86 CLINICAL BACTERIOLOGY AND HEMATOLOGY 



which the certainty of a direct diagnosis inspires, there is always 

 the possibility that legal questions may arise, and a practitioner 

 who made a diagnosis of gonorrhcEa without employing the only 

 means by which that disease can be diagnosed would make a 

 poor show in cross-examination. Lastly, a bacteriological 

 examination will often tell us that the disease is merely lying 

 latent and is still infective when apparently cured ; but not the 

 reverse, for it is not safe to assume that the disease is cured 

 because no gonococci are found. 



The gonococcus chiefly affects mucous surfaces : the urethra 

 in the male, the urethra and cervix uteri in the female, and the 

 conjunctiva in both sexes. These are the regions in which the 

 primary lesion usually occurs, and it may extend by continuity to 

 more distant parts. 



In the male it may involve the prostate, the vesiculffi seminales, 

 and the bladder. It is doubtful whether gonorrhoeal epididymitis 

 is usually due to this organism or to others. 



In the female the inflammation of the urethra may extend to 

 the bladder. The inflammation of the cervix may extend to the 

 mucosa of the uterus, and thence to the Fallopian tubes (causing 

 pyosalpinx), to the mouths of the tubes (causing local adhesive 

 peritonitis, which probably results in steriHty), or to the peri- 

 toneum, where it may cause general peritonitis. 



The gonococcus may escape into the blood from any of these 

 lesions, and the results of this occurrence are arthritis, ulcerative 

 endocarditis, or meningitis ; the two latter are rare. 



The search for the gonococcus may have to be made : (i) in 

 urethral pus from either sex ; (2) in pus from the cervix uteri ; 

 (3) in pus from the conjunctiva; (4) in pus from the meninges, 

 tubes, peritoneum, or other region, whether removed by operative 

 measures or at a post-mortem examination ; (5) in the blood ; or 

 (6) in the urine. It is to be noticed that the gonococcus rarely, 

 if ever, attacks the vagina, except in young children, and that in 

 cases of vaginitis the cervical secretion should be examined. 



In the vast majority of cases cultural examinations are quite 

 unnecessary. This is fortunate, for the gonococcus does not grow 

 readily on artificial media. It requires for its cultivation the 

 presence of haemoglobin, and in practice the simplest method 

 (should cultures be required for any purpose) is to smear sterile 

 blood over the surface of an ordinary agar tube and inoculate that 

 with the material to be examined. To prepare these tubes, 



