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Perhaps failure to appreciate the prevalence of gonorrheal vulvovaginitis accounts for the fact that so little has been done in the study of its effects. Serious complications during the acute stage of the infection are so rare that most children suffering from the disease never find their way to clinics. Therefore the real incidence in any given locality is never known. An impression of this incidence can be gained when one learns that more than three hundred cases were recorded in Baltimore in a single year (1927). Yet this city makes no particular effort to secure complete records of this disease. That this number represents only a small percentage of the true number of cases cannot be doubted when it is pointed out that more than two hundred of these cases were reported from one clinic alone, a clinic that does not make routine examinations of girls from schools and asylums. As a result, only those cases that are severe enough to cause aid to be sought . because of the gonorrhea itself are seen in this clinic. Obviously then, this number, which is appalling enough in itself, must fall far short of the actual incidence.Whenever the diagnosis of gonorrheal vulvovaginitis is made, the parents of the child immediately confront the physician with two ques¬ tions : Where did the child get the disease, and what will the effect be ?The answer to the second question cannot be given with any degree of certainty. Most writers of textbooks on the diseases of children con¬ tent themselves with a frank admission of ignorance or some reference to an allusion made by Sänger ' in a letter written nearly forty years ago, at a time when he did not recognize the etiology of the disease. Little or no attention has been given to the question in this country, though there has been some discussion of it among foreign writers.Stein 2 said that endometritis, gynatresia, sterility and dysmenorrhea may be late sequelae of the disease, but he does not support his state¬ ment by examples from his own experience or by reference to the work

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