GONORRHCEA IO/ 



appearances masked by numerous other organisms, especially 

 by the B. vagina, a rather large bacillus (somewhat resem- 

 bling that of anthrax), which stains by Gram and is often 

 present in large numbers, even if the film was taken in the 

 manner mentioned. Yet in a positive case you will probably 

 find the cells packed with non-Gram-staining diplococci 

 having the above characters without much difficulty. 



INTERPRETATION OF RESULTS. 



You are justified in considering a case to be one of gonor- 

 rhoea if in films made from the pus 



1. Large kidney-shaped diplococci are present. 



2. These cocci occur within the pus cells. 



3. The vast majority of cells are entirely free from cocci. 



4. The organisms in question do not stain by Gram's 

 method. This is an absolutely essential point. 



If cocci are present which answer to the above description, 

 except that they are not enclosed within cells, the case may 

 still be one of gonorrhoea. The gonococcus is frequently 

 extracellular during the early stages of an attack of urethritis, 

 and, though to a less extent, during its involution, whilst 

 cases sometimes occur in which a considerable number of the 

 cocci lie free during the whole course of the disease. They 

 are usually of a severe type. 



In the interpretation of films from a female, the above 

 criteria must be insisted on very stringently. In the extra- 

 ordinary assortment of bacteria met with, if there is an admix- 

 ture of the vaginal secretion, you may often find organisms 

 resembling the gonococcus in some points, but not in all. 

 These yield one of the most troublesome problems that the 

 clinical bacteriologist has to face. 



Vaccine treatment is of the highest possible value in the 

 complications such as arthritis or iritis, but of much less use, if 

 any, in the primary disease, whether acute or chronic. Where 

 indicated, the dose should be small to commence with, say 

 five millions, as some patients show a very marked hyper- 

 sensitiveness to the vaccine ; but it should be increased rapidly 

 until a definite reaction shows that the limit of sensitiveness 

 is reached. This may not occur until as much as 500 millions 

 are given. 



