THE aONOCOCCUS GROUP 345 
susceptible to reinfection than they were originally.' In the chronic 
cases, where the organisms lie dormant for months, even years, the 
tissues appear to be somewhat less suited for growth of the organisms, 
but the patient can infect others even at this stage of the disease. 
Various attempts to prepare sera for curative purposes have not been 
generally successful, although Rogers- has report efl cures in cases 
of gonorrheal rheumatism and chronic gonorrheal urethritis by the 
injection of the senun prepared by Torrey.^ 
Vaccines have been used with variable success. The injection of an 
autogenous vaccine, containing from 5,000,000 to 10,000,000 gonococci 
from a twenty-four-hour ascitic fluid agar culture, appears to give the 
best clinical results. Probably the extremely rapid autolysis of the 
gonococci plays a prominent part in the ineffectual attempts to induce 
improvement by the use of vaccines.'* 
Bacteriological Diagnosis. — (a) Micrnscopical.—'Pus from the urethra 
of acute cases of gonorrhea should be dropped upon a cover-glass or 
slide and spread by gently pressing a second cover-glass or slide 
upon the first, then sliding them apart. By so doing the organisms 
remain in the polymorphonuclear leukocytes and epithelial cells, a 
very important diagnostic point. In very acute cases a majority of 
the gonococci may be extracellular. Even in the more chronic cases 
many extracellular organisms are not infrequently found. A Gram 
stain (using preferably the Jensen modification, see page 204) and a 
methylene-blue stain should be made. The former reveals intra- 
cellular and intercellular bean-shaped diplococci which are Gram- 
negative. Occasionally leukocytes contain as many as twenty pairs 
of the cocci. Dilute methylene blue 1 to 10 (Loffler's) usually stains 
gonococci intensely; the remainder of the cellular elements are faintly 
colored. The morphology of the organisms is clearly shown by this 
procedure. 
In chronic cases the discharge is scanty and it is better to receive 
the morning urine in a sedimentation glass containing a crystal or 
two of thymol. After a short time threads of mucus separate out; 
these should be removed with a capillary pipette and examined as 
above. The pus from old cases of gonorrhea frequently contains but 
few gonococci, which are difficult to find. It has been found that 
the local injection of silver nitrate (properly diluted) will usually 
cause an elimination of pus which frequently contains the organisms 
in somewhat larger numbers. Drinking beer is said to produce the 
same result. Gonococci may remain latent for many weeks both 
in the male and in the female. In the male the prostate or seminal 
vesicles are frequently the points of lodgment. In the male and 
female the urethra may long remain infected. In females the cervix, 
1 It is uncommon, however, to find auto-eye infections from venereal lesions; even 
in cases of gonorrheal vulvo-vaginitis the eves are rarelv infected with the gonococcus. 
2 Jour. Am. Med. Assn., 1906, 46, 263. " " ' Il)id., 190C, 46, 2(11. 
■* Lespinasse: Illinois Med. Jour., April, 1912. 
