DISTRIBUTION OF GONOCOCCUS 225 



peritonitis, which is usually of a local character. It is chiefly to 

 the methods of culture supplied by Wertheim that we owe our 

 extended knowledge of such conditions. 



In gonorrhceal conjunctivitis the mode in which the gonococci 

 spread through the epithelium to the subjacent connective 

 tissue is closely analogous to what obtains in the case of the 

 urethra. Their relation to the leucocytes in the purulent 

 secretion is also the same. Microscopic examination of the 

 secretion alone in acute cases often gives positive evidence, and 

 pure cultures may be readily obtained on blood-agar. As the 

 condition becomes more chronic the gonococci are less numerous 

 and a greater proportion of other organisms may be present. 



Relations to Joint Affections, etc. The relations of the gono- 

 coccus to the sequelae of gonorrhoea form a subject of great 

 interest and importance, and the application of recent methods of 

 examination shows that the organism is much more frequently 

 present in such conditions than the earlier results indicated. 

 The following statements may be made with regard to them. 

 First, in a considerable number of cases of arthritis following 

 gonorrhoea the gonococcus has been found microscopically, and 

 pure cultures have been obtained, e.g. by Neisser, Lang, 

 Bordoni-Uffreduzzi, and many others. A similar statement 

 applies to inflammation of the sheaths of tendons following 

 gonorrhoea. Secondly, in a large proportion of cases no organ- 

 isms have been found. It is, however, possible that in a number 

 of these the gonococci may have been present in the synovial 

 membrane, as it has been observed that they may be much more 

 numerous in that situation than in the fluid. Thirdly, in some 

 cases, especially in those associated with extensive suppuration, 

 occasionally of a pyaemic nature, various pyogenic cocci have 

 been found to be present. In the instances in which the gono- 

 coccus has been found in the joints, the fluid present has usually 

 been described as being of a whitish-yellow tint, somewhat 

 turbid, and containing shreds of fibrin-like material, sometimes 

 purulent in appearance. In one case Bordoni-Uffreduzzi culti- 

 vated the gonococcus from a joint-affection, and afterwards 

 produced gonorrhoea in the human subject by inoculating with 

 the cultures obtained. In another case in which pleurisy was 

 present along with arthritis the gonococcus was cultivated from 

 the fluid in the pleural cavity. The existence of a gonorrhoeal 

 endocarditis has been established by recent observations. Cases 

 apparently of this nature occurring in the course of gonorrhoea 

 had been previously described, but the complete bacteriological 

 test has now been satisfied in several instances. In one case 

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