304 THE MENINGOCOCCUSGONOCOCCUS GROUP 



De Christmas has shown that the poisonous substance (endotoxin) 

 diffuses readily into the culture medium, probably because of the 

 rapid autolysis which is a noteworthy feature of the organism. The 

 endotoxin is fairly resistant to heat; a brief exposure to 120 C. fails 

 to entirely destroy its potency. 



Pathogenesis. Experimental. Bumm 1 and Finger, Ghon and 

 Schlagenhaufer 2 have reproduced typical urethritis in man with 

 pure cultures of the gonococcus. The latter successfully infected the 

 urethras of six healthy men with the organism (serum agar culture). 

 The incubation period was from two to three days, and the clinical 

 picture was typical in each instance. The organism was recovered 

 in pure culture from each patient. 



Animal. Laboratory animals are not susceptible to urethral 

 infection with the gonococcus. Intraperitoneal injections of cultures 

 into white mice produce a purulent peritonitis, but there is little 

 evidence that the organisms multiply there. Acute joint inflammations 

 with purulent exudation follows the inoculation of the cocci into the 

 joints of rabbits, and purulent conjunctivitis can be produced in 

 young rabbits by rubbing gonococci on the conjunctiva. There is no 

 evidence that the organisms multiply in these sites ; the reverse appears 

 to be the case for the cocci disappear rather rapidly. The endotoxins 

 are responsible for the local reactions. 



Human. Man is very susceptible to infection with the gonococcus. 

 The usual portals of entry are the mucous membranes of the urethra, 

 vagina, and the conjunctiva. The urethral mucous membrane is 

 particularly susceptible and it is commonly the primary site of inva- 

 sion. The uterine mucosa and adnexa are also readily infected in 

 adults; in young children the cervix is closed and infection of the 

 uterus by continuity of growth from the vagina is rare in them, but 

 vulvovaginitis is common, especially in hospital wards where infec- 

 tion is readily transmitted by thermometers, hands of ward attendants, 

 and by direct contact. 



The initial development of the organisms is upon the surface of the 

 mucosa, then they penetrate to the deeper layers, infecting the pros- 

 tate, and by continuity the epididymis in the male. Infection may 

 spread from the vagina to the uterus in the female, then by continuity 

 of growth to the Fallopian tubes, the ovaries, and the peritoneum, 

 causing endometritis, salpingitis, oophoritis, and peritonitis. Sterility 

 is usrally the result. Cystitis and arthritis are not uncommon sequelae 



1 Loc. cit. 2 Loc. cit 



