GONOCOCCUS IN JOINT AFFECTIONS, ETC. 177 



vated in a considerable number of cases. According to the 

 results of various observers they are present in one out of 

 four or five cases of this condition, usually unassociated with 

 other organisms. Lastly, they may pass to the peritoneum 

 and produce peritonitis, which is usually of a local character. 

 It is chiefly to the methods of culture supplied by Wertheim 

 that we owe our extended knowledge of such conditions. 



Relations to Joint Affections, etc. The relations of the 

 gonococcus to the sequels of gonorrhoea form a subject of 

 great interest and importance, but one which cannot be said 

 to be yet fully worked out. The reason of this is that till 

 within the last few years the cultivation of the gonococcus 

 had been a matter of considerable difficulty, and without 

 cultures it is not possible to be absolutely certain of the 

 identity of the organism, especially when present only in 

 small numbers, there being other species of diplococci, 

 some of which have been cultivated from the urethra in 

 normal and diseased conditions, and which resemble the 

 gonococcus not only in microscopical characters, but also 

 in staining reaction. At present, however, the following 

 statements may be made. First, in a certain number of 

 cases of arthritis following gonorrhoea the gonococcus has 

 been found microscopically, and pure cultures have been 

 obtained, e.g., by Neisser, Lang, Bordoni-Uffreduzzi, and 

 others. A similar statement applies to inflammation of the 

 sheaths of tendons following gonorrhoea. Secondly, in a 

 large proportion of cases no organisms have been found. 

 Thirdly, in some cases, especially in those associated with 

 extensive suppuration, occasionally of a pyaemic nature, 

 various pyogenic cocci have been found to be present. It 

 must therefore be considered that a secondary infection of 

 the joints by the gonococcus, evidently by way of the blood 

 stream, can occur, and it remains to be determined in what 

 proportion of cases it does so. In the instances in which 

 the gonococcus has been found in the joints, the fluid present 

 has been described as being usually of a whitish-yellow tint, 

 turbid in appearance, and containing shreds of fibrin-like 

 material, sometimes purulent in appearance. It has also 

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