262 GONORRHOEA AND SOFT SORE 



statement applies to inflammation of the sheaths of tendons 

 following gonorrhoea. Secondly, in a considerable proportion of 

 cases no organisms have been found. It is, however, probable 

 that in many of these the gonococci may have been present 

 in the synovial membrane, as it has been observed that they 

 may be much more numerous in that situation than in the 

 fluid. Thirdly, in some cases, especially in those associated 

 with extensive suppuration, occasionally of a pyaemic nature, 

 various pyogenic cocci have been found to be present. In the 

 instances in which the gonococcus has been found in the joints, 

 the fluid present has usually been described as being of a 

 whitish yellow tint, somewhat turbid, and containing shreds of 

 fibrin-like material, though sometimes purulent in appearance. 

 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 gonorrhceal endocarditis has been 

 established by recent observations. Cases apparently of this 

 nature occurring in the course of gonorrhoea had been previously 

 described, but the complete bacteriological test has now been 

 satisfied in several instances. In one case Lenhartz produced 

 gonorrhoea in the human subject by inoculation with the 

 organisms obtained from the vegetations. That a true gonor- 

 rhceal septicemia may occur has also been established, cultures 

 of the gonococcus having been obtained from the blood during 

 life on more than one occasion (Thayer and Blumer, Thayer 

 and Lazear, Ahmann). 



Vaccines. — Both gonorrhoea itself and the secondary infections have 

 been treated by means of vaccines, but the results reported vary greatly. 

 Ob the whole most success has been obtained in the case of joint infections 

 and allied conditions, though even here reports are contradictory. The 

 initial dose employed has been usually about five million cocci, but care 

 i? necessary in starting the treatment, especially in the case of acute 

 gonorrhoea. Harrison recommends that the organisms be killed by - 5 

 per cent, carbolic acid instead of by heat. 



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- orthionin-blue, as they do 

 not overstain, and the films do not need to be decolorised. Staining for 

 one minute is sufficient, ft 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 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 examination alone, we 

 may say that the presence in a urethral discharge of a large number of 



