198 GONORRHCEA, SOFT SORE, SYPHILIS. 



of the negative results when the fluid alone is examined. 

 In one case Bordoni-Uffreduzzi cultivated the gonococcus 

 from a joint-affection, and afterwards produced gonorrhoea 

 in the human subject by inoculating with the cultures 

 obtained. In another case in which pleurisy was present 

 along with arthritis the gonococcus was cultivated from the 

 fluid in the pleural cavity. The existence of a gonorrhctal 

 endocarditis has been established by recent observations. 

 Cases apparently of this nature occurring in the course of 

 gonorrhoea have been described by Leyden, Michaelis, 

 Thayer and Blumer, and others. In these there were 

 present in the vegetations micrococci which, in their posi- 

 tion within leucocytes, in their microscopical characters, 

 and in their staining reactions, corresponded to gonococci. 

 Cultures of the gonococcus were not obtained, but no other 

 organisms grew on the media used, a circumstance which 

 is in favour of the view that the organisms present were 

 really gonococci. Quite recently, however, Rendu has 

 cultivated the organisms from a diseased heart -valve. 

 Thayer and Blumer, moreover, obtained from the blood 

 during life colonies of an organism in every respect re- 

 sembling the gonococcus. After six days the growths were 

 found to have died and subcultures were not obtained. 

 In this case about 2 c.c. of blood were taken by venesection 

 and added to melted agar, as in Wertheim's method. So 

 far as we know it is the only record of successful culture 

 from the blood. 



Methods of Diagnosis. For microscopical examination 

 dried films of the suspected pus, etc., may be stained by 

 any of the simple solutions of the basic aniline stains. 

 We prefer methylene- or thionin-blue, as they do not over- 

 stain, and the films do not need to be decolorised. Stain- 

 ing for one minute is sufficient. It is also advisable to 

 stain by Gram's method, and it is a good plan to put at one 

 margin of the cover-glass a small quantity of culture of 

 staphylococcus aureus if available, in order to have a 

 standard by which to be certain that the supposed gonococci 

 are really decolorised. Regarding the value of microscopic 



