176 SUPPURATION. 



The gonococcus cannot be grown on potato, plain gelatin, 

 or agar-agar. It must be remembered that the growth is 

 never very heavy. The results obtained with cultures are so 

 variable that it is impossible to describe any characteristic 

 appearance other than that seen in the plates. 



Pathogenesis : The gonococcus is always found in the puru- 

 lent discharge from gonorrhoeal inflammations, and the posi- 

 tion of the germ within the pus-cells is absolutely characteris- 

 tic and a point in diagnosis. It must be borne in mind that 

 gonorrhoeal inflammations are not limited to the urethral canal, 

 but may occur in any part of the body. These inflammations 

 are always very serious, and should not be discussed lightly 

 nor in a facetious spirit. In old cases of gonorrhoea it is occa- 

 sionally impossible to find the gonococcus in the discharges 

 because of its position within the tissue-cells covering the 

 mucous membrane of the urethra or other parts of the body. 

 This enclosure serves as a protecting barrier to the germ. If 

 the gonococcus cannot be found, it is advisable to irritate the 

 mucous membrane with instruments, such as the passage of 

 sounds in the urethra, so as to induce free secretion. If the 

 gonococcus is contained in the cells, such irritation will 

 usually dislodge some cells and the germ will appear in the 

 discharge. 



The gonococcus is constantly present in all stages of the 

 disease, and in large numbers during the acute stage. It is 

 also present in the sequelae of gonorrhoea. It is never present 

 under normal conditions, although a number of organisms 

 which resemble the gonococcus, but which differ as to patho- 

 genicity and also in culture, are frequently found in the 

 vaginal and urethral discharges. 



The gonococcus will not develop on healthy mucous 

 membranes. The conditions suitable for its development 

 must exist. Congestion of these membranes furnishes the 

 necessary conditions. Once it has found lodgement on or in 

 a mucous membrane it is exceedingly difficult to dislodge it. 

 The cessation of the purulent discharge is by no means an 

 indication of the disappearance of the gonococcus. The 

 gonococcus is very resistant to heat and chemicals. It also 

 has a tendency to remain latent in the tissues for a long 



