Even the most unobservant man, having normally no secretion from his genital organs, at once notices the slightest discharge, besides suffering severe pain, while the woman may hardly experience any pain at the first onset of the disease. If a married woman has contracted gonorrhoea innocently from her husband, she is of course not informed by either him or her medical attendant; and if a woman acquires it out of wedlock her natural shame leads her to conceal her plight until she is compelled to seek relief for the remote effects. It is notorious as well as surprising that practitioners rarely see cases of acute gonorrhoea in women, except in prostitutes, and that their assistance is usually sought, not on account of the suppuration, but for the relief of the sequelae, or remote effects, only after irreparable damage has been done.
Although gonorrhoea has been clearly recognized from time immemorial, two decades have not yet elapsed since the medical profession has learned its true significance and its great social importance. The chief impetus to the study of gonorrhoea has come from gynaecologists and obstetricians, who are in the best position to observe its ravages in women; and to day we have a mass of accumulated evidence which puts our ideas regarding this disease on a firm scientific basis.
The first intelligent cry of alarm was sounded in 1872 by Dr. Emil Noeggerath, of New York, a gynaecologist, or specialist in diseases of women.
His observations led him to conclude that, as Eicord, of Paris, had previously said, eight hundred out of every thousand men who lived in large cities had had gonorrhoea; that gonorrhoea in males, in spite of apparent recovery, almost always remained latent for many years or for life; that ninety per cent of women who married these men suffered from either acute or latent gonorrhoea; and that the majority of these wives were either sterile or bore at the most from one to three or four children.
The following propositions were presented by him in a second paper in 1876:
1. Gonorrhoea in the male, as well as in the female, persists for life in certain sections of the organs of generation, notwithstanding its apparent cure in a great many instances.
2. There is a form of gonorrhoea which may be called latent gonorrhoea, in the male, as well as in the female.
3. Latent gonorrhoea in the male, as well as in the female, may infect a healthy person either with acute gonorrhoea or gleet.
4. Latent gonorrhoea in the female, either the consequence of an acute gonorrhoeal invasion or not, if it pass
from the latent into the apparent condition, manifests itself as acute, chronic, recurrent perimetritis (inflammation contiguous to uterus), or ovaritis, or as catarrh of certain sections of the genital organs.
5. Latent gonorrhoea, in becoming apparent in the male, does so by attacks of gleet or epididymitis.
6. About ninety per cent of sterile women are married to husbands who have suffered from gonorrhoea either previous to, or during married life.
Noeggerath's assertion, that such a vast amount of disease, suffering and sterility in women was due to their marriage with old gonorrhoeal patients, most of whom were supposed to be cured, met with a storm of opposition from medical men in both hemispheres; but his dignified answer was as follows: " After the gentlemen have given five years or more of careful study to this question, I shall expect to hear more approval than I have done to-day."' At the present time his name is held in high honor in medical circles, though his views have been considerably modified, as is usually the case with the promulgators of new doctrines. In the last edition of his standard work on gonorrhoea, Finger says: "At first Noeggerath's conclusions encountered only opposition. ...It was not until the discovery of the gonococcus that this question was cleared up and Noeggerath's opinions were found to be in the main correct".
The conservative belief of recent times is that a very large number, a majority, of old gonorrhoeal patients of both sexes continue to harbor gonococci within their genitourinary spheres for months or years, and sometimes for a lifetime, unless they have received very intelligent treatment which the most skilful specialists alone are able to give; and that a certain proportion never can be cured and consequently never should marry.
After Noeggerath's stirring propositions, the next int portant advance in our knowledge of gonorrhoea was made in 1879, when Neisser, of Breslau, proclaimed the discovery of the germ of gonorrhoea, which microbe he named the "Gonococcus".
This discovery he further substantiated by a second publication in 1882, and at the present time this gonococcus is definitely accepted by scientists as the infective organism, for it has passed through the imperative ordeal of Koch's classical tests:
(a), of being present in every case of gonorrhoea, and in no other disease;
(b), of having been propagated by culture, the new colonies of germs corresponding to those which are under experimentation;
(c), of always reproducing the specific disease when implanted on human mucous membranes, e.g., the urethra, conjunctiva, etc.