PYOGENIC BACTERIA. 299 



Bumm. Having succeeded in obtaining it in pure cultures from 

 gonorrhoeal pus, he made successful inoculations in the healthy ure- 

 thra in two cases once with a third culture and once with one 

 which had been transferred through twenty successive generations. 

 In both cases a typical gonorrhoea developed as a result of the inocu- 

 lation. 



The mucous membranes in man which are subject to gonorrhoeal 

 infection are those of the urethra, the conjunctiva, the cervix uteri, 

 and the vagina in children the vagina in adults is not involved. 

 Inoculations of gonorrhoeal pus into the vagina or conjunctival sac of 

 the lower animals dogs, rabbits, horses, apes are without result. 



The very numerous researches which have been made by compe- 

 tent bacteriologists show that the gonococcus is constantly present in 

 gonorrhoeal discharges, and in view of the facts above stated its etio- 

 logical import appears to be fully established. Bumm has studied 

 the development of blennorrhoea neonatorum, and has shown that 

 soon after infection the presence of gonococci may be demonstrated 

 in the superficial epithelial cells of the mucous membrane and be- 

 tween them ; that they soon penetrate to the deeper layers, and that 

 by the end of forty-eight hours the entire epithelial layer is invaded 

 by the diplococci, which penetrate by way of the connecting mate- 

 rial " Kittsubstance " between the cells. They also multiply in 

 the superficial layers of connective tissue and give rise to an inflam- 

 matory reaction, which is shown by an abundant escape of leuco- 

 cytes from the dilated capillary network. The penetration of the 

 gonococci to the deeper layers of the mucous membrane of the ure- 

 thra, and even to the corpus cavernosum, was observed by Bockhart 

 in a case studied by him in which death occurred during an acute 

 attack of gonorrhoea. But Bumm concludes from his researches 

 that this is not usual, and that the invasion is commonly limited to 

 the superficial layers of the mucous membrane. 



Staphylococcus pyogenes aureus is not infrequently associated 

 with the gonococcus in late gonorrhoeal discharges, and the abscesses 

 which occasionally develop as a complication of gonorrhoea, in the 

 prostate, the inguinal glands, or around the urethra, are probably 

 due to its presence, which has been demonstrated in the pus from 

 such abscesses in a number of cases. The same is true of the joint 

 affections and endocarditis which sometimes occur in the course of 

 an attack of gonorrhoea. Although some authors have claimed to 

 find the gonococcus in these so-called metastatic gonorrhoeal inflam- 

 mations, the evidence is not satisfactory, and it seems probable that 

 the Staphylococcus aureus is the usual microorganism concerned in 

 these affections. 



