398 Gonorrhea 



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 gonorrhea, 

 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 second- 

 ary to gonorrhea are caused by the more common organisms of 

 suppuration that have entered through the surface denudations 

 caused by the gonococcus. 



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. 



The injection of gonococci into the subcutaneous tissue is not 

 followed by either abscess formation or septic infection. 



Gonococci rarely enter the circulation of human beings and occa- 

 sion a peculiar septic condition with irregular temperature, apt to 

 be followed by invasion of the cardiac valves, joints, or other 

 tissues. P. Kraus* 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, nuriier- 

 ous, and in Young's paper {loc. cit.) its widespread powers of pyo- 

 genic infection are well shown in a collection of the cases recorded 

 in the literature, and some original observations showing the un- 

 doubted occurrence of the gonococcus in gonorrhea, ophthalmia 

 neonatorum, arthritis, tendosynovitis, perichondritis, subcutaneous 

 abscess, intramuscular abscess, salpingitis, pelvic peritonitis, adenitis, 

 pleuritis, endocarditis, septicemia, acute cystitis, chronic cystitis, 

 pyonephrosis, 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 irri- 

 tation as the superficial cells desquamate. 



All urethral inflammations, and in gonorrhea all of the inflam- 

 matory symptoms, do not depend upon the gonococcus. The 

 periurethral abscess, salpingitis, etc., not infrequently depend upon 

 ordinary pus cocci, and the author has seen a case of gonorrhea with 

 double orchitis, general septic infection, and endocarditis in which 

 the gonococci had no r61e in the sepsis, which was caused by a large 

 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 

 * "Berliner klin. Wochenschrift," May 9, 1904, No. ig, p. 494. 



