GONORRHOEA 105 



method is adopted; but here many films should be taken, as 

 a prolonged search may be required. If the patient suffers 

 from a slight discharge in the early morning, the best plan is 

 to give him two clean slides. These are to be smeared across 

 the meatus whilst wet with the discharge, and allowed to dry. 



In the female it is necessary to obtain the pus directly from 

 the urethra ; it may be expressed by the finger in the .vagina. 

 The first drop should be rejected. 



If the patient is suffering from cervicitis or endometritis, 

 the pus should be taken direct from the cervix, a speculum 

 being used, and the pus being removed by a platinum loop 

 or probe. It is necessary to emphasize the fact that the 

 material must be from these regions if a negative result is 

 to be of any value. The flora of the vagina in all cases of dis- 

 charge is so extraordinarily abundant that it is almost impos- 

 sible to recognize the gonococcus with certainty in such 

 material. 



It is absolutely necessary that you should spread the films 

 at once, even if you are having the examination made at a 

 distance. It is next to useless to send pus dried on linen, 

 cotton-wool, a Volkmann's spoon, or even in a thick layer on 

 a slide. The diagnosis may be made from material sent in 

 this way, but the difficulties are much greater, and in some 

 cases the results are less certain. 



Preparation of films from conjunctival pus presents no 

 difficulties. The same is true of pus from the tubes or other 

 internal regions, whether it is exposed by operative interfer- 

 ence or at a post-mortem examination. 



Instructions for the examination of the blood are given 

 subsequently. Cultures are practically essential. 



The urine may be examined in the female if a local examina- 

 tion is not considered advisable, or in the male to obtain 

 evidences as to whether the disease is cured or not. The 

 morning urine should be examined. It should be mixed with 

 a small quantity of carbolic lotion or other antiseptic and 

 allowed to settle for twenty-four hours; it is much better to 

 use a centrifuge if one is available. In cases where we require 

 evidences as to cure after an attack of gonorrhoea, the urine is 

 examined after gentle massage of the prostate. 



