The moral guilt of a person who infects another with gonorrhea is affected by the extent of the physical injury done. Gonorrhea causes, besides the effects already described: (1) chronic cystitis, with all the suffering, loss of work, and danger of renal infection in such a condition; (2) lymphadenitis of the inguinal canal, and rarely of other places; (3) proctitis, or inflammation of the rectum, especially in women and young children; (4) ophthalmia, vaginitis, and proctitis in infants and children, and metastatic conjunctivitis; (5) stomatitis or inflammation of the mouth in adults and children; (6) nasal gonorrhea (a doubtful condition); (7) gonorrheal septicemia, bacteremia, or toxemia, which may affect any organ in the entire body; (8) bone and joint lesions: (a) gonorrheal arthritis in any joint in the body (this condition may be fatal, or it may leave permanent disability, or it may disappear); (b) tenosynovitis, or pain, swelling, and edema along affected tendon sheaths; (c) gonorrheal periostitis, where the bone and periosteum near a joint are affected; (d) perichondritis and chondritis, a rare condition, where cartilage is attacked; (9) endocarditis, or inflammation of the lining membrane of the heart (one of the most frequent secondary lesions of gonorrhea); (10) pericarditis, or inflammation of the sac which contains the heart; (11) myocarditis, an inflammation of the heart muscle itself, usually as an extension of endocarditis; (12) aortitis, or inflammation of the aorta—a rare condition; (13) phlebitis, an inflammation of the veins—a very rare condition; (14) thrombosis, or blocking of a blood-vessel by exudate (this may be fatal); (15) skin lesions, as erythema, erythema nodosum, bullous and hemorrhagic eruptions, hyperceratosis, and ulcers; (16) gonorrhea of the lungs in septicemia; (17) gonorrheal pleurisy in septicemia; (18) gonorrheal nephritis, which is frequent in gonorrheal septicemia—the condition is often fatal; (19) perinephritis, a very rare condition; (20) gonorrhea of the nervous system, as neuritis or neuralgia, or neuroses, which vary from slight melancholia to severe mental disturbances; (21) parotiditis, a very rare condition; (22) otitis, or inflammation of the middle ear, a very rare condition; (23) suppuration in muscles, or under the skin; (24) wound septicemia; (25) venereal warts; and (26) epididymitis, which often causes not only sterility but impotence.
Campbell[195] reported a gonorrheal infection of a compound fracture at the ankle—it required four months to get the wound free of the infection. Gonorrheal obliterating epididymitis is quite common. Delbet and Chevassu[196] found 114 cases of male sterility in 131 cases of epididymitis. More than half of such cases are left permanently sterile, and if the function of the testicle cannot be restored by the surgeon the patient is impotent, and any marriage he would make, ... is rendered void. These two surgeons have restored function in six such cases by uniting the vas with the epididymis by Martin's operation. It is much easier to restore function after vasectomy than after obliterating epididymitis.
There are frequent cases of arthritic rheumatism in which the source of the infection is a chronic gonorrhea of the seminal vesicles. Fuller[197] has done 101 vesiculotomies for this condition, and of these twenty-three were gonorrheal. In these twenty-three the excision of the infected vesicles cured the rheumatism. In vesiculotomy great care must be taken not to cut the vas deferens. If it is cut the man is impotent until the vas is restored, and it would be a very difficult operation to reunite the vas if cut near the vesicles.
Of all the gonorrheal affections of the body the most dangerous and important are the cardiac inflammations and ophthalmia neonatorum. This ophthalmia is a purulent infection of the external parts of the eye in infants. It may be caused by many kinds of toxic bacteria, but the worst cases are from the diphtheria bacillus (a very rare condition) and the gonococcus (a very frequent condition). Before 1881, when Credé introduced prophylactic treatment for ophthalmia neonatorum, every maternity hospital had a department isolated for the care of babies suffering with this disease. At the present day, however, despite the precautions taken, this disease is quite common. Pennsylvania and New York alone spent $242,000 annually for the support of asylums for the blind, and about 40 per cent. of the children in these institutions were blinded by gonorrheal ophthalmia. The United States spends $1,800,000 yearly on victims of ophthalmia neonatorum. Stephenson[198] tells us that in the practice of forty-one oculists who reported to him the gonococcus was found in 67.14 per cent. of their 1658 cases of ophthalmia. Mayou found the gonococcus in 63.5 per cent. of 1483 cases.
There is an infection of the child's eyes by gonococci possible even while the child is in the womb, but this is very exceptional; the infection happens in the vagina during delivery, as a rule. When the child's head is born its lids and eyelashes should be cleansed with vaseline, or 1 to 5000 bichloride, or carbolized oil, before the eyes are opened to put in the silver nitrate solution. This solution should be made from a pure drug or it will injure the eyes. A one per cent. solution is strong enough for routine work, but if the gonococcus is suspected, or if it is known that the mother has gonorrhea, then the lids of the infant must be everted and touched everywhere with a five per cent. solution of silver nitrate. This is neutralized with a salt solution and washed out before the lids are turned back. It is rash to trust any of the albuminoid preparations of silver, like argyrol, silvol, or protargol, in gonorrhea or suspected gonorrhea of the eyes.
If the child develops ophthalmia the treatment should be turned over to an oculist when possible. When a child can have a day and a night nurse, this method should be adopted, but ordinarily there is no nurse except some woman about the house or the mother. In such cases one eye, commonly the right, does better than the other because the first eye treated is opened readily, but after the infant has been irritated it shuts the eyes so strongly that it is difficult to open them at all. The first eye treated is habitually the same. The nurse should begin to treat the eyes alternately on this account, or wait to treat the second eye until after the baby has quieted down. Iced compresses should be used, but not so long as to chill the eye very much—five to ten minutes at a time is enough. If the physician himself makes the applications of silver nitrate, the nurse should use some silver salt like argyrol. Three to eight grains of zinc sulphate to eight ounces of boric solution is a good regular eye-wash in these cases. Atropine must also be instilled to protect the iris. If only one eye is affected, the other eye should be protected under a watch glass sealed over it. All persons who have gonorrhea, or who treat gonorrhea, must be warned of the danger they are in of infecting their own eyes.
A new treatment of gonorrhea is described by Weiss.[199] The gonococci are killed by a temperature of 107.6 degrees Fahrenheit, and in eleven cases Weiss subjected men to a hot bath for forty to fifty-five minutes, with the temperature of the water gradually increased from 104 to 110 degrees Fahrenheit. In one instance the body temperature was raised to 108.5 degrees F. in a forty-minute bath and the gonococci disappeared at once. In the other cases the body temperature did not go up so high, but the vitality of the gonococcus was evidently reduced, and under a few local injections they all disappeared.