In those cases where gonorrhoea has spread to the internal genital organs there is almost surely a complete destruction of their normal functions; and in many instances the uterus, Fallopian tubes, ovaries, intestines and bladder are matted together by peritoneal adhesions into a compact mass, so as to render the patient a complete invalid. If operative interference be attempted, as it usually must be, the difficulties presented are extraordinary. These residual signs in the internal structures, though not so conclusive as the external maculae, afford ground for referring the cause to gonorrhoea, though other conditions may produce very similar results.
Sterility from Gonorrhoea. Gonorrhcea is characterized by its great tendency to cause sterility, while the tendency of syphilis is to bring about abortion after abortion. Thus nature protects the future of the human race from a preponderance of vicious offspring. Women who are married to men who have old, uncured gonorrhoeas gonococci bear ing men may remain in fairly good health till the first pregnancy, after which, as explained, they are liable to become sterile and to require the gravest surgical operations. The trouble does not usually manifest itself actively until several weeks after childbirth, and thus the correct diagnosis is generally missed. Saenger calls this "one child sterility". Many years subsequently, perhaps, another child may be born, but usually the sterility is brought about completely at the first parturition. Of course the wives of many old gonorrhceal men never have even the one child the uterus and ovaries becoming embedded in exudations very early after marriage.
"In investigating the causes of sterility, so pronounced among the women of France, the commission charged to study this question reached the following results, viz:
"Twenty four per cent of all the French marriages were marked with a complete sterility.
"Twenty per cent more never had more than one child, and if the authors of the above statistics have given out that the principal cause of this surprising phenomenon was the syphilis so general in France, the German physicians have the conviction that it was also greatly due to gonorrhoea, without at the same time denying the evil influence of syphilis".
In addition to these causes criminal abortion is also an important factor in keeping down the birth rate.
Husbands often lie when questioned about their previous gonorrhoeas, and women, as a rule, are less truthful and communicative regarding their amours than men. But notwithstanding this, the careful physician can often quite accurately conclude whether a woman has had gonorrhoea by learning (1), the history of the first childbirth; (2), whether a second pregnancy ever resulted; (3), whether the child's eyes were infected shortly after birth; and (4), the state of the mother's health thereafter.1
In sterile marriages it is quite the rule for the husband to put the blame upon the wife, but in a large number of instances he himself has either caused her sterility, or is impotent to procreate.
COMPLICATIONS OF GONORRHOEA COMMON TO BOTH SEXES.
It has been deemed necessary to devote a relatively large amount of space to the foregoing descriptions of gonorrhoea in the male and female. In few words it would be impossible to combat the prevalent erroneous ideas regarding this disease, and forcibly to impress upon the reader the very important fact that it is one of the most pernicious of all maladies. Much could yet be said upon this topic, but, having explained the general history of the disease as it exists locally in the sexual organs, we must condense our remarks on the remaining manifestations. However, the reader must not, because of this condensation, assume that the following affections are in any way trivial, for some of them represent the most aggravated and dangerous of the phases of gonorrhoea.
So far in our study of this disease we have only observed it as a local disorder causing mischief at sites where gonococci were implanted. But in a certain number of cases these organisms are carried in the blood stream to remote parts of the body, where they continue their tendency to cause suppuration. When this untoward result occurs, the gonococci thriving in the joints, heart, brain, or elsewhere, the conditions are uncontrollable by any medical measures, and little can be done, outside of careful nursing, except to watch the uncertain course of the disease. Gonorrhceal Inflammation of the Kidneys and Bladder.
Invasion of the bladder often occurs by direct propagation and spread of the gonococci from the urethra, or by artificial implantation if a catheter has carried the organisms down from that passage. On the other hand, if gonococci are circulating in the blood, they may be eliminated with the urine through the kidneys and thus invade them.