GONORRHCEA. 93 



cess forms, which may point either externally or else inwardly, giving 

 rise to symptoms of the most serious and varied character, for further 

 description of which we refer to the text-books of surgery. Gonor- 

 rhceal lymphangitis and lymphadenitis present no extraordinary features. 

 Resolution is the more frequent termination of a gonorrhceal bubo. 

 Suppuration of such a bubo indeed is so rare an occurrence, that it 

 always should excite suspicion of the existence of a glandular chancre. 

 Finally, gonorrhoeal orchitis, the most common of all the complications 

 of this disease, is undoubtedly the result of propagation of the inflam- 

 mation from the urethra to the seminal vesicles and vas deferens. 

 At first the pain in the cord, testicle, and epididymis is not very 

 severe, the patient complaining rather of a sense of weight in the 

 testicle. Soon, however, the pain augments, and the epididymis, which 

 is the chief seat of the inflammation, becomes very sensitive to the 

 slightest touch. To the hard irregular tumor formed by the inflamed 

 epididymis there is soon added an effusion into the tunica propria tes- 

 tis, so that in. a few days the testis may become as large as a goose- 

 egg or fist, or even larger. The enlarged testicle is less movable 

 than before, as the thickened and indurated spermatic cord has become 

 less flexible than when healthy. The greater the effusion into the 

 tunica vaginalis becomes, so much the more does the tenderness, 

 upon pressure of the swollen organ, concentrate itself at the point 

 where the epididymis is situated. Generally the disease terminates in 

 resolution, but a slight induration of the epididymis almost always 

 remains for some time, or even during life, occasionally proving an 

 object of groundless hypochondriacal anxiety to the patient. Some- 

 times, especially in persons suffering from varicocele, the gonorrhceal 

 orchitis recurs several times. The discharge from the urethra almost 

 invariably subsides during the continuance of the inflammation, but as 

 invariably reappears when the orchitis abates. Far more rarely, the 

 affection terminates in suppuration, tuberculous degeneration, or in- 

 duration. 



For some time the term gonorrhceal metastasis has been applied to 

 a variety of morbid processes affecting individuals who had had gon- 

 orrhoea. In the majority of cases, it cannot be proved that there is 

 any relation of cause and effect between these affections and the dis- 

 ease in question. Gonorrhoeal ophthalmia and the well-known inflam- 

 mation of the joints known as gonorrhceal rheumatism, or gonorrhoeal 

 gout, are the only ones of these maladies in any sense of the word 

 entitled to such name. The former proceeds from a direct transfer of 

 the virus to the conjunctiva, and is one of the most dreadful con- 

 sequences of the disease. I have seen an instance in which a married 

 man, having contracted a clap, abstained from all sexual intercourse 



