316 Gonorrhea 



pleuritis, endocarditis, septicemia, acute cystitis, chronic 

 cystitis, pyonephrosis, and diffuse peritonitis. In addition, 

 Young observed the gonococcus in pyonephrosis, chronic 

 cystitis, and diffuse peritonitis. 



In the beginning of the inflammatory process the cocci 

 grow in the superficial epithelial cells, but soon penetrate 

 between the cells to the deeper layers, where they continue 

 to keep up the irritation as the superficial cells desquamate. 

 Opinions differ as to whether the gonococci can, with equal 

 facility, penetrate squamous and columnar epithelium. 

 Their attacks are usually made upon surfaces covered with 

 squamous epithelium. 



All urethral inflammations, and in gonorrhea all of the 

 inflammatory symptoms, do not depend upon the gonococcus. 

 The peri-urethral abscesses, salpingitis, etc., not infrequently 

 depend upon ordinary pus cocci, and I remember having 

 seen a case of gonorrhea with double orchitis, general septic 

 infection, and endocarditis, in which the gonococci had no 

 role in the sepsis, which was caused by a large dumb-bell 

 coccus that stained beautifully by Gram's method. 



In the remote secondary inflammations the gonococci 

 disappear after a time, and the inflammation either subsides 

 or is maintained by other bacteria. In synovitis, however, 

 the inflammation excited may last for months. 



So long as the gonococci persist in his urethra or other 

 superficial tissue the patient may spread the contagion, 

 and after apparent recovery from gonorrhea the cocci may 

 remain latent in the urethra for years, not infrequently 

 causing a relapse if the patient partake of some substance, 

 as alcohol, irritating to the mucous membranes. Bearing 

 this in mind, physicians should be careful that their patients 

 are not too soon discharged as cured and permitted to 

 marry. 



Immunization against the gonococcus has not yet been 

 successfully achieved by Wassermann, though Christmas 

 claims to have immunized goats. The serum of these ani- 

 mals could not be shown to contain any antitoxin, and has 

 not been shown to be bacteriolytic. 



Torrey* prepared an antigonococcus serum by immunizing 



rabbits with gonotoxin. The culture used was isolated from 



a case of acute gonorrhea in a medium of rich ascitic fluid 



and slightly acid beef infusion, peptone broth, equal parts. 



* "Journal Amer. Med. Assoc.," 1906, XLVI, p. 261, Jan. 27. 



