The number, variety and gravity of these systemic manifestations has led to the serious consideration of the question whether gonor rhea is not to be classed as a constitutional affection. The cause or relation between these systemic affections and the gonococcus has been proved•by the identification of the gonococcus in the lesions it has produced. These general effects have been also ascribed not simply to the pathogenetic action of the gonococci, but to their toxins and the presence of certain pyo genic microbes associated with the gonococcus.
The more common com plications of gonorrhea are acute and chronic inflammation of the postate and bladder and seminal ducts and vesicles, the cord and testes.
Gonorrheal One of the most important complications of gonorrhea is seen in certain joint-affections, which are usually described under the term of gonorrheal rheuma tism. This complication usually occurs from the• second to the third week of the disease, but may develop as early as the fifth or sixth day. Gonorrheal arthritis manifests a remark able affinity for the large articulations, as the knee and ankle joints, the hip and elbow. Only one joint may be involved, constituting what is termed mono-articular arthritis, or a number of joints may be involved, constituting poly articular arthritis. In the latter case, different joints are more likely to be involved in suc cession, rather than simultaneously. As a re sult of the inflammation of the synovial mem brane, which is particularly involved, there often occur serous, fibrinous or purulent effusions. It is essentially a hydrarthrosis, and in most instances the disease is confined to the synovial membrane of the joint during the whole course of the affection. Gonorrheal arthritis is usually chronic in duration, often lasting from two to three or for many months. In some cases it is chronic and practically indefinite. Anchylosis or immobility of the joint from rapid forma tion of adhesions is a not infrequent termina tion. Very often the tendinous sheaths, the bursa and fascia may be involved.
Unfortunately the treatment of gonorrheal rheumatism is extremely unsatisfactory. It does not seem to be susceptible to the curative action of remedies which are valuable in attacks of ordinary rheumatism. In quite a large propor tion of cases there is more or less deformity or permanent disability.
Gonorrheal There is usually recognized a distinction between an ophthalmia which is due to a septic absorption, like gonor rheal rheumatism, and that form of purulent conjunctivitis which is caused by direct trans ference of pus containing gonococci to the eye. The former never results from the direct inoc ulation of the contagious matter. Its symptoms are milder, and there are rarely changes which occasion adhesions or permanent injury to the sight. On the contrary, purulent conjunctivitis is due to the inoculation of the mucous mem brane of the conjunctiva. The inflammatory process is characterized by greater intensity and rapidity of action, and not infrequently results in partial or complete loss of vision. Unless prompt and efficient treatment be at once in stituted the cornea may rapidly ulcerate and slough, and prolapse of the contents of the globe of the eye may occur through the perforation. These changes are sometimes almost incredibly rapid, taking place in three or four days, ex ceptionally in 24 hours, and leading to com plete destruction of vision. In the ophthalmia of the new-born, the eyes of the child are liable to be soiled with the uterine and vaginal liquids containing gonococci — one of the most fre quent causes of blindness. It is estimated that
from 10 to 20 per cent of all blindness is caused by gonococcic infection.
Gonorrhea in Our knowledge of gonorrhea in women is essentially a modern acquisition. Until within recent years it had never been the subject of serious and careful study. In the female the local and general ef fects of gonorrhea are apt to be much more serious and permanent, owing to the extent and character of the structures exposed to in fection. The greater extent of the genital tract permits a larger field for infection by direct continuity of tissue. The periodic vascular changes incident to the menstrual period, and the more pronounced modifications caused by pregnancy, exert a marked influence in accen tuating the gravity of gonorrhea in women. As a result of these changes gonococci, invading the uterine cavity and ascending along the tubes and ovaries to the peritoneal covering, produce peritonitis. Not only do these inflammatory changes imperil the life and health of the woman (which danger, in many instances, can only be averted by an operation involving the sacrifice of her reproductive organs), but they may absolutely extinguish her hope of children. Gonorrhea is one of the most prolific causes of sterility. The inflammatory changes result in the blocking up of the channels of communica tion between the ovaries and the uterine recep tacle of the ovum, thus preventing contact with the germinative spermatozoids. This mechani cal obstacle to the passage of the ovum is, as a rule, permanent and irrelievable. It thus happens that the aptitude of the gonorrheic woman for conception is often extinguished by the first pregnancy, the first child represent ing the sum total of her productive energy. In this connection, it may be said that one of the complications of gonorrhea affecting the male (epididymitis) is a very frequent cause of sterility in men. Neisser believes that gonor rhea in the male is responsible for 45 per cent of sterile marriages. The proportion of sterility due to the husband is variously estimated from 17 to 25 per cent, and almost the entire pro portion of sterility in women is due to gonor rhea communicated to her by her husband. The low birth-rate of married women is not, as is generally supposed, always voluntary, but it often proceeds from physical causes relating to the health or productive capacity of the married parties; it is not from choice, but from inca pacity.
Gonorrhea as a Social Danger.-- Owing to its great frequency, the persistent vitality and virulence of its germs, even after apparent cure, and especially to the grave nature of the in fection in women, and the serious menace to the health and even the life of the victim — to say nothing of its destructive effects upon the pro creative functions — gonorrhea is now regarded by the medical profession as one of the most formidable social plagues of our age. Every year in this country thousands of young, inno cent women are infected by their husbands, who in most cases are not aware that they carry with them the germs of a disease destined to wreck the health or lives of their partners. Many such women drag out a miserable exist ence of semi-invalidism, subject to painful or difficult menstruation, no longer able to walk freely, condemned to pass their days of suffer ing in a reclining position; and after years, it may be, of this suffering, worn out and desper ate, they apply to the surgeon, who, at the price of the sacrifice of their generative organs, ren ders their existence possible in making them castrated women.
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