GONOCOCCUS 67 



ordinary blood-serum. The M . catarrhalis will grow on plain agar as 

 well as on other media. 



Other Gram-negative organisms of confusing morphology are M . pharyngis siccus, 

 the colonies of which show great crinkly dryness, and M. pharyngis flavus. 



Gonococcus (Neisser, 1879). This organism is characteristically a 

 diplococcus, the separate cocci being plano-convex with their plane 

 surfaces apposed. (Biscuit shape, coffee-bean shape.) They are gen- 

 erally found grouped in masses of several pairs, most strikingly in pus 

 cells or epithelial cells, but also found extracellularly. Except in the 

 height of the disease, there is a great tendency for the organisms to 

 show involution forms, so that instead of biscuit-shaped diplococci we 

 have round, irregular and uneven cocci. 



It is therefore advisable in searching smears from chronic gonorrhoea to continue 

 the search of Gram-stained specimens until some fairly typical diplococci are found. 

 There is nothing requiring greater discrimination than a diagnosis from such a , 



smear. At the commencement of a gonorrhoea the epithelial cells are abundant 

 and gonococci are found, adhering to them or lying free. Later on, at theacjmejpf ^r 

 the discharge (the creamy, abundant discharge), it isjn the piis^cells wj^md them 

 and they may be so abundant that 10 to 20% of the pus cells may contain theni. 

 In the subacute_stage the epjthelial .cells, which practically disappear when the 

 discharge is so abundant, begin tojreappear, and in the chronic stage the epithelial 

 cells_are the chief ones, and are the ones on which we find an occasional gonococcus, 

 often distorted in shape. In gonorrhceal ophthalmia the gonococci may show 

 appearances in the conjunctival epithelium resembling the inclusion bodies of 

 trachoma. 



The best method of diagnosis in cases of chronic gonorrhoea is to have the patient 

 eat the stimulating food previously interdicted, to take active exercise and to have 

 a sound passed. To obtain material for examination the glans penis should be 

 washed and the patient who has presented himself with a full bladder should pass 

 a portion of the contained urine. Next the prostate and seminal vesicles should be 

 massaged with the patient standing but bent over and the penis pendant. The 

 drops of discharge from the massage should be received in a small Petri dish and 

 finally the remaining urine should be passed into a sterile bottle. Smears and 

 cultures should be made from the sediment of the two urinary specimens and 

 from the secretions of the massaged prostate and vesicles. 



The smears made from the resulting discharge or centrifuged urine will probably 

 contain gonococci if they are present in the urethra. In the female the favorite 

 sites are the urethra and the cervix uteri. In municipal examinations it is customary 

 to make two smears: one from the urethral meatus and a second from the cervix. 

 The vagina is not a suitable soil for their development. In female children it is 

 most often found in the discharge of the vulvovaginitis. Gram-stained smears from 

 pus sediments of urine, especially in pyelitis or cystitis, may show coccoid forms of 

 B. coli, which may be phagocytized and thus be reported as gonococci. 



