Gonorrhea Treatment

PREFACE

Until a comparatively recent date gonorrhea has been regarded by many medical men as a purely local disease, and it is only during the last twelve or fifteen years that the rare lesions resulting from this infection have been traced to their proper source. Indeed, prior to the appearance of Noeggerath's epoch-making monograph even the common intraperitoneal manifestations of gonorrhea were not recognized. Up to this time practically all pelvic inflanmiations were regarded as cellulitis, and their etiologic relationship to gonorrhea was not generally known, although Goupil and Bernutz had described the pathology as early as 1862. The discovery of the gonococcus by Neisser in 1879 placed the study of gonorrhea upon a scientific basis, and within recent years the symptomatology and jiathology that follow in the wake of this infection have received marked attention.

In the preparation of a work such as this one of the chief difficulties consists in selecting the important and omitting the unimportant references to the various subjects dealt with. This difficulty will be apparent when it is considered that during the last ten years over 20,000 papers bearing more or less directly upon the subject of gonorrhea have appeared. From this voluminous material over 2300 references have been utilized, and even in this moderately extensive list it is likely that some important publications have been overlooked. The chapter on Serum and Vaccine Therapy and Organotherapy is based largely on the work of other investigators. For the indications and technic of this form of treatment the reader is referred to the special chapter devoted to this subject. Chapters XI and XII, the substance of which appeared in Surgery, Gynecology, and Obstetrics, October, 1910, and which was written in collaboration with Dr. John G. Clark, have been extensively revised and brought up to date.

In the selection of the literature an endeavor has been made to utilize only such material as embodies the most modern trend of science or that refers to rare cases. The attempt has been made to incorporate either references to or abstracts from the reported histories of all unusual gonorrheal lesions. Thus, under this head will be found a short abstract of all cases of rupture or torsion of the uterine adnexa in inflammatory conditions, of all gonorrheal lesions of tli(> pleura and



kidney, etc. The not infrequent practice of reporting rare cases under misleading or ambiguous titles is especially to be deprecated, and makes the complete list of such cases practically impossible to obtain.

I wish to acknowledge my indebtedness to the excellent papers of Finger and Spooner, which have been extensively drawn upon in compiling the chapter on the History of Gonorrhea. Stephenson's masterly monograph on ophthalmia neonatorum has been freely utilized in the chapter on eye lesions. Nixon's important article on renal gonorrhea, and Menge's monograph on gonorrhea in women, have also been found of great assistance, as well as many other valuable contributions too numerous to mention, the references to which can be found in the foot-notes.

In the preparation of this work I have received the most hearty support and encouragement from Dr. John G. Clark, who has placed at my disposal his abundant clinical and pathologic material. It gives me much pleasure to acknowledge my indebtedness to Dr. Thomas B. Holloway, who has kindly reviewed the chapter dealing with ej'e lesions and has made many valuable suggestions. My thanks are also due to Dr. George W. Outerbridge for reading the chapter on the Pathology of the Female Genital Tract, to Miss Dorothy Peters, for the excellent illustrations, and to the W. B. Saunders Company, for much practical aid and for painstaking efforts to obtain the best possible reproductions of the drawings.....