarsan or other arsino-ben-zol treatment early enough to destroy the spirochietes. Unless the patient can be persuaded to continue the treatment until the doctor is sure of a cure, little or no good is done by beginning it. The treatment may have to be continued for two years. GONORRHOEA Gonorrhoea and syphilis may both exist in the same person, but if present singly in a woman its chief signs are redness, swelling, heat, pain and a vaginal discharge of yellowish-greenish matter, which is highly contagious. On infants, the chief result is the infection of the child's eyes during labour, causing ophthalmia neonatorum (a purulent inflammation of the conjunctive) from contact with this discharge, which, according to statistics, causes one-fourth of all cases of blindness. Under the microscope, the gonococcus in children, which is the germ producing gonorrhoea, has an appearance somewhat like pearl barley. The germs become buried in the soft cells of the tissues, causing symptoms of redness, swelling, heat, pain, itching, and discharge, and affect the mucous membrane of the eye, nose, bladder, vagina, cervix, uterus, tubes and ovaries. Of all the serious operations on the generative organs of a woman, about one-fourth are due to gonorrhoea. Syphilis and gonorrhoea together account for one-half the cases of sterility. -From "The Nursing Mirror and Midwives' Journal."