102 CLINICAL BACTERIOLOGY AND H^MATOLOGY 



the test, but in that 'case the patient's serum must clump at a 

 dilution two or three times as great as the normal for the 

 results to be of significance. Another point to notice is that 

 it is necessary to test the blood in a series of dilutions, as 

 sometimes a specimen will be found which clumps at a high 

 dilution but not at a low one; the same thing is occasionally 

 seen in typhoid fever. 



The M. melitensis is a minute coccus, apparently motile, not 

 staining by Gram, and, in some cultures at least, of compara- 

 tively slow growth. Its appearances on agar are not dis- 

 tinctive. 



Vaccine treatment has been used, apparently with some 

 success. 



GONORRHOEA 



Nothing is more certain than the fact that gonorrhoea can 

 only be diagnosed by bacteriological methods; and every 

 practitioner is very strongly urged to practise himself in these 

 methods and to employ them in all cases. Leaving out of 

 account the confidence which the certainty of a direct diag- 

 nosis inspires, there is always the possibility that legal ques- 

 tions may arise, and a practitioner who made a diagnosis of 

 gonorrhoea without employing the only means by which that 

 disease can be diagnosed would make a poor show in cross- 

 examination. Lastly, a bacteriological examination will often 

 tell us that the disease is merely lying latent and is still 

 infective when apparently cured ; but not the reverse, for it is 

 not safe to assume that the disease is cured because no 

 gonococci are found. 



The gonococcus chiefly affects mucous surfaces ; the urethra 

 in the male, the urethra and cervix uteri in the female, and 

 the conjunctiva in both sexes. These are the regions in 

 which the primary lesion usually occurs, and it may extend by 

 continuity to more distant parts. 



In the male it may involve the prostate, the vesiculae 

 seminales, the bladder, and the epididymis, though epididymitis 

 occurring in the course of gonorrhoea may be due to other 

 organisms. 



In the female the inflammation of the urethra may extend 

 to the bladder. The inflammation of the cervix may extend 

 to the mucosa of the uterus, and thence to the Fallopian tubes 



