Gonorrhœa is principally a disease of the mucous membrane, and is, in this way, distinguished from syphilis, which is a general disorder, diffusing itself by way of the bloodvessels. In rare cases, indeed, gonorrhœa can exhibit general morbid manifestations, the so-called gonorrhœal rheumatism, gonorrhœal affections of the spinal cord and of the heart, and gonorrhœal nervous troubles, all of which are so rare, that for practical purposes they can be left out of consideration.
The typical seat of gonorrhœa is the mucous membrane of the urinary and the genital organs of the male and the female; in the male affecting chiefly the urinary organs, and in the female affecting chiefly the genital organs. The cause of genuine gonorrhœa is always infection, the transmission from one human being to another of the purulent inflammation produced by the gonococcus discovered by Neisser in 1879. Simple urethral inflammations with a purulent discharge also occur in which no gonococci are found. These arise also from infection, but their actual exciting cause has not yet been discovered. Not less obscure is the relationship of many of the irritants giving rise to simple urethral catarrh—for example, that which is active during menstruation—to the supposed exciting cause. In any case, these simple catarrhs have a very mild course, and undergo a cure after a few days or weeks, spontaneously or as a result of treatment with mild injections.
Quite otherwise is it with genuine gonorrhœa. In the male it begins from two to six days after the infective intercourse, with a burning sensation on passing water, itching at the urethral orifice, which very easily becomes reddened, and this is soon followed by the discharge, either spontaneously or as a result of pressure on the urethra, of a thick fluid, at first mucous, later purulent, and then of a yellow or a greenish colour. Inflammation, discharge, and pain, the latter especially in association with urination, increase during the subsequent weeks; in addition, in a good many cases there are slight fever, lassitude, and mental depression, and the patient is tormented, especially during the night, by violent, painful erections. In exceptional cases there are hæmorrhages from the urethra (the so-called “Russian clap”). In some cases the disease terminates favourably; this is especially observed after the first attack of gonorrhœa. As early as the third week the above symptoms become less severe, and in the fourth or sixth week after infection the whole morbid process may come to an end, the discharge ceases, the urine becomes clear once more, and, in fact, definite cure of the gonorrhœa ensues.
But the number of those who are so fortunate is comparatively small. In the majority of cases, there are other morbid phenomena and complications; the gonorrhœa becomes “subacute,” and later “chronic.” Ricord wrote many years ago: “When anyone has once acquired gonorrhœa, God only knows when he will get well again!” Happily, this pessimism is no longer fully justified at the present day; but it is a fact that in the majority of cases even to-day gonorrhœa is a very obstinate, wearisome illness, a long-continued burden, not only for the patient, but also for the doctor. The gonococci proliferate in the deeper layers of the mucous membrane, and pass upwards into the posterior part of the urethra, this latter migration being manifested especially by frequent and painful strangury; further, the bladder, the prostate gland, and the epididymis may be attacked. Bilateral epididymitis has often serious consequences as regards the procreative capacity. In about 50 % of the cases incapacity for fertilization (impotentia generandi) has resulted.
If the gonorrhœa becomes chronic, thickenings occur in isolated portions of the urethral mucous membrane; the urine remains turbid for a long time; the discharge, it is true, becomes scantier, but shows itself with the most annoying persistency every morning as soon as the patient leaves his bed, in the form of the so-called “bon jour” drops in the meatus; there are also troubles connected with the prostate (painful sensations, especially during defæcation), and symptoms of stricture of the urethra may occur. Very often, also, relative impotence and severe sexual neurasthenia are observed, as consequences of chronic gonorrhœa. Worst of all is the long duration of the infectivity. There is always the danger that somewhere or other some gonococci may remain hidden, and, given an opportunity, may start the process all over again, or may transmit the infection to another person. Zweifel reports a case in which a man actually infected a woman thirteen years after he had first acquired gonorrhœa!
The infection of a woman with gonorrhœa, as we know to-day, is a disaster. It is the immortal service of the German-American physician Noeggerath that, in the year 1872, he proved that the majority of the stubborn “diseases of women” were nothing more than the consequences of gonorrhœal infection. Gonorrhœa selects by preference the internal reproductive organs of woman; upon the extensive mucous membranes of these organs the gonococci find the most favourable conditions for their persistent life; they find a thousand out-of-the-way comers and hiding-places, where they can elude the therapeutic activity of the physician.
“They grow luxuriantly, like a weed which it has not been possible to uproot, over the entire surface of the genital mucous membrane, attacking with the same vigour the mucous membrane of the uterus and that of the Fallopian tubes. In women, as in men, they induce ulceration, they cause adhesions, and they give rise to sterility. But in the case of women, something further must be added—that, namely, this disease has upon them a miserably depressing effect, and that, in contradistinction from men, they are likely to suffer for many years from intense pains. Whenever they execute certain bodily movements, it may be during ten years in succession, they experience pains, often horribly severe, and in most cases they are condemned to a life of deprivation and misery—not usually for any fault of their own, since most women are infected by their husbands” (Zweifel).
Gonorrhœa in women, attacking successively the vagina, the uterus, the Fallopian tubes, the ovaries, and the peritoneum, is a true martyrdom, a hell upon earth. Sick in body and in mind, these unhappy women drag out a miserable existence; and to them so often the last consolation, that of motherhood, is denied, for gonorrhœa is the most frequent cause of sterility in woman.
Patients infected with gonorrhœa further run the danger of blindness, by transference of the gonorrhœal virus to the eye. This is one of the most distressing of the possible results of the disease. New-born children whose mothers are infected with gonorrhœa are during birth exposed to the same danger of eye infection, as they pass down the genital passage. In earlier days a very large proportion of the blind were persons who had lost their sight in this way very shortly after birth. Since Crédé advocated the admirable method of introducing nitrate of silver solution into the conjunctival sacs of new-born children, gonorrhœal inflammation of the eye has become one of the greatest rarities.