DISTRIBUTION OF GONOCOCCUS 265 



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 may be mentioned here that 

 Wertheim cultivated 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 invariably 

 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 gonorrhceal vulvo- 

 vaginitis of young subjects. They have also been found in 

 suppurations in connection with Bartholini's glands, and some- 

 times produce an inflammatory 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 cultivated in a considerable number of cases. 

 According to the results of various observers they are present 

 in one out of four or five cases of this condition, usually un- 

 associated with other organisms. Further, in a large proportion 

 of the cases in which the gonococcus has not been found, 

 no organisms of any kind have been obtained from the pus, and 

 in these cases the gonococci may have been once present and 

 have subsequently died out. Lastly, they may pass to the 

 peritoneum and produce peritonitis, which is usually of a local 

 character. It is chiefly to the methods of culture supplied by 

 Wertheim that we owe our extended knowledge of such 

 conditions. 



In gonorrhoeal conjunctivitis the mode in which the gonococci 

 spread through the epithelium to the subjacent connective 

 tissue is closely analogous to what obtains in the case of the 

 urethra. Their relation to the leucocytes in the purulent 

 secretion is also the same. Microscopic examination of the 

 secretion alone in acute cases often gives positive evidence, and 

 pure cultures may be readily obtained. As the condition 

 becomes more chronic the gonococci are less numerous and a 

 greater proportion of other organisms may be present. Some 

 observers have recently put forward the view that the " chlamy- 

 dozoa" (p. 622) found in trachoma represent a mutation stage 

 of the gonococcus, but there does not appear to be sufficient 

 evidence that this is the case. 



Relations to Joint-Affections, etc. The relations of the gono- 



