Pathogenesis 315 



mann* have studied gonotoxin, and have all found that it 

 remains in the bodies of the bacteria. The toxin seems 

 to be quite stable and is not destroyed by temperatures 

 fatal to the cocci. Wassermann obtained some cultures of 

 which o.i c.c. would kill mice; others, of which i.o c.c. 

 was required. The poison can be precipitated with absolute 

 alcohol. Small quantities of the toxin introduced into the 

 urethra cause suppuration at the point of application, fever, 

 swelling of the neighboring lymphatic nodes, and muscular 

 and articular pains. 



Pathogenesis. It is generally believed that gonorrhea 

 cannot be communicated to animals. 



There is no doubt but that the gonococcus causes gonor- 

 rhea, as it has on several occasions been intentionally and 

 experimentally inoculated into the human urethra with 

 resulting typical disease. It is constantly present in the 

 disease, and very frequently in its sequelae, though it not 

 infrequently happens that the lesions secondary to gonor- 

 rhea are caused by the more common organisms of suppu- 

 ration that have entered through the surface denudations 

 caused by the gonococcus. 



The mucous membranes, especially those covered with 

 squamous epithelium, are the appropriate portals for gonor- 

 rheal infection. 



The injection of gonococci into the subcutaneous tissue is 

 not followed by either abscess-formation or septic infection. 



Gonococci may enter the circulation of human beings and 

 occasion a peculiar septic condition with irregular tempera- 

 ture, apt to be followed by invasion of the cardiac valves, 

 joints or other tissues. P. Krausf has twice succeeded in 

 cultivating the gonococcus from the blood of patients in the 

 stage of septic infection. 



The deep lesions caused by the gonococcus are, however, 

 numerous, and in Young's paper (loc. cit.) its widespread 

 powers of pyogenic infection are well shown in a collection 

 of the cases recorded in the literature, and some original 

 observations showing the undoubted occurrence of the gono- 

 coccus in gonorrhea, ophthalmia neonatorum, arthritis, ten- 

 dosynovitis, perichondritis, subcutaneous abscess, intra- 

 muscular abscess, salpingitis, pelvic peritonitis, adenitis, 



* " Zeitschrift fur Hygiene," 1898, and "Berliner klin. Wochen- 

 schrift," 1897, No. 32, p. 685. 



t "Berliner klin. Wochenschrift," No. 19, p. 494, May 9, 1904. 



