84 CLINICAL BACTERIOLOGY AND HEMATOLOGY 



opposite the marks. This will give you a series of short capillary 

 tubes each holding yV of the volume of the typhoid emulsion in 

 the pipettes. These are to be used for the serum, as already 

 described. 



GONORRHCEA 



Nothing is more certain than the fact that gonorrhoea can only 

 be diagnosed by bacteriological methods ; and every practitioner 

 is very strongly urged to practise himself in these methods and to 

 employ them in all cases. Leaving out of account the confidence 

 which the certainty of a direct diagnosis inspires, there is always 

 the possibility that legal questions may arise, and a practitioner 

 who made a diagnosis of gonorrhoea without employing the only 

 means by which that disease can be diagnosed would make a 

 poor show in cross - examination. Lastly, a bacteriological 

 examination will often tell us that the disease is merely lying 

 latent and is still infective when apparently cured ; but not the 

 reverse, for it is not safe to assume that the disease is cured 

 because no gonococci are found. 



The gonococcus chiefly affects mucous surfaces : the urethra 

 in the male, the urethra and cervix uteri in the female, and the 

 conjunctiva in both sexes. These are the regions in which the 

 primary lesion usually occurs, and it may extend by continuity to 

 more distant parts. 



In the male it may involve the prostate, the vesiculae seminales, 

 and the bladder. It is doubtful whether gonorrhceal epididymitis 

 is due to this organism or to another. 



In the female the inflammation of the urethra may extend to 

 the bladder. The inflammation of the cervix may extend to the 

 mucosa of the uterus, and thence to the Fallopian tubes (causing 

 pyosalpinx), to the mouths of the tubes (causing local adhesive 

 peritonitis, which probably results in sterility), or to the peri- 

 toneum, where it may cause general peritonitis. 



The gonococcus may escape into the blood from any of these 

 lesions, and the results of this occurrence are arthritis, ulcerative 

 endocarditis, or meningitis ; the two latter are rare. 



The search for the gonococcus may have to be made : (i) in 

 urethral pus from^either sex ; (2) in pus from the cervix uteri ; 

 (3) in pus from the~conjunctiva ; (4) in pus from the meninges, 

 tubes, peritoneum, or other region, whether removed by operative 

 measures or at a post-mortem examination ; (5) in the blood ; or 



