554 INFECTION AND IMMUNITY. 



fected by way of the lymphatics or local blood 

 vessels (gonorrheal thrombosis). 



The influence of the enormous phagocytosis of 

 the cocci on the course of gonorrhea is unknown. 

 Since the ingested cocci usually have a typical 

 form and stain well, it would seem that they resist 

 the action of the leucocytic ferments. Likewise 

 the nuclei of the leucocytes usually stain well, 

 hence there is no evidence of a marked toxicity 

 of the cocci for these cells. The mechanical im- 

 prisonment of the organisms by the leucocytes 

 may be of influence in localizing the infection. 

 urethrai During the course of gonorrhea "there takes 



Changes. 



place a pronounced metaplasia of the epithelium 

 in which the cylindrical cells are changed into a 

 more cuboidal and even pavement form." Follow- 

 ing this change the gonococci are limited to the 

 surface of the altered epithelium and penetrate 

 more deeply only in the vicinity of the glands and 

 crypts. "Eventually the gonorrheal process is 

 limited to such isolaled points and the gonorrhea 

 thereby enters into a chronic stage" (observations 

 of Finger, cited by Keisser and Scholtz). 

 chronic The conditions which cause the subsidence of 

 ea ' acute gonorrhea and allow it to persist as a chronic 

 infection have been the subject of much specula- 

 tion, unproductive for the most part. It is not 

 due to a decrease in the virulence of the cocci 

 since their original infectiousness is retained for 

 others ; nor does the local resistance of the mucous 

 membrane reach a high point, since reinfection, 

 or better "superinfection" is possible at any time. 

 A man suffering from chronic gonorrhea and 

 having infected his wife, may again be infected 

 by his wife when the gonorrhea of the latter has 



