GONOCOCCAL OR SPECIFIC Predisposing Causes.—These are precisely the same as those enumerated for simple urethritis.
Exciting Causes.—The author will not enter into a discussion of the various arguments relative to the specificity of the gonococcus. It is sufficient to say that certain types of virulent urethritis are characterized by the presence of a germ of peculiar character—the gonococcus—which microbe may be the cause or the effect of the disease. Whether it be the cause or effect, however, it has been conclusively shown that this microbe is capable of producing in a per fectly healthy mucous membrane an inflammation similar to that from which the secretion which contains it was originally derived.
Apropos of the method of contagion in gonorrhoea, it has seemed to the author that considerable illogical reasoning has been indulged in regarding the possibility of infection with gonorrhoea in an inno cent manner. Syphilis insontium is well recognized, but whenever an individual presents himself with a gonorrhoea and gives a history of unknown or innocent source of infection, the practitioner treats the history with lofty disdain and a contempt born of a profound knowledge of human nature, particularly as manifested in venereal diseases. The author unhesitatingly affirms that, other things being equal, gonorrhoea is more likely to be contracted innocently than is syphilis. The principal limitation of the application of this state ment is the fact that the structures susceptible to gonorrhoea are of comparatively small area and not very readily accessible, whereas in the case of syphilis any abraded surface will serve as a port of entry for the germ disease. Granted, however, the contact of the mucous membrane with gonorrhoeal virus, infection very much more readily occurs than in the case of syphilis, the latter disease requiring an abrasion as one of the essential requisites for infection. Granted that the gonorrhcea, depends upon a very virulent germ, or even lay ing the germ theory aside for the moment and accepting the broad proposition that gonorrho3a, affords a secretion which is extremely virulent, it only remains to show that facilities for the innocent con veyance of the disease are of daily occurrence in order to substanti ate the proposition that gonorrhoea may possibly be frequently con tracted in a perfectly innocent manner.
The water-closet theory of the origin of gonorrhoea has received much ridicule, yet the author is inclined to the belief that if logic rather than ridicule be applied to a study of the question, the theory will not appear quite so absurd. It is a practical impossibility for an individual affected with a gonorrhoea to use the public closets found in saloons and hotels without leaving more or less of the virulent dis charge behind him. The meatus urinarius is dragged over the closet seat in such a manner as inevitably to deposit more or less secretion, unless the patient be much more careful than the average man. The next individual who uses the same convenience will in the majority of instances, unless extremely careful, inevitably bring his meatus urinarius in contact with the infected surface. Is it illogical to sup pose that gonorrhoeal infection may occasionally occur in this man ner? We are entirely too fond of questioning the veracity of the patient, hut ridicule is hardly a safe argument as applied to a ques tion that can be reasoned upon quite as logically as can the subject of infection of any other kind. The author unhesitatingly affirms that this is important from a medico-legal standpoint. The man who goes upon the witness-stand and offers expert testimony to the effect that any individual might not possibly have contracted gonorrhoea in the innocent manner above described, must certainly depart from the ordinary rules of logic, and, however profound his knowledge of bac terial infection in other directions, must necessarily manifest upon this question the densest ignorance of sound pathological and bacte riological principles. The same argument is pertinent, although perhaps not equally so, as applied to possible innocent infection of the female. The author is well aware that this statement is likely to be received with derision, but, as already stated, ridicule upon a question so open to logical reasoning as the one under consideration is hardly worthy of respect. The possible medico-legal application of the author's opinion has received due consideration, but has by no means weakened the conviction above outlined.