SOFT SOEE 263 



micrococci having the characters, position, and staining reactions de- 

 scribed above, is practically conclusive that the case is one of gonorrhoea. 

 There is no other condition in which this sum-total of microscopical 

 characters is present. We consider 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 may give a definite positive result. When other organisms are 

 present, and especially when the gonococci are few in number, it is diffi- 

 cult, 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. In the 

 case of the female a drop of secretion should be taken on a platinum loop 

 from the urethra or, with the aid of a speculum, from the cervix uteri, 

 the adjacent parts being cleansed as far as possible by swabbing with 

 sterile cotton wool. Microscopic examination, therefore, though often 

 giving positive results, will sometimes be inconclusive. As regards 

 lesions in other parts of the body, microscopic examination alone is quite 

 insufficient ; it is impossible, for example, to distinguish by this means 

 the gonococcus from the meningococcus. Cultures alone supply the test, 

 and the points above detailed are to be attended to. 



Soft Sore. 



The bacillus of soft sore 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 state- 

 ments of these observers regarding the presence and characters 

 of this organism have been fully confirmed by other observers. 



Microscopical Characters. — The organism occurs in the form 

 of minute oval rods measuring about 1 - 5 /* in length, and '5 ft. 

 in thickness (Fig. 71). It is found mixed with other organisms 

 in the purulent discharge from the surface, and is chiefly arranged 

 in small groups or in short chains. When studied in sections 

 through the ulcer, it is found in the superficial part of the floor, 

 but more deeply situated than other organisms, and may be present 

 in a state of purity amongst the leucocytic infiltration. In this 

 position it is usually arranged in chains, which may be of con- 

 siderable length, and which are often seen lying in parallel rows 

 between the cells. The bacilli chiefly occur in the free condition, 

 but occasionally a few may be contained within leucocytes. 



There is no doubt that in many cases the organism is present 

 in the buboes in a state of purity ; it has been found there by 

 microscopic examination, and cultures have also been obtained 

 from this source. The negative results of some observers are 



