56 CLINICAL BACTERIOLOGY AND H/EMATOLOGY 



6. Pyorrhoea alveolaris. It is not the only cause of this con- 

 dition, but it is of special importance in that the prognosis (if 

 suitable treatment, vaccine or otherwise, is used) is better than 

 in most other forms of the disease. 



Pneumococci may escape into the blood from any of these 

 lesions, and may appear in that fluid when there is no obvious 

 primary lesion from which it could have gained access, The 

 most common results are : 



1. Septic amia. 



2. Ulccrative endocarditis. Many other bacteria may cause 

 this disease. 



3. Meningitis. Pneumococcal meningitis may also be due 

 to direct spread from the middle ear. 



4. Arthritis. 



5. Peritonitis. 



The prognosis in these latter affections is on the whole 

 slightly better if they are due to the pneumococcus than if 

 caused by other organisms; except in the case of meningitis, 

 which is usually fatal in a few days. 



In actual practice we have most commonly to search for the 

 pneumococcus in sputum, pus, and blood. In the latter case 

 cultural methods are usually necessary, and we shall defer its 

 consideration for the present. 



Sputum. The examination of sputum may be made in order 

 to make a diagnosis as to the presence or absence of pneu- 

 monia, in a case in which the physical signs are indeterminate, 

 or to establish the nature of a lobular pneumonia. It is also 

 frequently required for the preparation of vaccines. 



The patient must wash out his mouth with water, which 

 should have been boiled and allowed to cool. He must then 

 spit into a clean wide-mouthed bottle, also containing boiled 

 water, and care must be taken that the sputum used for the 

 examination comes directly from the lungs, and is not merely 

 mucus which has collected in the mouth. 



The mass of mucus forming a single " spit " is agitated 

 gently in the water to remove contaminations from the bron- 

 chial tubes and mouth; the water is poured off and more added, 

 and the process repeated several times. Then the mass of 

 mucus is fished out, placed in a watch-glass, carefully opened 

 with a pair of scissors, and a piece about as big as a pea is 

 removed from the centre of the mass with a platinum loop. It. 



