346 MENINGOCOCCUS— GONOCOCCIJS— CAT ABRHALIS GROUP 
Bartholin's glands, the uterus and Fallopian tubes may harbor gono- 
cocci for months. Patients treated with gonococcus vaccines usually 
give a positive fixation test. Inquiry should be made upon this 
point. "S^aginal smears may be obtained from swabs which are intro- 
duced into the vagina, or by means of long pipettes with rounded 
ends, containing a few drops of 1 to 1000 mercuric chloride, which 
are expressed and draAvn up into the pipette several times deep in 
the vagina. The material thus removed is stained in the usual manner. 
Smears from the conjunctiva should be diagnosed very conservatively; 
Micrococcus catarrhalis and other Gram-negative diplococci which 
may occur within polymorphonuclear leukocytes are occasionally 
associated with an inflamed conjunctiva. The clinical picture should 
be considered in making the final diagnosis in such cases, and whenever 
possible cultures should be made as well as a complement-fixation 
test, using the Torrey strains for an antigen, to confirm the results. 
(6) Cultural.— QwXtwre?, of the gonococcus are best obtained early 
in the disease, when secondary infection with staphylococci or other 
organisms has not taken place. The external genitalia should be 
carefully cleaned as for a surgical operation, and pus collected on a 
sterile swab which is rubbed over the surface of blood- or ascitic 
agar. The isolation of gonococci from pus of the subacute and chronic 
stages of the disease is extremely difficult; indeed, it is practically a 
matter of chance if pure cultures are obtained at this time. Vaginal 
cultures may be obtained upon sterile swabs which are inoculated 
in the same manner. 
The gonococcus does not grow upon ordinary media, not even 
Loffler's blood serum, which distinguishes it from the meningococcus 
and from other Gram-negative cocci, including Micrococcus catar- 
rhalis. Plain, nutrient agar enriched by blood or serum (preferably 
human, heated to 55° C. for thirty minutes) is best adapted to the 
direct cultivation of the gonococcus. The small, clear, dewdrop-like 
colonies are fairly distinctive. Confirmatory tests by the method of 
complement-fixation, and by fermentation reactions are required to 
justify a diagnosis. (For fermentation reaction of the gonococcus, 
see page 340.) 
Serological Diagnosis. — Jf/f//?//?7n'/?5.— The diagnosis of gonorrhea by 
agglutination of the gonococcus with the serum of the patient has not 
been successful.^ 
Precipitins.— Y^SitSihWi^ has found that the precipitin reaction is 
frequently positive in severe cases which have lasted for some time. 
Recent cases may or may not give a precipitin reaction. 
1 Torrey (Jour. Med. Res., 1907, 16, 329) has isolated ten strains of gonococcus 
identical morphologically and culturally, but distinct serologically. This may explain 
in part the irregularity of the reaction of agglutination, provided but a single strain of 
organism is used. 
2 Jour. Infec. Dis., 1918, 22, 115. 
