176 GONORRH(EA, SOFT SORE, SYPHILIS. 



within leucocytes. They are constantly being carried to 

 the surface by leucocytes and discharged, but by multiplica- 

 tion they are able to maintain their footing till such a 

 time as the disease comes naturally to an end. In acute 

 gonorrhoea there is often a considerable degree of inflam- 

 matory affection of the prostate and vesiculse seminales, out 

 whether these conditions are due to the presence of gono- 

 cocci in the affected parts we have not at present the data 

 for determining. A similar statement also applies to the 

 occurrence of orchitis and also of cystitis in the early stage 

 of gonorrhoea. During the more chronic stages other 

 organisms appear in the urethra, aid in maintaining the 

 irritation, and may produce some of- the secondary results. 

 The bacillus coli, the pyogenic cocci, etc., are often present, 

 and may extend along the urethra to the bladder and set up 

 cystitis, though in this they may be aided by the passage of 

 a catheter. It is then also that buboes usually occur, often 

 associated with the presence of a small ulcer in the urethra. 

 Though the bacteriology of these cannot yet be said to be 

 fully worked out, they are certainly sometimes produced by 

 the ordinary pyogenic organisms and by some varieties of 

 diplococci which are often present in the urethra in abnorfnal 

 conditions. It may be mentioned here that Wertheim culti- 

 vated the gonococcus from a case of chronic gonorrhoea of 

 two years' standing, and by inoculation on the human subject 

 proved it to be still virulent. 



In the disease in the female, gonococci are almost in- 

 variably present in the urethra, the situation affected next 

 in frequency being the cervix uteri. They do not appear 

 to infect the lining epithelium of the vagina of the adult 

 unless some other abnormal condition be present, but they 

 do so in the gonorrhoeal vulvo-vaginitis of young subjects. 

 They have also been found in suppurations in connection 

 with Bartholini's glands, and sometimes produce an inflam- 

 matory condition of the mucous membrane of the body of 

 the uterus. They may also pass along the Fallopian tubes 

 and produce inflammation of the mucous membrane there. 

 From the pus in cases of pyosalpinx they have been culti- 



