196 GONORRHCEA, SOFT SORE, SYPHILIS. 



out, they are certainly sometimes produced by the ordinary 

 pyogenic organisms and by some varieties of diplococci 

 which are often present in the urethra in abnormal conditions. 

 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 in- 

 variably 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 sometimes produce an inflam- 

 matory 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 culti- 

 vated 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 unassociated 

 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 gonorrhceal 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 



