464 PATHOGENIC MICROORGANISMS 



be excreted within the first day after the onset of the disease, and 

 may continue in the urine during early convalescence. Since it is 

 almost always present in septicemia, it may have some value in 

 sizing up a case in this way. 



The substance can be demonstrated by direct precipitation of 

 the clear urine against specific pneumococcus sera. A curious thing 

 about the substance is that it can be obtained in concentrated urine 

 in the following way. 25 c.c. of the urine is boiled with weak acetic 

 acid and the proteins removed by filtration. The filtrate is then 

 precipitated with 95 per cent alcohol, rapidly dried, and redissolved 

 in small amounts of salt solution up to 3 c.c. This solution reacts 

 specifically with the serum. 



Blood Cultures in Pneumonia. During the course of pneumonia, 

 pneumococcus septicemia is common. Frankel 72 in 1902 stated that 

 he believed in most, if not all cases of pneumonia the organisms are 

 present in the blood stream at some stage of the disease. Proschaska, 

 in a carefully repeated culturing of ten unselected cases, obtained 

 the organisms in every one of them. The older literature, if carefully 

 reviewed, shows positive blood cultures in about 25 per cent of the 

 cases. In the Rockefeller Hospital where systematic blood cultures 

 were done, among other things, it is stated by Cole that in 448 

 cases of lobar pneumonia, the pneumococci were obtained by blood 

 culture in 30.3 per cent. When blood cultures were repeatedly made 

 at frequent intervals the positive findings were obtained in 50 

 per cent. 



In taking blood cultures it is important that plenty of blood is 

 taken and inoculated. The culture is taken from the basilic vein 

 with a sterile syringe as follows: At least 5 or 10 c.c. of blood 

 should be added to flasks of hormone glucose broth, of a P H of 7.6 

 or 7.8, containing not less than 100 c.c. of broth. Hormone glucose 

 agar plates should at the same time be made, and graded quantities 

 of blood can be added to successive plates in order that one may 

 obtain a numerical estimate of the number of organisms per c.c. 

 Growth is often delayed, and no negative report should be finally 

 turned in for at least three days. Cole and others have attached 

 great prognostic significance to blood cultures. Cole believes that 

 the development of a septicemia is of very serious prognostic sig- 

 nificance, and the typing of the organisms from the blood culture 



72 Frankel, "v. Leyden Festschr.," 1902. 



