224 GONORRHCEA, SOFT SORE, SYPHILIS 



mucous membrane of the urethra, possibly also in the prostate, 

 and may thus be capable of producing infection. The prostatic 

 secretion may sometimes be examined by making pressure on 

 the prostate from the rectum when the patient has almost emptied 

 his bladder, the secretion being afterwards discharged along with 

 the remaining urine. (Foulerton.) In acute gonorrhoea there 

 is often a considerable degree of inflammatory affection of the 

 prostate and vesiculse seminales, but whether these conditions are 

 always due to the presence of gonococci in the affected parts 

 we have not at present the data for determining. A similar 

 statement also applies to the occurrence of orchitis and also of 

 cystitis in the early stage of gonorrhoea. Gonococci have, 

 however, been obtained in pure culture from peri-urethral abscess 

 and from epididymitis : it is likely that the latter condition, 

 when occurring in gonorrhoea, is usually due to the actual 

 presence of gonococci. During the more chronic stages other 

 organisms may appear in the urethra, aid in maintaining the 

 irritation, and may produce some of the secondary results. 

 The bacillus coli, the pyogenic cocci, etc., are often present, and 

 may extend along the urethra to the bladder and set up cystitis, 

 though in this they may be aided by the passage of a catheter. 

 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 invariably 

 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 gonorrhoeal vulvo- 

 vaginitis of young subjects. They have also been found in 

 suppurations in connection with Bartholini's glands, and some- 

 times produce an inflammatory 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 mem- 

 brane there. From the pus in cases of pyosalpinx they have 

 been cultivated -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 



