1 66 CLINICAL BACTERIOLOGY AND H^MATOLOGY 



This will enable you to study the organisms more closely, and 

 to see whether they retain Gram or not. The staphylococcus 

 (which appears in the urine mostly as diplococci) and the 

 M. urea do so, and the gonococcus and the gonococcus-like 

 diplococcus which causes cystitis are decolorized. 



Where cultures are required, a catheter specimen must be 

 used. The catheter must be boiled, and the urinary meatus 

 sterilized. The first portion of the urine is to be rejected, and 

 a small quantity of the last part collected in a sterile test-tube, 

 and the plug immediately replaced. A small quantity only is 

 required. 



CYSTITIS, PYELITIS, ETC. These may be due to many 

 organisms, either pure or mixed, and there is but little prac- 

 tical interest in their recognition, except in cases in which the 

 vaccination treatment is to be used. There is, unfortunately, 

 no method of distinguishing' between cystitis and pyelitis by 

 the examination of the urine. The chief bacteria causing 

 suppuration in the urinary passages are : 



B. Coli. This is by far the commonest form, and in cystitis 

 or pyelitis due to it the urine remains acid unless other organ- 

 isms gain access. 



The organism can usually be identified with a fair amount 

 of certainty by an examination of an unstained hanging- 

 drop preparation, when numerous short bacilli will be seen 

 in active movement, and the fluid will be found to contain pus 

 cells. Follow this examination by making a film of the urine, 

 staining by Gram and counterstaining by dilute carbol fuch- 

 sin, when the bacilli will be seen stained red. These appear- 

 ances in an acid urine raise strong presumptive evidence of 

 B. coli, but are not conclusive, as the typhoid bacillus is almost 

 identical. Where cocci or other organisms are present, the 

 urine may be alkaline in spite of the presence of B. coli. 

 Urinary infections due to B. coli are not necessarily associated 

 with suppuration, the organism being the chief cause of bacil- 

 luria or bacteriuria, in which there is no pus, or practically 

 none; but the urine contains enormous numbers of micro- 

 organisms. 



B. coli infections of the urinary passages are frequently 

 most resistant to ordinary treatment, and often yield to vac- 

 cines. An autogenous preparation should be used in all cases, 

 as the organism is so variable that stock vaccines are usually 



