THE PLEURA. 12$ 



scopical examination, the inference is that the case is 

 tubercular. If a cultural examination is also negative 

 the inference becomes almost a certainty. 



Having these facts in view the practitioner is recom- 

 mended to proceed to examine cases of purulent pleurisy 

 in the following manner : The pus is to be withdrawn 

 with a hypodermic needle or exploring syringe, and a 

 few drops deposited at once on the surface of a culture 

 tube of agar: this is to be incubated at the body 

 temperature. 



The microscopical examination is made in the manner 

 described for pus, a simple stain and also Gram's stain 

 being used. The presence of streptococci, staphylo- 

 cocci, and pneumococci will be revealed ; bacilli may 

 be present, and in this case it should not be forgotten 

 that the tubercle bacillus stains by Gram's method. If 

 no organisms are found in these films, or if there are 

 organisms which resemble the tubercle bacillus in 

 general appearance, another specimen should be sub- 

 mitted to prolonged staining in hot carbol-fuchsin and 

 decolorisation in dilute sulphuric acid, and thoroughly 

 searched for the tubercle bacillus. If the result is 

 negative several other films should be searched. 



The cultures are to be examined after twenty -four 

 hours' incubation. The pneumococcus will produce 

 tiny colourless colonies on the surface of the agar ; the 

 streptococcus forms similar small colourless colonies, 

 but these are distinctly more opaque in the centre; 



* The practitioner is recommended to inoculate the culture 

 directly from the hypodermic needle. The cotton-wool plug is to 

 be withdrawn somewhat and the projecting end thoroughly singed 

 in the flame: .the needle (still attached to the syringe) is then pushed 

 through the plug, and a drop or two of the fluid expelled directly on 

 to the surface of the medium. A similar device may be employed 

 where the fluid is collected in a pipette. 



