SOFT SORE. 199 



examination alone, we may say that the presence of a 

 large number of micrococci in a urethral discharge having 

 the characters, position, and staining reactions described 

 above, is practically conclusive that the case is one of 

 gonorrhoea. There is no other condition in which the sum 

 total of the microscopical characters is present. We con- 

 sider that it is sufficient for purposes of clinical diagnosis, 

 and therefore of great value ; in the acute stage a diagnosis 

 can thus be made earlier than by any other method. The 

 mistake of confusing gonorrhoea with such conditions as a 

 urethral chancre with urethritis, will also be avoided. Even 

 in chronic cases the typical picture is often well maintained, 

 and microscopic examination alone gives a definite positive 

 result. When other organisms are present, and especially 

 when the gonococci are few in number, it is difficult, and 

 in some cases impossible, to give a definite opinion, as 

 a few gonococci mixed with other organisms cannot be 

 recognised with certainty. This is often the condition in 

 chronic gonorrhoea in the female. Microscopic examina- 

 tion, therefore, though often giving positive results, will 

 sometimes be inconclusive. Cultures alone supply the 

 absolute test, and when the organism is present in an 

 apparent condition of purity, Wertheim's medium or blood- 

 agar should be used. If other organisms are present, we 

 are practically restricted to Wertheim's plate method. 



SOFT SORE. 



Within recent years a considerable amount of attention 

 has been directed to the bacteriology of this condition, 

 owing to the discovery of a somewhat characteristic bacillus 

 in the affected parts. This organism was first described 

 by Ducrey in 1889, who found it in the purulent discharge 

 from the ulcerated surface; and later, in 1892, Unna 

 described its appearance and distribution as seen in sections 

 through the sores. The statements of these observers 

 regarding the presence and characters of this organism 

 have been fully confirmed by other observers. 



