306 THE MENINGOCOCCUSGONOCOCCUS GROUP 



In chronic cases the discharge is scanty and it is better to receive 

 the morning urine in a sedimentation glass containing a crystal or two 

 of thymol. After a short time threads of mucus separate out; these 

 should be removed with a capillary pipette and examined as above. 

 The pus from old cases of gonorrhea frequently contains but few gono- 

 cocci, which are difficult to find. It has been found that the local 

 injection of silver nitrate (properly diluted) will usually cause an 

 elimination of pus which frequently contains the organisms in some- 

 what larger numbers. Drinking beer is said to produce the same 

 result. Vaginal smears may be obtained from swabs which are intro- 

 duced into the vagina, or by means of long pipettes with rounded ends, 

 containing a few drops of 1 to 1000 mercuric chloride, which are 

 expressed and drawn up into the pipette several times deep in the 

 vagina. The material thus removed is stained in the usual manner. 

 Smears from the conjunctiva should be diagnosed very conservatively; 

 Micrococcus catarrhalis and other Gram- negative diplococci which 

 may occur within polymorphonuclear leukocytes are occasionally 

 associated with an inflamed conjunctiva. The clinical picture should 

 be considered in making the final diagnosis in such cases, and whenever 

 possible cultures should be made to confirm the results. 



(b) Cultural. Cultures of the gonococcus are best obtained early 

 in the disease, when secondary infection with staphylococci or other 

 organisms has not taken place. The external genitalia should be 

 carefully cleaned as for a surgical operation, and pus collected on a 

 sterile swab which is rubbed over the surface of blood- or ascitic agar. 

 The isolation of gonococci from pus of the subacute and chronic stages 

 of the disease is extremely difficult; indeed, it is practically a matter 

 of chance if pure cultures are obtained at this time. Vaginal cultures 

 may be obtained upon sterile swabs which are inoculated in the same 

 manner. 



The gonococcus does not grow upon ordinary media, not even 

 Loffler's blood serum, which distinguishes it from the meningococcus 

 and from other Gram-negative cocci, including Micrococcus catar- 

 rhalis. (For fermentation reaction of the gonococcus, see page 299). 



Serological Diagnosis. Agglutinins. The diagnosis of gonorrhea 

 by agglutination of the gonococcus with the serum of the patient has 

 not been successful. 1 



1 Torrey (Journ. Med. Res., 1908, xx, 771) has isolated ten strains of gonococcus 

 identical morphologically and culturally, but distinct serologically. This may explain 

 in part the irregularity of the reaction of agglutination provided but a single strain of 

 organism is used. 



