344 MENINGOCOCCUS— GONOCOCCUS—CATARRHALIS GROUP 
F&thogenesis. — Experimental.— Bumm^ and Finger, Ghon and Schla- 
genhaufer- have reproduced typical urethritis in man with pure 
cultures of the gonococcus. The latter successfully infected the 
urethras of six healthy men with the organism (serum agar culture). 
The incubation period was from two to three days, and the clinical 
picture was typical in each instance. The organism was recovered 
in pure culture from each patient. 
.lwi//m/.— Laboratory animals are not susceptible to urethral infec- 
tion with the gonococcus. Intraperitoneal injections of cultures 
into white mice produce a purulent peritonitis, but there is little 
evidence that the organisms multiply there. Acute joint inflamma- 
tions with purulent exudation follows the inoculation of the cocci 
into the joints of rabbits, and purulent conjunctivitis can be pro- 
duced in young rabbits by rubbing gonococci on the conjunctiva. 
There is no evidence that the organisms multiply in these sites; the 
reverse appears to be the case for the cocci disappear rather rapidly. 
The endotoxins are responsible for the local reactions. 
Human.— Man is very susceptible to infection with the gonococcus. 
The usual portals of entry are the mucous membranes of the urethra, 
vagina and the conjunctiva. The urethral mucous membrane is 
particularly susceptible and it is commonly the primary site of inva- 
sion. The uterine mucosa and adnexa are also readily infected in 
adults; in young children the cervix is closed and infection of the 
uterus by continuity of growth from the vagina is rare in them, but 
vulvo-vaginitis is common, especially in hospital wards, where infection 
is readily transmitted by thermometers, hands of ward attendants, 
and by direct contact. 
The initial development of the organisms is upon the surface of the 
mucosa, then they penetrate to the deeper layers, infecting the pros- 
tate, and by continuity the epididymis in the male. Infection may 
spread from the vagina to the uterus in the female, then by continuity 
of growth to the Fallopian tubes, the ovaries and the peritoneum, 
causing endometritis, salpingitis, oophoritis and peritonitis. Sterility 
is usually the result. Cystitis and arthritis are not uncommon sequelae 
of infection with the gonococcus, and the mucosa of the rectum is 
occasionally involved. Serous surfaces are rarely invaded. Occa- 
sionally a generalized invasion takes place; this may result in septi- 
cemia with endocarditis. Ophthalmia neonatorum is a particularly 
common infection of the new-born of infected mothers. The con- 
junctivae become contaminated with gonococci as the child passes 
through the vagina. A large percentage of the blind have lost their 
eyesight in this manner of birth. The instillation of silver prepara- 
tions, required by law in many States, has greatly reduced this form 
of infection. 
Immunity.— Man exliibits little or no resistance to infection with 
the gonococcus and the mucous membranes may actually be more 
1 Loc. cit. 2 Loc. cit. 
