228 GONORRHCEA, SOFT SORE, SYPHILIS. 



large number of the organisms. The organisms also penetrate 

 the subjacent connective tissue, and are especially found along 

 with extensive leucocytic emigration around the lacunae. 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, possibly 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 vesiculae 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 determining. A similar 

 statement also applies to the occurrence of orchitis and also of 

 cystitis in the early stage of gonorrhoea. Gonococci have, how- 

 ever, been obtained in pure culture from periurethral abscess 

 and from epididymitis. During the more chronic stages other 

 organisms may appear in the urethra, aid in maintaining the 

 irritation, and 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 is then also that buboes usually occur, often associated with 

 the presence of a small ulcer in the urethra. Though the 

 bacteriology of these cannot yet be said to be fully worked out, 

 they are certainly sometimes produced by the ordinary pyogenic 

 organisms and by some varieties of diplococci which are often 

 present in the urethra in abnormal conditions. It may be 

 mentioned here that Wertheim cultivated the gonococcus from 

 a case of chronic gonorrhoea of two years' standing, and by 

 inoculation on the human subject proved it to be still virulent. 



In the disease in the female, gonococci are almost invariably 

 present in the urethra, the situation affected next in frequency 

 being the cervix uteri. They do not appear to infect the lining 

 epithelium of the vagina of the adult unless some other abnor- 

 mal condition be present, but they do so in the gonorrhoeal 

 vulvo-vaginitis of young subjects. They have also been found 



