ACTION OF GOXOCOCCUS ON THE TISSUES. 235 



so, that Bumm claims that a true gonorrhoea in the vagina of adults 

 is impossible, while it does occur in children. The gonococcus 

 reaches the deeper tissue layers exclusively by its growth into the 

 intercellular passages, consequently the advance is very slow. The 

 first effect of the infection upon the mucous membrane is an increase 

 of the physiological secretion a thin mucous fluid. Suppuration 

 is not the result of the cocci, but of chemical substances which are 

 produced by them, as pus corpuscles appear before the microbes 

 have reached the vascular layer of the mucous membrane. As the 

 pus corpuscles enter the epithelial layer the latter becomes still looser 

 and some of the cells exfoliate. After this stage the pus cells are 

 the structures in which the gonococci are developed. Cessation of 

 the suppurative process is not always a sign that infection has also 

 ceased, as during the latent stage only a catarrhal secretion is pres- 

 ent, but suppuration may be lighted up again at any time under the 

 influence of additional causes which produce an aggravation of the 

 chronic inflammatory process. 



In serous cavities gonorrhoeal pus produces, as a rule, a circum- 

 scribed abscess. Sinclair, in his excellent monograph (Gronorrhceal 

 Infection in Women, London, 1888, p. 79), after describing the gonor- 

 rhoeal infection from the vagina, says : *' The proper character and 

 results of the pathogenous activity of the gonorrhoeic microbes are 

 therefore seen, pure and unadulterated, in the tubes. They cause 

 purulent inflammation of the mucous membrane, but the sur- 

 rounding connective tissue remains free from them. The gouor- 

 rhoeic tubal pus is evacuated into the peritoneum, and whereas in 

 other conditions the bursting of an abscess into the abdominal 

 cavity is followed by the gravest consequences, in this case the 

 whole process terminates with a circumscribed inflammation, encap- 

 sulating the exuded pus. The cause of this difference is the varying 

 pathogenic value of the organisms which are contained in the pus. 

 A puerperal pelvic cellulitic abscess bursting into the peritoneum 

 causes general peritonitis, because it contains pyogenous strepto- 

 cocci, which rapidly multiply in serous cavities and are capable of 

 exerting the most deleterious effects. Gonorrhoeal tubal pus cannot 

 do this; its microbes do not find in the peritoneum conditions for 

 their increase ; the pus, therefore, acts as an aseptic foreign body, 

 becomes encapsulated, and is finally absorbed. " 



That this favorable termination does not always follow gonor- 

 rhoeal infection of the peritoneal cavity is well shown by a case 

 reported by Loven (" Fall von Gonorrhea bei einem fiinf jahrigen 

 Madchen ; Peritonitis ; Tod/ 7 Schmidt's Jahrbiicher, B. ccxiv. p. 

 39) which is by no means an isolated one. The source of infection 

 could not be learned in this case, but the diagnosis of gonorrhceic 

 ascending infection was positive. The disease commenced as an 



