This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1913 Excerpt: ...cervix. This, however, is unusual; as a rule, a much longer time elapses before involvement of these structures takes place. The relative frequency with which the appendages are invaded in comparison with gonorrhea of the endometrium is difficult to estimate accurately, but it seems likely that if the mucosa of the ...
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This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1913 Excerpt: ...cervix. This, however, is unusual; as a rule, a much longer time elapses before involvement of these structures takes place. The relative frequency with which the appendages are invaded in comparison with gonorrhea of the endometrium is difficult to estimate accurately, but it seems likely that if the mucosa of the body of the uterus becomes infected, in the majority of cases, at least, the disease extends to the tubes, and from the latter to the ovaries. Menge,1 in combining the statistics of Bumm, Steinschneider, Fabry, Briinschke, Brose, and Welander, found that the tubes, ovaries, and pelvic peritoneum were involved in 25 per cent. of the acute and in 50 per cent. of the chronic cases. As Bumm2 has amply proved, and as previously stated in this work, the gonococcus is chiefly a surface microorganism, so that the first lesion produced in the tube by this type of infection is a catarrhal inflammation. The inflammation, however, quickly spreads from the superficial portions to the deeper layers of the tube, so that in advanced cases the muscularis and serosa are extensively involved. Wertheim3 and others have repeatedly demonstrated the presence of gonococci in the depths of the tubal wall. A moderate amount of cellulitis is usually present as an accompaniment of advanced tubal disease. Gonorrhea travels by continuity along the mucous membrane. Rare exceptions to this are occasionally noted, as sometimes in cases of extensive cellulitis or in gonorrheal endocarditis and other metastatic gonorrheas. As a result of the salpingitis an inflammatory exudate forms, which, when it escapes from the abdominal ostium, produces at first a perioophoritis and localized peritonitis. This may increase in gravity until an oophoritis or even an ovarian abscess results. The...
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