PYOGENIC BACTERIA. 395 
Bumm. Having succeeded in obtaining it in pure cultures from 
gonorrhceal pus, he made successful inoculations in the healthy ure- 
thra in two cases—once with a third culture and once with one 
which had been transferred through twenty successive generations. 
In both cases a typical gonorrhcea developed as a result of the inocu- 
lation. 
The mucous membranes in man which are subject to gonorrhceal 
infection are those of the urethra, the conjunctiva, the cervix uteri, 
and the vagina in children—the vagina in adults is not involved. 
Inoculations of gonorrhceal pus into the vagina or conjunctival sac of 
the lower animals—dogs, rabbits, horses, apes—are without result. 
The very numerous researches which have been made by compe- 
tent bacteriologists show that the gonococcus is constantly present in 
gonorrhceal discharges, and in view of the facts above stated its etio- 
logical import appears to be fully established. Bumm has studied 
the development of blennorrhwa neonatorum, and has shown that 
soon after infection the presence of gonococci may be demonstrated 
in the superficial epithelial cells of the mucous membrane and be- 
tween them ; that they soon penetrate to the deeper layers, and that 
by the end of forty-eight hours the entire epithelial layer is invaded 
by the diplococci, which penetrate by way of the connecting mate- 
rial—‘* Kittsubstance ”—between the cells. They also multiply in 
the superficial layers of connective tissue and give rise to an inflam- 
matory reaction, which is shown by an abundant escape of leuco- 
cytes from the dilated capillary network. The penetration of the 
gonococci to the deeper layers of the mucous membrane of the ure- 
thra, and even to the corpus cavernosum, was observed by Bockhart 
in a case studied by him in which death occurred during an acute 
attack of gonorrhea. But Bumm concludes from his researches 
that this is not usual, and that the invasion is commonly limited to 
the superficial layers of the mucous membrane. 
Staphylococcus pyogenes aureus is not infrequently associated 
with the gonococcus in late gonorrhceal discharges, and the abscesses 
which occasionally develop as a complication of gonorrhcea, in the 
prostate, the inguinal glands, or around the urethra, are probably 
due to its presence, which has been demonstrated in the pus from 
such abscesses in a number of cases. The same is true of the joint 
affections and endocarditis which sometimes occur in the course of 
an attack of gonorrhea, Although some authors have claimed to 
find the gonococcus in these so-called metastatic gonorrhceal inflam- 
mations, the evidence is not satisfactory, and it seems probable that 
the Staphylococcus aureus is the usual microédrganism concerned in 
these affections. 
