Gonorrhoeal rheumatism and gonococcic infection / by William Murrell.

  • Murrell, William, 1853-1912
Date:
[1909?]
Catalogue details

Licence: In copyright

Credit: Gonorrhoeal rheumatism and gonococcic infection / by William Murrell. Source: Wellcome Collection.

    11/20 (page 9)
    was examined too late in the progress of the case to carry much weight. It is practically certain that this was a true case of conjunctival arthritis, the conjunctivas being inoculated with an attenuation of gonococcus. Gonococci in the ophthalmic secretion were discovered by Darier in 1889, and demonstrated by Deutschmann in the fluid from the inflamed joints in 1890. The synovial membrane should always be carefully examined. The remote effects of the infection are probably due to gonotoxin. The purulent form may be associated with streptococci or staphylococci. The diagnosis of gonorrhoeal rheumatism rests on (1) the history of gonococcic infection or on the presence of obvious gonococcic lesions ; (2) the implication of certain joints not usually affected in other forms of articular disease; (3) the absence of metastasis; (4) the involvement of the fasciae and tendon sheaths. In many chronic cases the diagnosis is difficult, and must remain uncertain. The patient cannot be made to remember whether or not he had a urethritis and if there is a history of an attack it was so many years before and so long an interval has elapsed that it is doubtful if it can be regarded as an antecedent cause. In the case of married O women the difficulty is enormously increased, and it is often inadvisable to inquire too curiously into the antinuptial history of either husband or wife. Bacteriological investiga¬ tion in these cases, unless the infection is recent, throws but little light on the subject. It is difficult to find the gonococci in late cases, probably because they are ousted by more robust pathogenic organisms. Gonotoxin inhibits phagocytic action, and so predisposes to mixed infection. It is well to recognise the fact that gonorrhoea is very easily overlooked in women. It is usually regarded as an acute vaginitis, but it much more frequently involves the ducts of the vulvo¬ vaginal glands, and the parts immediately surrounding their orifices. Unless the urethra is implicated it gives rise to little scalding or inconvenience. The greater danger arises from the fact that the cervix becomes early infected, and the