GONOCOCCUS IN JOINT AFFECTIONS, ETC. 229 



in suppurations in connection with Bartholini's glands, and some- 

 times produce an inflammatory condition of the mucous mem- 

 brane of the body of the uterus. They may also pass along the 

 Fallopian tubes and produce inflammation of the mucous mem- 

 brane there. From the pus in cases of pyosalpinx they have 

 been cultivated in a considerable number of cases. According 

 to the results of various observers they are present in one out 

 of four or five cases of this condition, usually unassociated with 

 other organisms. Further, in a large proportion of the cases in 

 which the gonococcus has not been found no organisms of any 

 kind have been obtained from the pus, and in these cases the 

 gonococci may have been once present, and have subsequently 

 died out. Lastly, they may pass to the peritoneum and produce 

 peritonitis, which is usually of a local character, but cases of 

 acute diffuse peritonitis are recorded by Meija, Frank, Gushing, 

 Hunner and Harris. It is chiefly to the methods of culture 

 supplied by Wertheim that we owe our extended knowledge of 

 such conditions. 



In gonorrhoial conjunctivitis the mode in which the gonococci 

 spread through the epithelium to the subjacent connective 

 tissue is closely analogous to what obtains in the case of the 

 urethra. Their relation to the leucocytes in the purulent secre- 

 tion is also the same. Microscopic examination of the secretion 

 alone in acute cases often gives positive evidence, and pure cul- 

 tures may be readily obtained on blood agar. As the condition 

 becomes more chronic the gonococci are less numerous and a 

 greater portion of other organisms may be present. 



Relations to Joint Affections, etc. — The relations of the gono- 

 coccus to the sequelae of gonorrhoea form a subject of great 

 interest and importance, and the application of recent methods 

 of examination show that the organism is much more frequently 

 present in such conditions than the earlier results indicated. 

 The following statements may be made with regard to them. 

 First, in a considerable number of cases of arthritis following 

 gonorrhoea, the gonococcus has been found microscopically, 

 and pure cultures have been obtained, e.g. by Neisser, Lang, 

 Bordoni-Uffreduzzi, and many others. A similar statement 

 appHes to inflammation of the sheaths of tendons following 

 gonorrhoea. Secondly, in a large proportion of cases no organ- 

 isms have been found. It is, however, possible that in a number 



