238 GONORRHOEA. 



but no gonococci. These were undoubtedly cases in which suppura- 

 tion in the glands was caused by a mixed infection. Smirnoff 

 (Wratch, 1886, No. 31) examined the sero-purulent contents re- 

 moved from the knee-joint by aspiration, in a patient twenty-eight 

 years of age, six weeks after gonorrhoeal infection and two weeks 

 after the commencement of the joint affection, and found numerous 

 clusters of gonococci within the pus-corpuscles. Afauasieff made 

 similar observations. 



Sahli has recorded a very interesting case of gonorrhoeal meta- 

 stasis of the skin. In a patient who for two months had suffered 

 from gonorrhoea, there appeared two abscesses, as large as a man's 

 fist, situated in the region of the knee-joint. On incision a large 

 quantity of sero-sanguinolent pus escaped. Microscopical examina- 

 tion revealed the presence of typical gonococci, imbedded, as usual, 

 within pus-corpuscles. 



Some pathologists, among them Watson Cheyne (" Lectures on 

 Suppuration and Septic Diseases," Brit. Med. Journ., February 15, 

 March 3, 10, 1888), assert that, when in cases of gonorrhoea sup- 

 purative adenitis and para-adenitis in the inguinal glands take 

 place, pus-microbes are present in the pus, and the suppuration 

 must be considered as the consequence of a mixed infection. 



DIAGNOSTIC VALUE OF THE GONOCOCCUS. Neisser, Bumrn, 

 Bockhardt, Eschbaum, ISTewberry, Campona, Aufrecht, Schwarz, 

 Lundstrom, Weiss, Ehrlich, Brieger, Hartdegen, and others have 

 never failed in finding the gonococcus present in gonorrhoeal dis- 

 charges. The best ophthalmologists rely upon its presence in differ- 

 entiating between specific and simple conjunctivitis. Only a few 

 authorities have arrayed themselves against Neisser's claim. 



Sanger (" Gonorrhoeal Disease of the Uterine Appendages and 

 its Operative Treatment," Archiv f. Grynakologie, B. xxv. Heft 1) 

 states that the hope aroused by the discovery of Neisser, that in the 

 gonococcus we should find the means of diagnosing chronic gonor- 

 rhoea, had proved to be in vain, and holds it to be an established 

 fact that gonorrhoea can exist without the demonstrable presence of 

 gonococci. The absence of the gonococcus proved nothing against 

 the gonorrhoeal nature of the disease ; whilst the presence of diplo- 

 cocci, in view of the occurrence of non -pathogenic forms, did not 

 prove the gonorrhoeal nature of the disease. If the cocci cannot be 

 found, they may have been somewhere broken up, while a ferment 

 produced by them may still be active ; or they are absent from the 

 secretion while present in the tissues; or there exists and this 

 would render the high degree of infectiousuess of a comparatively 

 trifling amount of secretion in latent gonorrhoea the most intelli- 

 gible a permanent form (Dauer-form) of the gonococcus not yet 

 discovered. 



