go CLINICAL BACTERIOLOGY AND HEMATOLOGY 



turn to the specimen which has been stained by Gram's method 

 and counterstained by carbol fuchsin (Plate I., Fig. 6). In this 

 all bacteria which retain Gram's stain will be coloured violet, 

 while organisms which do not retain it will be red. You must, 

 therefore, search for groups of diplococci contained within the 

 cells and possessing the above characteristics. They will not be 

 so prominent as in the other specimen, for the cells, nuclei, etc., 

 will be coloured red also, and the contrast is not so great. But if 

 the case is one of gonorrhoea, you will find them after a careful 

 search. 



If the films came from a female, you will probably find the 

 appearances masked by numerous other organisms, especially by 

 the B. vagina, a rather large bacillus (somewhat resembling that 

 of anthrax), which stains by Gram and is often present in large 

 numbers, even if the film was taken in the manner mentioned. 

 Yet in a positive case you will probably find the cells packed with 

 non-Gram-staining diplococci having the above characters without 

 much difficulty. 



Interpretation of Results. 



You are justified in considering a case to be one of gonorrhoea 

 if in films made from the pus — 



1. Large kidney-shaped diplococci are present. 



2. These cocci occur within the pus cells. 



3. The vast majority of cells are entirely free from cocci. 



4. The organisms in question do not stain by Gram's method. 

 This is an absolutely essential point. 



If cocci are present which answer to the above description, 

 except that they are not enclosed within cells, the case may still 

 be one of gonorrhoea. The gonococcus is frequently extracellular 

 during the early stages of an attack of urethritis, and, though to a 

 less extent, during its involution, whilst cases sometimes occur in 

 which a considerable number of the cocci lie free during the 

 whole course of the disease. They are usually of a severe type. 



In the interpretation of films from a female, the above criteria 

 must be insisted on very stringently. In the extraordinary assort- 

 ment of bacteria met with, if there is an admixture of the vaginal 

 secretion, you may often find organisms resembling the gono- 

 coccus in some points, but not in all. These yield one of the 

 most troublesome problems that the clinical bacteriologist has 

 to face. 



