Volume 1

Operative gynecology / by Howard A. Kelly.

  • Howard Atwood Kelly
Date:
1901, ©1898
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Operative gynecology / by Howard A. Kelly. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    rect infection is more frequent than in grown persons. In children infection usually starts at the vulva, whence it spreads to the urethra and vagina, and seldom to the cervix and corpus utei'i and tubes; in children also joint metastases are rare. In women, according to J. Veit, the first attack of gonor- rhea usually disappears spontaneously, and the tubes become involved in the first attack only in the rare cases of infection shortly before or shortly after delivery. During childbed gonorrhea may cause a special form of peritonitis characterized by an explosion beginning in the latter days of confinement; repeated attacks only are to be regarded as dangerous. Kapytowsky finds that ten per cent of prostitutes still have gonococci in the vaginal secretions after they have been discharged from the hospital as cured of gonorrhea. He finds that seven per cent of prostitutes admitted to the hos- pital for diseases other than gonorrhea have gonococci in the secretion, and that eight per cent of all healthy prostitutes harbor the gonococcus. Klein has found that in chronic gonorrhea the individual may become accustomed to the presence of the gonococci, but the micro-organisms from such cases may cause the virulent disease in other persons, and can then cause reinfection of the original person. Furthermore, that immunity after recuvery does not seem to take place. The micrococcus g o n o r r h oe ae , or gonococcus, was first observed by J^eisser in gonorrheal pus, and was subsetjuently cultivated by E. Bnnmi upon artificial media, from which the cultures were siiccessfuUy inoculated upon human beings. The gonococcus is found in the gonorrheal discharge lodged within the pus cells, and this is its characteristic feature. In gonorrheal pus numerous gonococci are also found lying free between the pus cells; fre- quently there are clumps of the cocci about the size and shape of a pus cell, evidently resulting from the destruction of the cell by the growth of the cocci. The cocci occur in pairs, occasionally as tetrads. Their opposing surfaces are flat or slightly concave. The gonococcus is colored readily by the ordinary aniline stains, but does not retain the stain by Gram's method. In stained preparations the band between the cocci remains clear. The morphology and staining properties do not suffice alone to distinguish the gonococcus from other similar micro-organisms, but its peculiar grouping within the pus cells is quite characteristic. The gonococcus does not grow upon the usual culture media employed for other bacteria. It was first cultivated upon human blood serum, upon which medium it grows in the form of a thin layer, scarcely visible to the naked eye. The surface is smooth and glistening; by reflected light the color is grayish yellow. The growth is weak at best and ceases in two or three days; the organism often stops growing for no apparent reason. E. Wertheim made an important advance in the study of the gonococcus by discovering that the micro-organism grows much better upon blood serum mixed with nutrient ag;i]-. The best plan is to use human blood serum, though cattle serum will also give some growth. The gonorrheal pus should be mixed with the uncoagulated serum, and the mixture added to one or two parts of melted