GONOCOCCUS. 49 



the subacute stage the epithelial cells, which practically disappear 

 when the discharge is so abundant, begin to reappear, and in the 

 chronic stage the epithelial cells are the chief ones, and are the ones, 

 in which we find an occasional gonococcus, often distorted in shape. 



The best method of diagnosis in cases of chronic gonorrhoea is to 

 have the patient drink beer and eat the stimulating food previously 

 interdicted, inject a weak solution of silver nitrate and massage the 

 prostate or seminal vesicles. The smears made from the resulting 

 discharge or centrifuged urine will probably contain gonococci if they 

 are present in the urethra. In the female the favorite sites are the 

 urethra and the cervix uteri. In municipal examinations it is custom- 

 ary to make two smears: one from the urethral meatus and a second 

 from the cervix. The vagina is not a suitable soil for their develop- 

 ment. In female children it is most often found in the discharge of 

 the vulvovaginitis. 



In addition to the genital organs, the gonococcus may at times 

 invade and be isolated from the eye (gonorrhceal ophthalmia), the 

 joints, rarely as a cause of endocarditis and possibly as the factor in 

 septicaemia. Grown upon hydrocele or ascites agar, or blood streaked 

 agar, or upon blood agar from man or the rabbit, the colonies appear 

 as irregular, minute, dew-drop spots. By the second or third day the 

 involution forms are abundant, and within four to seven days the 

 culture will probably be found to be dead. Unless frequent transfers 

 are made, it will be best kept alive on blood agar. The organism 

 grows best at 37 C, and will not grow below 25 C. It will not grow 

 on plain or glycerin agar or ordinary blood-serum unless the transfer 

 of considerable pus in inoculating the slants give it a suitable culture 

 medium. In material from joints, it is in the fibrin flakes that the 

 gonococci are most apt to be found, if found at all. 



Diplococcus IntracellularisMeningitidis (Weichselbaum, 1887). 

 This is the organism of epidemic cerebrospinal meningitis, and is 

 frequently termed the meningococcus. The diplococcus is Gram 

 negative and biscuit shaped and is, like the gonococcus, chiefly con- 

 tained in pus cells. It is also found free in the cerebrospinal fluid 

 withdrawn from spotted fever cases. There is a greater tendency to 

 variation in size and shape than is the case with the gonococcus, which 

 4 



