158 CLINICAL BACTERIOLOGY. 



urine of a patient suffering from nephritis complicating that 

 disease. In other cases streptococci were found in the kidneys 

 (smallpox, rheumatism, some cases of scarlet fever, etc.) ; 

 under these conditions it is possible that a secondary or a 

 mixed infection existed. Finally, complicating nephritis 

 need not be excited directly by the bacteria, but it may be 

 of toxic origin, resulting from the elimination through the 

 kidneys of the toxins generated by the bacteria at the site 

 of the primary disease. This is true peculiarly of diphtheric 

 nephritis ; in conjunction with which, likewise, as is usual 

 with scarlatinal nephritis, bacteria can not be found in the 

 majority of the kidneys examined. 



The bacteriologic diagnosis can be made during life 

 from examination of the urine (possibly after centrifugation), 

 when there is no disease of the conducting passages, and 

 especially of the bladder. Under normal conditions the 

 urine that enters the bladder is and remains sterile, only 

 becoming contaminated with bacteria in the urethra. For 

 this reason the urine removed from the healthy bladder 

 with a sterile catheter may be transferred directly to a 

 nutrient medium, and such bacteria as develop may be con- 

 sidered as being derived from the kidney. In men, gener- 

 ally, irrigation of the urethra with the first half of the urine 

 contained in the bladder is sufficient ; the last half is, as a 

 rule, sterile in healthy individuals. 



Diagnostic or prognostic significance can not be at- 

 tached to the demonstration of bacteria in the urine in 

 cases of nephritis. According to Mannaberg, streptococci 

 are found in the urine only in cases of true acute nephritis 

 that pursue a rapid and favorable course, while they are 

 wanting from the beginning in the apparently acute cases 

 that subsequently prove to be chronic. This statement 

 has, however, not been confirmed by other observers. 



PERINEPHRITIS. 



Perinephritis consequent upon disease of adjacent organs 

 (kidney, intestine) is generally due to the bacterium coli. 

 Perinephritis following traumatism, or attending general 

 infection, may be due to any pyogenic microorganism. 



