IOO BACTERIOLOGICAL DIAGNOSIS. 



the Fallopian tubes (causing pyosalpinx), to the mouths 

 of the tubes (causing local adhesive peritonitis, which 

 probably results in sterility), or to the peritoneum, 

 where it may cause general peritonitis. 



The gonococcus may escape into the blood from any 

 of these lesions, and the results of this occurrence are 

 arthritis, ulcerative endocarditis and meningitis ; the 

 two latter are rare. 



The search for the gonococcus may have to be made 

 (i) in urethral pus from either sex, (2) in pus from the 

 cervix uteri, (3) in pus from the conjunctiva, (4) in pus 

 from the meninges, tubes, peritoneum, or other region, 

 whether removed by operative measures or at a post- 

 mortem examination, (5) in the blood, or (6) in the 

 urine. It is to be noticed that the gonococcus rarely, 

 if ever, attacks the vagina, and that in cases of vaginitis 

 the cervical secretion should be examined. 



In the vast majority of cases cultural examinations 

 are quite unnecessary. This is fortunate, for the gono- 

 coccus does not grow readily on artificial media. The 

 organism has well marked morphological characters, 

 and the deductions drawn from these characters need 

 only be corroborated in cases of generalised infection or 

 of meningitis, in which the results are to be published 

 (as they should be), and must, therefore, be proved 

 beyond doubt. In such cases the services of a bacterio- 

 logist should be called in if possible : or the material 

 may be collected in pipettes with the most careful 

 precautions as to asepsis and forwarded at once to a 

 laboratory. 



