Immunization 437 



facility, penetrate squamous and columnar epithelium. 

 Their attacks are usually made upon surfaces covered with 

 squamous epithelium. 



All urethral inflammations, and in gonorrhea all of the 

 inflammatory symptoms, do not depend upon the gonococcus. 

 The periurethral abscess, salpingitis, etc., not infrequently 

 depend upon ordinary pus cocci, and I remember having 

 seen a case of gonorrhea with double orchitis, general septic 

 infection, and endocarditis in which the gonococci had no 

 role in the sepsis, which was caused by a large dumb-bell 

 coccus that stained beautifully by Gram's method. 



In the remote secondary inflammations the gonococci 

 disappear after a time, and the inflammation either subsides 

 or is maintained by other bacteria. In synovitis, however, 

 the inflammation excited may last for months. 



So long as the gonococci persist in his urethra or other 

 superficial tissues the patient may spread the contagion, 

 and after apparent recovery from gonorrhea the cocci may 

 remain latent in the urethra for years, not infrequently 

 causing a relapse if the patient partake of some substance, 

 as alcohol, irritating to the mucous membranes. Bearing 

 this in mind, physicians should be careful that their patients 

 are not too soon discharged as cured and permitted to 

 marry. 



Immunization against the gonococcus has not yet been 

 successfully achieved. Wassermann failed altogether ; Christ- 

 mas claims to have immunized goats, but the serum of these 

 animals could not be shown to contain any antitoxin or to 

 be bacteriolytic. 



Torrey* prepared an antigonococcus serum by immunizing 

 rabbits with gonotoxin. The culture used was isolated from 

 a case of acute gonorrhea in a medium of rich ascitic fluid 

 and slightly acid beef infusion, peptone broth, equal parts. 

 In speaking about this mixture Dr. Torrey told me that 

 the exact reaction was its most important feature, as other- 

 wise the gonococci soon died. Tubes of about 12 cm. of 

 the mixture were heated to about 60 C. for several hours 

 and then tested for sterility. The cocci were cultivated at 

 36 to 37 C. After eighteen to twenty-four hours' incuba- 

 tion a slight granular growth appears near the surface and on 

 the sides of the tube. This slowly increases until after six 

 days the medium is well clouded on shaking. Large rab- 

 * "Journal Amer. Med. Assoc.," Jan. 27, 1906, XL,VI, p. 261. 



