Buboes. Inflammation and suppuration of the inguinal glands sometimes occur as the result of gonorrhoea, though the same condition may result from chancroid, syphilis, cancer, tuberculosis, and other affections. Peritonitis. In the female we saw that peritonitis was exceedingly common as a result of the escape of gonorrhoeal pus from the Fallopian tubes into the peritoneal cavity. In the male, peritonitis may also occasionally be caused, not by direct contamination as in the female, but by migration of the gonococci through the tissues, e.g., when the seminal vesicles, which lie in close relationship to the peritoneum, are involved. Intense suffering is always the rule, and death is very frequently the result.
Gonorrhceal Rheumatism. This affection is a form of septic infection and is in no way akin to ordinary rheumatism. It is more common in men because gonorrhoea is far more prevalent among them; but it may occur in either sex at any age, even in an infant suffering with gonorrhoeal inflammation of the eyes. It usually develops from two to four months after the local infection in the sexual organs. It is caused by gonococci entering the blood stream and being carried to remote parts. The knee joint is most frequently involved, and, next in frequency, the ankle, wrist, finger joints, elbow, shoulder, hip, jaw, etc. Many joints, however, may be involved at the same time. The tendency of gonococci, wherever situated, is to promote suppuration, and not infrequently an ankylosis results in the affected joint, whereby the bones which enter into its formation coalesce, or grow together, so that consolidation or stiffening occurs.
As complications of gonorrhoeal rheumatism there may also be serous effusions into the sheaths of tendons, various inflammations in the eyeball, in the large veins, in the brain, heart, etc. With each new infection of gonorrhoea there is a great tendency to relapse. Taylor1 says that it occurs in ten per cent of gonorrhoeal cases. Treatment is exceedingly unsatisfactory, no drug being known which antagonizes the activity of the gonococci, and in many instances it becomes necessary for the surgeon to open the joint and wash out the purulent synovial fluids with germicides. The severest constitutional effects are as liable to follow upon a mild case of gonorrhoea as upon a severe attack; and in no case can the physician give assurance that grave septic infections will not result.
Gonorrhceal Affections of the Heart, and Pyaemia (septic contamination of the blood). Since the discovery of the gonococcus a number of well attested cases of gonorrhoeal affections of the heart have been reported, usually occurring as complications of gonorrhoeal rheumatism, but not necessarily so.
The gonococci produce ulcerative conditions on the valves of the heart, leaving permanent damage behind and making the prognosis grave. Sometimes the microbes are present in such number in the blood that they produce a blood poisoning and abscesses; and other inflammatory conditions may appear in any organ or tissue of tne body. The mildest attacks of gonorrhoea may be followed by these constitutional symptoms.
Gonorrhoeal Conjunctivitis and Gonorrhoeal ophthalmia. These specific infections of the eye characteristically show the action of the gonococci, the one as a result of local infection, the other as a result of systemic invasion.
Of the two, gonorrhoeal ophthalmia is the more frequent, while gonorrhoeal conjunctivitis is the more grave. Gonorrhoeal ophthalmia results secondarily from septicemic infection and is quite uncontrollable by any line of treatment, but fortunately its results are not usually grave. It is very frequently associated with gonorrhceal rheumatism, and as a rule recurs with each fresh infection. Ordinarily both eyes are involved, and the inflammation chiefly affects the fibrous tissues of the eye, the sclerotic and the iris.
Gonorrheal conjunctivitis is produced primarily by direct contagion, or the local deposition of gonorrhceal pus upon the mucous membrane of the eye. Ordinarily one eye is involved, though of course this is fortuitous. As this condition is purely an accident, resulting from contamination by the fingers, or towels, or otherwise, it may be acquired readilv by a healthy person from an infected one by inoculation. The symptoms are among the most urgent and grave of all the emergencies which arise in medical practice, for every hour's delay favors a rapid destruction of the tissues involved. Without the most energetic treatment the free discharge of pus is extremely liable to inoculate the other eye, and rapidly to ulcerate the cornea, so that the contents of the globe, or eyeball, may pour out, and thus the case terminates in total blindness. Every gonorrhoeal patient is therefore the generator of a most virulent poison, one drop of which carried to his eye would, within the space of two or three days, cause complete blindness, unless active treatment were at once instituted.
And, furthermore, so "unclean" and positively dangerous to the community is such an individual, that he should be quarantined; for but few such men can be relied upon to exercise care in the use of towels, commodes, bathtubs, etc., which others must use. Gonorrhceal Affections of the Shin. Instances of cutaneous eruptions are rare, and on that account interesting. Having observed that the gonococci may enter the bloodstream and thus invade the whole system, it is not, afterall, difficult to understand that the minute capillaries of the skin may show their presence by eruptions. A number of such cases have been reported, those only being accepted in which gonocotti were demonstrated in the pus from the eruptions.