436 Gonorrhea 



was required. The poison can be precipitated with absolute 

 alcohol. Small quantities of the toxin introduced into the 

 urethra cause suppuration at the point of application, fever, 

 swelling of the neighboring lymphatic nodes, and muscular 

 and articular pains, 



Pathogenesis. It is generally believed that gonorrhea 

 cannot be communicated to animals. 



There is no doubt but that the gonococcus causes gonor- 

 rhea, as it has on several occasions been intentionally and 

 experimentally inoculated into the human urethra with 

 resulting typical disease. It is constantly present in the 

 disease, and very frequently in its sequelae, though it not 

 infrequently happens that the lesions secondary to gonor- 

 rhea are caused by the more common organisms of suppu- 

 ration that have entered through the surface denudations 

 caused by the gonococcus. 



The mucous membranes, especially those covered with 

 squamous epithelium, are the appropriate portals for gonor- 

 rheal infection. 



The injection of gonococci into the subcutaneous tissue is 

 not followed by either abscess formation or septic infection. 



Gonococci may enter the circulation of human beings and 

 occasion a peculiar septic condition with irregular tempera- 

 ture, apt to be followed by invasion of the cardiac valves, 

 joints, or other tissues. P. Kraus* has twice succeeded in 

 cultivating the gonococcus from the blood of patients in the 

 stage of septic infection. 



The deep lesions caused by the gonococcus are, however, 

 numerous, and in Young's paper (loc. cit.) its widespread 

 powers of pyogenic infection are well shown in a collection 

 of the cases recorded in the literature, and some original 

 observations showing the undoubted occurrence of the gono- 

 coccus in gonorrhea, ophthalmia neonatorum, arthritis, ten- 

 dosynovitis, perichondritis, subcutaneous abscess, intra- 

 muscular abscess, salpingitis, pelvic peritonitis, adenitis, 

 pleuritis, endocarditis, septicemia, acute cystitis, chronic 

 cystitis, pyonephrosis, and diffuse peritonitis. 



In the beginning of the inflammatory process the cocci 

 grow in the superficial epithelial cells, but soon penetrate 

 between the cells to the deeper layers, where they continue 

 to keep up the irritation as the superficial cells desquamate. 

 Opinions differ as to whether the gonococci can, with equal 

 * "Berliner klin. Wochenschrift," No. 19, p. 494, May 9, 1904. 



