The etiological importance of gonorrhoea in relation to some of the more common diseases of women.

  • Charles James Cullingworth
Date:
[1889]
Catalogue details

Licence: Public Domain Mark

Credit: The etiological importance of gonorrhoea in relation to some of the more common diseases of women. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    was healthy in appearance; the outer half was either oc- cluded, or at any rate so constricted that a fine wire would not pass. Between the constriction and the black spot on the peritoneal surface the tissues were softened and of a deep red colour. No perforation could be detected. Be- yond this were two hard nodules (gummata ?) which, on section, were seen to be pale circumscribed masses of exudation, completely surrounding the mucous membrane. The left ovary was of normal size and much softened. This case offers several points for comment. Here was a girl of 19, otherwise in excellent health, totally incapaci- tated by pelvic disease resulting from gonorrhoeal infection. In the earlier part of the clinical history it will have been noted that the symptoms were all on the left side; so decidedly was this the case, that the diagnosis was inflam- mation of the left ovary. Read in the light of the post- mortem appearances, the course of pathological events at that time would seem to have been as follows : Gonorrhoeal salpingitis on the left side, with pyosalpinx, complicated by ulceration at one portion of the tube, namely, at the outer half of the intra-uterine portion ; extension of the ulceration into the surrounding uterine tissue, and eventual perforation at the left cornu, with escape of the purulent contents of the tube into the peritoneal cavity, causing peritonitis and dangerous collapse; recovery from the attack, absorption of the extravasated contents of the tube, occlusion of the tube at the site of the perforation during the subsequent cicatrisation, and roofing in of the aperture in the uterus by a band of omentum becoming adherent over it. It may be objected to this theory that it is contrary to general belief that pus can be absorbed by the peritoneum. There is, however, good reason for believing that, whatever hap- pens in the case of ordinary pus, gonorrhoeal pus, when extravasated into the cavity of the peritoneum, excites a
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