Gonorrhea.
A contagious, specific inflammation of the mucous membrane of the urethra or vagina, accompanied by a muco-puru lent discharge. The disease may also be communicated to other mucous surfaces. Of these, the conjunctiva is most fre quently affected (see CONJUNCTIVA, Drs EASES oF), and occasionally the rectum is involved. True gonorrhoea is due to infection with the gonococcus, first de scribed by Neisser. Inflammation of the urethra (urethritis) may, however, be es tablished by other causes, probably by other micro-organisms under certain conditions. According to the definition given, these cases should not be consid ered as examples of gonorrhea, but in practice it is common so to do, as the treatment is almost or quite identical. If any legal questions are apt to arise, it may be necessary to establish positively the nature of the disease.
Gonorrhea usually results from sexual intercourse with a person suffering from the disease. It may be transmitted in exceedingly rare cases by means of con taminated towels, etc.
- Symptoms.—The commonest example of gonorrhoea is that of the urethra in the male, and the remarks that follow will refer exclusively to this form. The disease usually begins to manifest itself within from three to five days after the infecting intercourse. The first symp tom is an irritation of the meatus, which is found to he of a deeper-red color than normal, and from which a very slight watery discharge escapes. The urine passing over the affected area usually causes considerable smarting. The flammation, which began at the meatus, extends backward, and rapidly becomes more intense, so that in twenty-four to forty-eight hours the discharge has come profuse, thick, yellowish, and, in the severer cases, even tinged with blood. The pain experienced in uri nating is very intense (ardor urinx). The patient has obstinate erections, es pecially at night, which are accompanied by severe pain. This symptom, which is called "chordee," is rarely absent in some degree of intensity. In many eases the patient is obliged to urinate at very quent intervals. This is especially true of the cases in which the inflammation invades the posterior urethra. The swelling of the mucous membrane and periurethral tissues may be so great that the stream of urine is very small.
The severity of each of these symp toms varies widely in different cases, de pending largely, no doubt, upon the virulence of the infection. It is a matter
of common observation, also, that the first attack of gonorrhoea is usually companied with more severe symptoms than subsequent attacks. In fact, a son who has once had gonorrhoea seems predisposed to urethral irritations or in flammation, doubtless induced by infec tious or other causes so mild that a per fectly-healthy urethra would remain en tirely unaffected. In this so-called acute or catarrhal type the chief tom is the discharge, which is more watery than in the acute severe form. There may or may not be slight irrita tion on passing urine.
Four hundred cases of gonorrhoea ex amined with a view to the relative fre quency of the different complications. Each case examined per rectum. Of the cases, 160 were acute. 1S0 subacute. and GO chronic.
Posterior urethra affected in 92.8 per cent. Prostate, vesiculm seminales, or prerectal vas deferens affected in 141 cases, or 35.25 per cent. (28 per cent. in acute cases, 40 per cent. in the subacute and chronic cases). Of these 141 cases, 88 had prostatitis, 5 vesiculitis, 46 both prostatitis and vesiculitis, and 2 both of these with pelvic vasitis in addition.
All the cases were free from symptoms of complications. Colombini (Giorn. Ital. Mal. Yener. e Pelle., No. v, '96).
From a study of urethritis the follow ing conclusions are reached: 1. Of 160 patients attacked with acute urethritis and examined by the author, 26 had anterior urethritis, 22 posterior urethri tis, and 112 total urethritis. 2. Vesical tenesmus with frequent micturition was observed in 6 out of the 26 cases of ante rior urethritis. 3. Out of the 22 cases of posterior urethritis vesical tenesmus with frequent micturition was observed 7 times, and in 10 cases there were fre quent pollutions. 4. In total urethritis, even when complicated by prostatitis, gonecystitis, or epididymitis, vesical tenesmus was never observed, nor were pollutions or pains in the posterior ure thra. In 13 out of the 112 cases of this group there was a little blood at the end of micturition. 5. The terminal hmnia turia would seem to indicate that the internal orifice of the bladder is pro foundly affected by the inflammatory process which, in this case, occupies the fold of the vesico-urethral orifice. S. Rona (Archiv f. Berm. ii. Syph., p. 141, '95).