GONORRHEA is perhaps the most uni versal and widespread of all diseases that affect the human race. Competent authorities have computed that fully three-fourths of the adult male population and from one-sixth to one-third of the adult female population have contracted this disorder. The great majority of women who have gonorrhea are reputable mar ried women who have been infected by their husbands. Material as well as moral and sani tary conditions modify venereal morbidity. It is much greater in large centres of population than in suburban and rural communities.
Gonorrhea may be defined as a specific inflammation peculiar to certain mu cous membranes, attended with the production of a purulent discharge. This discharge has the property of exciting a similar inflammation when brought in contact with other mucous surfaces susceptible to its action. The urethral mucous membrane in the male and the mucous membrane of the urethra, vagina and cervix in the female are ordinarily the seat of gonorrheal inflammation. Almost all mucous surfaces of the body, particularly the conjunctival mucous membranes, are susceptible to the irritant action of gonorrheal pus.
The cause of gonorrhea is a spe cific micro-organism termed the gonococcus, which was discovered by Neisser in 1879. In flammation of the urethra may result from a multiplicity of causes, chemical, irritant and others, but true gonorrheal inflammation has as its unique etiological factor the gonococcus.
The This micro-organism is a diplococcus; in shape each individual of a pair resembles a coffee bean —flat or slightly concave on one side and rounded on the other, with their flat surfaces opposed. The two hem ispheres are separated by such a narrow interval that it is only recognizable under a lens of high power. The diplococci are grouped in pairs, fours and other multiples of two. Their growth occurs by fissure, at right angles to the central interspace. The gonococci are always grouped in irregularly shaped columns and are never met with in chains or pairs, as certain other micro-organisms. The differential characteristic of the gonococci is, that they quickly take a stain of aniline dyes and are more rapidly bleached than other micro-organisms. They may occur both within and without the pus and epithelial cells. In acute cases they are very
numerous, but have a tendency to grow fewer with the decline of the inflammatory process. They are characterized by a marked longevity, are susceptible of existing in a latent state for an indefinite period and are capable of being revived and exalted in virulence by local irri tation which causes congestion of the parts, or when transferred to virgin tissues in which they find conditions favorable for their germi nation and growth. Numerous cases are on record where the gonococcus has been found still conserving all its virulence and susceptible of being provoked into new activity by a variety of irritant causes years after infection.
Within the past two or three decades our knowledge of gonorrhea has undergone most marked and revolutionary changes. The old conception of gonorrhea was that of a purely local disease, confined to the mucous tract in which it had its habitual origin, trivial in char acter, of limited duration and entailing no serious consequences to the individual, except from neglected complications. The occasional occurrence of rheumatism or of ophthalmia, which was recognized by the older observers, was thought to be due to the development of a latent rheumatic diathesis, to sympathetic in flammation or simple metastasis. The idiosyn crasy of the patient was thought to play an important role in their production.
Since the discovery of the gonococcus, new facts have been developed, showing that instead of being limited to the genitourinary tract, the range of its morbid action is much more extensive and not infrequently is radiated to important internal organs. As a result of mod ern investigations it may be positively affirmed that the gonococcus is susceptible of being taken up by the blood vessels and lymphatics, and that it may affect almost every organ of the body. Staining and culture experiments have demonstrated its presence not only in the ovaries, tubes and peritoneal cavity, which it reaches through invasion of the intermediate mucous membrane, but also in the lining mem brane of the brain and cord, of the heart, of the pleura, liver, spleen, kidneys, as well as thejoints and tendinous sheaths.