COCCACE^: AND THEIR PARASITIC RELATIONSHIPS 253 



mis. In the female, pyosalpinx is a not unusual complication. 

 Secondary infection with staphylococci is common in chronic 

 gonorrhea. 



Specific diagnosis by finding gonococci usually presents no 

 difficulties in acute inflammations of the genital tract, in which 

 the characteristic groups of Gram-negative intracellular diplococci 

 are practically diagnostic. In chronic cases and in extra-genital 

 inflammations the diagnosis presents greater difficulty. Both 

 microscopic and cultural examinations should be made and if 

 negative they should be repeated many times. Even repeated 

 failure to find the gonococcus by these methods does not justify 

 the positive assertion that it is absent. Specific diagnosis by 

 the method of complement fixation has been developed by 

 Schwartz and McNeill. 1 The antigen is prepared from several cul- 

 ture strains of the gonococcus and in all other respects the test is 

 similar to the Wassermann test for syphilis. Irons 2 has employed 

 a cutaneous test, using a glycerin extract of gonoc< -cci. The tech- 

 nic is similar to that of the von Pirquet test for tuberculosis. 



The prevalence of gonorrhea throughout the civilized world 

 is much greater than has been popularly supposed. Erb, in a 

 study of 2000 males among private patients of the middle and 

 better classes, found a history of gonorrhea in 50 per cent. Many 

 other students of the disease disagree with Erb, regarding his 

 figures as much too low. Among women in German obstetrical 

 hospitals, largely from the poorer class, gonorrhea is present in 

 10 to 30 per cent. The danger to the eyes of the new-born 

 infant is now overcome by the use of silver nitrate in the eyes 

 when they are first cleansed. The general prevention and re- 

 striction of gonorrheal infection is engaging more and more the 

 serious attention of thoughtful citizens, and it is already recog- 

 nized as a sanitary problem of the first magnitude. 



Diplococcus Meningitidis. Weichselbaum in 1887 examined 

 the cerebrospinal fluid in six sporadic cases of meningitis and 



1 Amer. Joitrn. med. Sciences, 1912, Vol. CXLIV, pp. 815-826. 



2 Jour n. Infec. Diseases, 1912, Vol. XI, pp. 77-93. 



