260 GONORRHOEA AND SOFT SORE 



attended with purulent^fcharge. He found that no tolerance to the 

 toxin resulted after fivej^ftcessive injections at intervals. In a more 

 recent publication he poiri(rout that the toxin on intracerebral injection 

 has marked effects ; he also claims to have produced an antitoxin. 

 He states that the toxin diffuses out in the culture medium, and does 

 not merely result from disentegration of the organisms. This has, 

 however, been called in question by other investigators. 



Distribution in the Tissues. — The gonococcus having been 

 thus shown to be the direct cause of the disease, some additional 

 facts may be given regarding its presence both in the primary 

 and secondary lesions. In the human urethra the gonococci 

 penetrate the mucous membrane, passing chiefly between the 

 epithelial cells, causing a loosening and desquamation of many 

 of the latter and inflammatory reaction in the tissues below, 

 attended with great increase of secretion. There occurs also 

 a gradually increasing emigration of leucocytes, which take up 

 a large number of the organisms. The organisms also penetrate 

 the subjacent connective tissue and are especially found, along 

 with extensive leucocytic emigration, around the lacunas. Here 

 also many are contained within leucocytes. Even, however, 

 when the gonococci have disappeared from the urethral dis- 

 charge, they may still be present in the deeper part of the 

 mucous membrane of the urethra, and 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 vesicuke 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 deter- 

 mining. 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 



