GONORRHOEA 103 



(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, or 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 examina- 

 tipn; (5) in the blood; or (6) in the urine. It is to be noticed 

 that the g'onococcus rarely, if ever, attacks the vagina, except 

 in young children, and that in cases of vaginitis the cervical 

 and urethral secretion should be examined. 



In the vast majority of cases cultural examinations are quite 

 unnecessary. This is fortunate, for the gonococcus does not 

 grow readily on artificial media. It requires for its cultiva- 

 tion the presence of haemoglobin, and in practice the sim- 

 plest method (should cultures be required for any purpose) is 

 to smear sterile blood over the surface of an ordinary ag'ar 

 tube, or, better, glycerin agar, and inoculate that with the 

 material to be examined. To prepare these tubes, sterilize 

 the tip of the finger with iodine, washing off the latter with 

 alcohol; then prick the finger and squeeze two or three drops 

 of blood into the tube. It will run down the medium and mix 

 with the water of condensation at the bottom. Put the tube 

 in the incubator for twenty-four hours to see if it is sterile. 

 This will probably be the case, as the living- leucocytes and 

 fresh serum are probably sufficient to kill the few stray bac- 

 teria that may have entered. It is then ready for use, and at 

 the time of inoculation the blood is to be smeared over the 

 surface of the agar with the loop. The colonies are very 

 small and translucent (like those of the pneumococcus), and 

 readily die out. The organism has well-marked morphological 

 characters, and the deductions drawn from these characters 

 need only be corroborated in cases of generalized 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 bacteriologist should be called 

 in if possible ; or the material may be collected in pipettes with 



