In the terminal stages of a case of chronic gonorrhoea specialists sometimes make use of the following plan, in order to see if a man is fit to marry and entirely free from the poison germs:
To make certain that the patient is innocuous, after pus corpuscles and clap-shreds can no longer be found by the microscope in his urine, an artificial irritation is induced in the urinary organs in order to temporarily lower the resisting power of the tissues, so that if there are any gonococci dormant or lurking in the folds and crypts and canaliculi of the genital passages, they may have a fair opportunity to make their appearance.
To effect this the patient is either directed to go out and take a large and rather indigestible dinner with plenty of wine or beer; or a relapse is purposely induced by throwing into his urethra a "test irritating injection". These test irritant methods bring about a simple urethritis, with suppuration, and the pus is then examined for gonococci.
If gonococci cannot be found after repeated trials of this artificial method of inducing a relapse, then there are almost certainly none present, and the patient may marry. If, on the other hand, gonococci are found, he must in no event marry until they cannot be made to reappear; nor for a considerable period, preferably six months, thereafter.
If the doctor tell the patient that there are no longer any gonococci, the latter will consider himself cured; but as a rule, after a chronic gonorrhoea, there is not a "cure" in the real sense of the word, since the urethral tissues have been unfavorably modified by the smouldering inflammation, and his genital apparatus is not as good as it once was.
In order to insure him against a narrowing of the calibre of the urinary tube stricture he will present himself more or less frequently, for a period of several months, for the passage of "sounds".
"Neisser (1884) was the first who studied the subject scientifically. He proved that the infectiousness of chronic gonorrhoea is a conditional one, in so far as the secretion may contain gonococci, that there are cases in which the secretion contains the cocci only at times, and finally others which are always found to be free from gonococci despite the most careful and frequent examinations.
Furthermore, since the secretion is small in amount, and after being washed away by the urine requires a considerable time for its regeneration, it follows that a single act of coitus with an individual suffering from chronic gonorrhoea does not necessarily produce infection.
As the result of numerous examinations I concur in this opinion, and permit a patient who is suffering from chronic gonorrhoea, i.e., the morning drop or clap-threads, to have marital intercourse only after I have convinced myself by a two to four weeks' daily examination of the secretion or clap-shreds that these contain only epithelium and no pus cells, and when, after irrigation of the urethra with a solution of silver nitrate or corrosive sublimate and consequent suppuration, the secretion is entirely free from gonococci, and there is no further indication for the continuance of treatment". Before a man can indulge in marital intercourse, Finger requires three conditions "the absence of gonococci, pus corpuscles, and peri-ure-thral complications".
"One condition I must especially emphasize, viz., the absence of pus corpuscles.
The presence of shreds of pus corpuscles in the secretion is always an indication that the inflammation is not extinguished. It is possible that the inflammation still continues despite the disappearance of the gonococcus, its original etiological factor, but this will probably not be true of many cases. On the other hand, the question of the presence of gonococci is often answered with difficulty.
Positive findings put the matter beyond question, but negative findings do not prove that gonococci are not present.
After long and laborious examinations with negative results the gonococci may suddenly reappear, so that I most urgently caution against answering the question with regard to marital intercourse from the results of bacteriological examination. This should be refused so long as pus corpuscles are present".