266 GONORRHOEA AND SOFT SORE 



coccus to the sequelae of gonorrhoea form a subject of great 

 interest and importance, and the application of recent methods 

 of examination shows that the organism is much more frequently 

 present in such conditions than the earlier results indicated. 

 The following statements may be made with regard to them : 

 First, in a large number of cases of arthritis following gonorrhoea 

 pure cultures of the gonococcus may be obtained. A similar 

 statement applies to inflammation of the sheaths of tendons 

 following gonorrhoea. Secondly, in a considerable proportion of 

 cases no organisms have been found. It is, however, possible 

 that in many of these the gonococci may have been present 

 in the synovial membrane, as it has been observed that they 

 may be much more numerous in that situation than in the 

 fluid. Thirdly, in some cases, especially in those associated 

 with extensive suppuration, occasionally of a pysemic nature, 

 various pyogenic cocci have been found to be present. In the 

 instances in which the gonococcus has been found in the joints, 

 the fluid present has usually been described as being of a 

 whitish yellow tint, somewhat turbid, and containing shreds 

 of fibrin-like material, sometimes purulent in appearance. In 

 one case Bordoni-Uffreduzzi cultivated the gonococcus from a 

 joint - affection, and afterwards produced gonorrhoea in the 

 human subject by inoculating with the cultures obtained. In 

 another case, in which pleurisy was present along with arthritis, 

 the gonococcus was cultivated from the fluid in the pleural 

 cavity. The existence of a gonorrhoeal endocarditis has been 

 established by recent observations. Cases apparently of this 

 nature occurring in the course of gonorrhoea had been previously 

 described, but the complete bacteriological test has now been 

 satisfied in several instances. In one case Lenhartz produced 

 gonorrhoea in the human subject by inoculation with the 

 organisms obtained from the vegetations. That a true gonor- 

 rhoeal septicaemia may occur has also been established, cultures 

 of the gonococcus having been obtained from the blood during 

 life on more than one occasion (Thayer and Blumer, Thayer 

 and Lazear, Ahmann). 



Within recent years the treatment of gonorrhoeal infections by 

 means of vaccines has been pretty extensively practised; and 

 favourable results have been reported by some observers. The 

 doses used have varied much, 5,000,000 cocci being recommended 

 as the initial dose by some, whilst others begin with much larger 

 doses. The effects reported have been more favourable in the 

 case of the interstitial inflammations, joint, etc., than in the case 

 of infections of the mucous membranes. 



