BACTERIOLOGICAL EXAMINATION OF MATERIAL 200 



It is of value also to do a globulin reaction on such clear fluids, 

 which is easily done by Noguchi's butyric acid method as follows: 



To 0.2 c.c. of spinal fluid add 0.5 c.c. of a 10 per cent butyric acid 

 solution in physiological salt solution. Boil the mixture and add 0.1 c.c. 

 of normal sodium hydrate, and boil again. A flocculent precipitate forms 

 in positive reactions. 



Clear specimens of fluid of this kind should be examined with 

 an intelligent understanding of the nature of the case. Syphilitic 

 spinal fluids are almost always clear, but the cells are increased to 

 100 or more per cubic millimeter. The cells consist mainly of 

 lymphocytes. Low counts may be encountered in tabes and general 

 paresis. The determination of these facts will be valuable in con- 

 nection with the subsequent Wassermann reaction or colloidal gold 

 reaction on these fluids, and with bacteriological examination. 



In infantile paralysis or acute poliomyelitis, the spinal fluid is 

 usually clear. The cells here are increased from the beginning. 

 According to Peabody, Draper and Dochez 1 during the early days 

 of the disease, 80 or more per cent of the cells may be polynuclear. 

 After 72 hours, however, the mononuclears preponderate. The cell 

 count may go up even in the prodromal period. The highest cell 

 count is usually found in the first week, gradually coming down 

 until the fourth week of the disease. The globulin reaction is 

 usually highest in the second and third week, but the writers men- 

 tioned above found a percentage of cases in which the cell counts 

 were normal. These facts are given because they should be taken 

 into consideration, together with bacteriological examinations. 



Tuberculous fluids are entirely clear, or but slightly turbid. 

 When the suspicion of tuberculosis exists, the fluid should be handled 

 as sterilely as possible, and allowed to stand in the ice-chest until 

 a little, white, thread-like clot appears in the center, which sinks 

 to the bottom of the tube. It is in this clot that tubercle bacilli 

 can be found by careful search. It is smeared on the slide and 

 stained by the usual methods. If enough fluid is available, the 

 residue should be injected into one or two guinea pigs in as large 

 quantities as can be obtained. The cells in tuberculous fluid are 

 chiefly lymphocytes. 



Acute meningitis is most commonly caused by the meningococcus, 

 pneumococcus, streptococcus, less commonly by influenza bacilli and 



1 Peabody, Draper and Dochez. 



