256 GONORRHCEA AND SOFT SORE 



coccus to the sequelae of gonorrhoea form a subject of great 

 interest and importance, and the application of recent methods 

 of examination shows that the organism is much more frequently 

 present in such conditions than the earlier results indicated. 

 The following statements may be made with regard to them : 

 First, in a large number of cases of arthritis following gonorrhoea 

 pure cultures of the gonococcus may be obtained. A similar 

 statement applies to inflammation of the sheaths of tendons 

 following gonorrhoea. Secondly, in a considerable proportion of 

 cases no organisms have been found. It is, however, possible 

 that in many of these the gonococci may have been present 

 in the synovial membrane, as it has been observed that they 

 may be much more numerous in that situation than in the 

 fluid. Thirdly, in some cases, especially in those associated 

 with extensive suppuration, occasionally of a pya3mic nature, 

 various pyogenic cocci have been found to be present. In the 

 instances in which the gonococcus has been found in the joints, 

 the fluid present has usually been described as being of a 

 whitish yellow tint, somewhat turbid, and containing shreds 

 of fibrin-like material, sometimes purulent in appearance. 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 been 

 established by recent observations. Cases apparently of this 

 nature occurring in the course of gonorrhoea had been previously 

 described, but the complete bacteriological test has now been 

 satisfied in several instances. In one case Lenhartz produced 

 gonorrhoea in the human subject by inoculation with the 

 organisms obtained from the vegetations. That a true 

 gonorrhoeal septicaemia may occur has also been established, 

 cultures of the gonococcus having been obtained from the 

 blood during life on more than one occasion (Thayer and 

 Blumer, Thayer and Lazear, Ahmann). 



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 methy- 

 lene- or thionin-blue, as they do not overstain, and the films do 

 not need to be decolorised. Staining 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 



