58 STUDY AND IDENTIFICATION OF BACTERIA 



Later on, at the acme of the discharge (the creamy, abundant discharge) , 

 it is in the pus cells we find them and they may be so abundant that 10 

 to 20% of the pus cells may contain them. In the subacute stage the 

 epithelial cells, which practically disappear when the discharge is so 

 abundant, begin to reappear, and in the chronic stage the epithelial 

 cells are the chief ones, and are the ones, on which we find an occasional 

 gonococcus, often distorted in shape. 



The best method of diagnosis in cases of chronic gonorrhoea is to have the patient 

 drink beer and eat the stimulating food previously interdicted, to take active ex- 

 ercise and to have a sound passed. To obtain material for examination ihe glans 

 penis should be washed and the patient who has presented himself with a full 

 bladder should pass a portion of the contained urine. Next the prostate aj*9 seminal 



FIG. 14. Gonococcus. Film from urethral pus. (Coplin.) 



vesicles should be massaged with the patient standing but bent over and the penis 

 pendant. The drops of discharge from the massage should be received in a small 

 Petri dish and finally the remaining urine should be passed into a sterile bottle. 

 Smears and cultures should be made from the sediment of the two urinary specimens 

 and from the secretions of the massaged prostate and vesicles. 



The smears made from the resulting discharge or centrifuged urine will probably 

 contain gonoccocci if they are present in the urethra. In the female the favorite 

 sites are the urethra and the cervix uteri. In municipal examinations it is customary 

 to make two smears: one from the urethral meatus and a second from the cervix. 

 The vagina is not a suitable soil for their development. In female children it is 

 most often found in the discharge of the vulvovaginitis. 



