5. Senile type.--This comes only after the change of life.

Symptoms.--There is pain in the lower abdomen. Passing of urine is

frequent and is attended with smarting and burning pain. There is a

feeling of heat and burning in the vagina, and a copious discharge of

mucus and pus. In the gonorrheal variety the urinary disturbances are most

marked.

In gonorrheal variety the symptoms date from a distinct onset, last

longer, do not yield so rapidly to treatment, and complications, such as

enlarged glands in the groin and in the vulva and vagina, inflammation of

the lining of the womb and fallopian tubes, inflammation of the bladder,

often make their appearance early.

Treatment (in acute cases).--Rest in bed and prolonged vaginal injections

of a solution of corrosive sublimate (1 to 4000 strength) three times a

day. If the gonorrheal poison is present in the pus, the walls of the

vagina, cervix and cervical canal should be dried and thoroughly painted

with a twenty per cent solution of nitrate of silver. The patient should

be in the knee-chest position for this treatment.

In chronic cases the gonorrhea poison (gonococcus) is found most

frequently just behind the posterior lip of the cervix and here the silver

solution should be applied very thoroughly.

VAGINISMUS.--This is a painful reflex muscular contraction of the vaginal

orifice, and is most often observed in patients of a nervous and sensitive

temperament. Treatment.--Any local cause of irritation should be removed.

If there is no local irritation, the opening should be dilated under an

anesthetic. Tonics, exercise, and a complete change of scene are

beneficial.

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