226 GONORRHCEA, SOFT SOEE, SYPHILIS 



Lenhartz produced gonorrhoea in the human subject by 

 inoculation with the organisms obtained from the vegetations. 

 That a true gonorrhoeal septicaemia may also occur has also been 

 established, cultures of the gonococcus having been obtained 

 from the blood during life on more than one occasion (Thayer 

 and Blumer, Thayer and Lazear, Ahmann). 



Methods of Diagnosis. For microscopical examination dried 

 films of the suspected pus, etc., may be stained by any of the 

 simple solutions of the basic aniline stains. We prefer methy- 

 lene- or thionin-blue, as they do not overstain, and the films do 

 not need to be decolorised. Staining for one minute is sufficient. 

 It is also advisable to stain by Gram's method, and it is a good 

 plan to put at one margin of the cover-glass a small quantity of 

 culture of staphylococcus aureus if available, in order to have a 

 standard by which to be certain that the supposed gonococci are 

 really decolorised. Regarding the value of microscopic examina- 

 tion alone, we may say that the presence of a large number of 

 micrococci in a urethral discharge having the characters, position, 

 and staining reactions described above, is practically conclusive 

 that the case is one of gonorrhoea. There is no other condition 

 in which the sum total of the microscopical characters is present. 

 We consider that it is sufficient for purposes of clinical diagnosis, 

 and therefore of great value ; in the acute stage a diagnosis can 

 thus be made earlier than by any other method. The mistake 

 of confusing gonorrhoea with such conditions as a urethral chancre 

 with urethritis, will also be avoided. Even in chronic cases the 

 typical picture is often well maintained, and microscopic examina- 

 tion alone may give a definite positive result. When other organ- 

 isms are present, and especially when the gonococci are few in 

 number, it is difficult, and in some cases impossible, to give a 

 definite opinion, as a few gonococci mixed with other organisms 

 cannot be recognised with certainty. This is often the condition 

 in chronic gonorrhoea in the female. Microscopic examination, 

 therefore, though often giving positive results, will sometimes be 

 inconclusive. As regards lesions in other parts of the body 

 microscopic examination alone is quite insufficient ; it is practi- 

 cally impossible, for example, to distinguish by this means the 

 gonococcus from the diplococcus intracellularis of meningitis. 

 Cultures alone supply the absolute test, and when the organism 

 is present in an apparent condition of purity, Wertheim's 

 medium or blood -agar should be used. If other organisms 

 are present, we are practically restricted to Wertheim's plate 

 method. 



