Immunization 415 



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, an'd the author has 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 

 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 

 tissues 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 success- 

 fully achieved. Wassermann failed altogether; Christmas claims 

 to have immunized goats, but the serum of these animals could 

 not be shown to contain any antitoxin or 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. . In speaking about 

 this mixture Dr. Torrey said that the exact reaction was its most 

 important feature, as otherwise the gonococci soon died. Tubes of 

 about 12 cm. of the mixture were heated to about 6o°C. for several 

 hours and then tested for sterility. The cocci were cultivated at 

 36° to 37°C. After eighteen to twenty-four hours' incubation a 

 slight granular growth appears near the surface and on the sides of 

 the tube. This slowly increases until after six days the medium is 

 well clouded on shaking. Large rabbits were used for making the 

 serum, and were intraperitoneally inoculated with 10 cc. of an 

 entire culture. The first inoculation resulted in a loss of weight, 

 sometimes amounting to one-fourth of the body-weight. After an 

 interval of five or six days a second injection is given, then after a 

 similar interval, a third, and so on. The best results were ob- 

 tained when cultures from six to fifteen days old were employed. 

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



