230 GONORRHCEA, SOFT SORE, SYPHILIS. 



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 pysemic nature, various pyogenic cocci have 

 been found to be present. In the instances in which the gono- 

 coccus has been found in the joints, the fluid present has been 

 described as being usually of a whitish-yellow tint, somewhat 

 turbid, and containing shreds of fibrin-like material, sometimes 

 purulent in appearance. In one case Bordoni-Uffreduzzi culti- 

 vated 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 gonorrhoeal 

 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 inocu- 

 lation with the organisms obtained from the vegetations. That 

 a true gonorrhoeal septicmmia may also 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, Wilson, and Harris 

 and Johnston). 



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 methy- 

 lene, or thionin-blue, as they do not overstain, and the films do 

 not need to be decolorised. Staining for one minute is sufficient. 

 It 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 aureus 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 examina- 

 tion alone, we may say that the presence of a large number of 

 micrococci in a urethral discharge having the characters, position, 

 and staining reactions described above, is practically conclusive 

 that the case is one of gonorrhoea. There is no other condition 



