SOFT SORE. 



231 



in which the sum total of the microscopical characters is present. 

 We consider that it is sufficient for purposes of clinical diagnosis, 

 and therefore of great value ; in the acute stage a diagnosis can 

 thus be made earlier than by any other method. The mistake of 

 confusing gonorrhoea with such conditions as a urethral chancre 

 with urethritis, will also be avoided. Even in chronic cases the 

 typical picture is often well maintained, and microscopic exam- 

 ination alone gives a definite positive result. When other organ- 

 isms are present, and especially when the gonococci are few in 

 number, it is difficult, and in some cases impossible, to give a 

 definite opinion, as a few gonococci mixed with other organisms 

 cannot be recognised with certainty. This is often the condition 

 in chronic gonorrhoea in the female. Microscopic examination, 

 therefore, though often giving positive results, will sometimes 

 be inconclusive. As regards lesions in other parts of the body, 

 microscopic examination alone is quite insufficient ; it is practi- 

 cally impossible, for example, to distinguish by this means the 

 gonococcus from the diplococcus intracellularis of meningitis. 

 Cultures alone supply the absolute test, and this test should 

 never be neglected when a diagnosis is rendered absolutely 

 necessary in reference to moral social status, or to medico-legal 

 inquiry. We then have recourse to the plate method, using 

 Wertheim's medium, or hydrocele-fluid agar. 



SOFT SORE. 



Within recent years a considerable amount of attention has 

 been directed to the bacteriology of this condition, owing to the 

 discovery of a somewhat characteristic bacillus in the affected 

 parts. This organism was first described by Ducrey in 1889, who 

 found it in the purulent discharge from the ulcerated surface ; 

 and, later, in 1892, Unna described its appearance and distribution 

 as seen in sections through the sores. The statements of these 

 observers regarding the presence and characters of this organism 

 have been fully confirmed by other observers. 



Microscopical Characters, This organism appears in the form 

 of minute oval rods measuring about 1.5 /^ in length, and .5 /* 

 in thickness. It is found mixed with other organisms in the 

 purulent discharge from the surface, and is chiefly arranged in 

 small groups or in short chains. When studied in sections 

 through the ulcer it is found in the superficial part of the floor, 



