GONORRHCEA 89 



Instructions for the examination of the blood are given subse- 

 quently. A considerable number of films should be taken, as 

 the cocci are present in but very small numbers. Cultures are 

 practically essential. 



The urine may be examined in the female if a local examination 

 IS not considered advisable, or in the male to obtain evidences as 

 to whether the disease is cured or not. The morning urine should 

 be examined. It should be mixed with a small quantity of carbolic 

 lotion or other antiseptic and allowed to settle for twenty-four 

 hours ; it is much better to use a centrifuge if one is available. 

 In cases where we require evidences as to cure after an attack of 

 gonorrhoea, the urine is examined after gentle massage of the 

 prostate. 



Staining of Films. 



One film is to be stained by a simple stain such as methylene 

 blue or carbol thionin. The other is to be stained by Gram's 

 method, and then in dilute carbol fuchsin for half a minute. 



Examination of Films.— First take the specimen in which the 

 simple stain has been used, and examine it with the oil-immersion 

 lens. You will see that it shows numberless cells with very 

 irregularly lobed nuclei ; these are the pus cells or polymorpho- 

 nuclear leucocytes. There will also be some flat squamous 

 epithelial cells. 



The gonococci will be stained even deeper than the cell nuclei, 

 and will be mostly contained within the pus cells. If you see a 

 cell which contains numerous small blue or violet granules, bring 

 it into the centre of the field and examine it more thoroughly, to 

 see whether the granules have the characters of the organism 

 which we are about to describe. 



The gonococcus is a large diplococcus, each component of the 

 pair being shaped like a kidney, the hilum being turned toward 

 that of its fellow. Single forms (which may be rounded) and 

 tetrads are sometimes seen. It does not stain by Gram's method, 

 and this is one of its most important features. Another important 

 point is its arrangement ; during the height of an attack of 

 gonorrhcea it is almost entirely intracellular, being contained 

 within the polymorphonuclear leucocytes. Further, several pairs 

 occur in each cell, and the great majority of cells are entirely 

 devoid of cocci (Plate III., Fig. 2). 



If the organism which you find possesses these characteristics 



