Gonorrhoea after the more acute and evident symptoms have passed off, and its contagious properties have been oblit erated, leaves in its train a series of characteristic signs on the organs it has implicated, which are designated "the residual signs of gonorrhoeal infection." (a) On the vulva it may be noted in the form of red spots around the openings of the glands of Bartholin, around the para urethral ducts, or on the summits of the carunculm vulvae. (b) As adenitis gland ulm of Bartholin is described the hard nodular, though painless, condition of these glands are felt when the region of the gland is squeezed between the finger and thumb. (c) As shallow circum scribed ulcers at the mouths of the Bartholinian ducts, the result of rupture of a previous abscess. (d) As the great majority of cysts of the gland of Bar tholin. Slinger (Ann. de Gynec., May, '97).
On 310 women who had been married for at least a year without becoming pregnant, 72 had been married ten years or over, the others three years, on an average. Of 50 of these women's hus bands, 38 had had gonorrhoea and 34 had infected their wives. According to this ratio, in the whole number of husbands there must have been 235 who had had gonorrhoea, and 210 who had infected their wives: an inference that is sup ported by the fact that in 198 of the women the same inflammatory lesions were found as in the 34 who were known to have contracted the disease from their husbands. Vedelar (Norsk Mag. f.
Laegevid.; Hot Springs Med. Jour., July, '98).
Demonstration of the gonococcus is the only reliable method of diagnosing gonorrhcea in prostitutes. Many cases of undoubted gonorrhcea would escape rec ognition if clinical evidences alone were relied upon. Several examinations should be made if the gonococcus is not found at first. Neisser (Berl. klin. Woch., No. 10, '93).
In the diagnosis of chronic gonorrhcea in the female the symptoms upon which the most reliance can be placed is chronic urethritis. There are other symptoms of chronic gonorrhcea, which, though not of themselves pathognomonic, may become so if associated with disease of the uterus and adnexa. Among these may be in cluded condylomata, signs of inflamma tion of the glands of Bartholin, the maculae gonorrhoica of Sanger, tissue-de fects and scars in the vulva, vaginitis maculosa and granulosa. As a rule, the joint appearance of endometritis and in flammatory diseases of the adnexa be speaks gonorrhcea. Dependence cannot be placed upon a microscopical examina tion of the secretion; while the finding of the gonococci is of positive diagnostic value, failure to do so is not proof against the existence of gonorrhcea. P. Broese
and H. Schiller (Berl. klin. Woch., July 18, TS).
Where large numbers of other organ isms are present and gonococci are rela tively few in number, the methylene-blue cannot be depended upon at all, and Gram's method is not satisfactory. In just such cases, the following, which is Pick-Jacobsohn's stain, if properly used, will show the organism, if present, beau tifully differentiated. It is made and used as follows:— 17 Ziehl's carbol-fuchsin, 15 drops. Concentrated alcoholic solution of methyl-blue, 8 drops.
Distilled water, 20 cubic centime tres.
The specimen is to be stained cold for 10 seconds, washed with water, dried, and mounted. The gonococcus will be stained a deep blue, other bacteria a light blue, cell-nuclei a still lighter blue, and pro toplasm pink. R. G. Schnee (Bull. Cleve land Gem Hosp., Apr., '99).
A study of gonorrhoeal ulcerative en docarditis, with cultivation of the gono coccus, shows that (1) gonococeal ure thritis may be the starting-point for a fatal septicaemia induced by a pure in fection with the gonococcus; (2) endo carditis and arthritis are occasionally complications of such an infectious dis ease; (3) the endoeardial processes may be incited by the gonococcus without the association of other organisms. A. J. Lartigau (Amer. Jour. Med. Sci., Jan., 1901).
While formerly gonorrhoea was pre sumed to be a simple disease, it is now known to be very serious. The gono coccus has been found capable of affect ing all the serous membranes. Some of the Germans go so far as to say that SO per cent. of gynaecological affections are due to the gonococcus. Most of the children who lose their sight shortly after birth do so because of gonorrhoeal ophthalmia. This disease still continues to furnish a large contingent to blind asylums, and 10 to 20 per cent. of all the blind owe their affliction to gonor rhoeal infection. Formerly the number of such eases was even larger, running as high as 40 to 60 per cent. At the present moment there are in Germany, according to Neisscr, 30,000 patients who are blind because of the gonococcus. Gonorrhoea has more to do with failure of the population to increase than syph ilis. At least 20 per cent. of sterile marriages are due to gonorrhoeal proc esses either in the husband or wife, and 90 per cent. of the cases of azoOspermia that occur owe their origin to gonor rhoeal affections of the epididymis. Prince A. Morrow (Med. News, Mar. 23, 1901).