414 Gonorrhea 



Nicolaysen,* and Wassermannf 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 

 cc. would kill mice; others, of which i.o cc. 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 appUcation, fever, swelhng of the neighboring lymphatic 

 nodes, and muscular and articular pains. 



Pathogenesis. — It is generally believed that gonorrhea cannot 

 be communicated to animals. 



When the cocci are injected into the peritoneal cavity of mice, a 

 purulent form of peritonitis is produced. Injected into the joints 

 of young rabbits results in purulent arthritis. Applied to the con- 

 junctiva, conjunctivitis is produced. From all these lesions the 

 gonococci rapidly die out, and Kendall thinks that it is the toxin and 

 not the cocci that produces the inflammatory reaction. 



There is no doubt but that the gonococcus causes gonorrhea. 

 Bummt and Finger, Gohn and Schlaugenhaufer§ have several times 

 intentionally and experimentally inoculated gonococci into the 

 human urethra with resulting typical disease. It is constantly pres- 

 ent in the disease, and very frequently in its sequelas, though it not 

 infrequently happens that the lesions secondary 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 epithehum. 



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. Krausll has twice succeeded in cultivating the gono- 

 coccus from the blood of patients in the stage of septic 

 infection. 



The deep lesions caused by the gonococcus are, however, numer- 

 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, 



* "Centralbl. f. Bakt. u. Parasitenk.," 1897, Bd. xxn, Nos. 12 and 13, p. 303. 



f'Zeitschrift fur Hygiene," 1898, and "Berliner klin. Wochenschrift," 1S97, 

 No. 32, p. 685. 



{Die Mikroorganisum des gonorrheischen Schleinhautkrankungen Gono- 

 coccus," Neisser, Weisbaden, 1885. 



§ "Centralbl. f. Bakt. u., Parasitenk.," 1894, xvi, 350. 



II "Berliner klin. Wochenschritt," May 9, 1904, No. 19, p. 494. 



