1 78 GONORRHCEA, SOF7" SORE, SYPHILIS. 



been noted in one or two cases, where the surface of the 

 synovial membrane has been carefully examined, that the 

 gonococci have been much more numerous there than in 

 the fluid a circumstance which may explain some of the 

 negative results when the fluid alone is examined. In one 

 case Bordoni-Uffreduzzi cultivated the gonococcus from a 

 joint-affection, and afterwards produced gonorrhoea in the 

 human subject by inoculating with the cultures obtained. 

 In another case in which pleurisy was present along with 

 arthritis the gonococcus was cultivated from the fluid 

 in the pleural cavity. The existence of a gonorrhoeal 

 endocarditis has not yet been absolutely proved by means 

 of cultures, though cases such as those described by Leyden 

 and Michaelis are probably of this nature. In these cases 

 organisms were present in the vegetations which, in their 

 position within leucocytes, in their microscopical characters, 

 and in their staining reactions, corresponded to gonococci. 

 Cultures of the gonococcus were not obtained, but no 

 growth of any organism took place on the media used, a 

 circumstance which is in favour of the view that the organ- 

 isms present were really gonococci. 



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 methylene- or thionin-blue, as they do not over- 

 stain, and the films do not need to be decolorised. Stain- 

 ing 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 

 examination 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 



