THE PLEURA 173 



stomach, intestine, etc., into the pleura, in those due to an 

 external wound, with free contamination of the membrane 

 and its contents, and in those due to the rupture of very foul 

 tuberculous vomicae, contain vast numbers of organisms of 

 all kinds bacilli, cocci, etc. mixed together. These fluids 

 usually smell badly, and are of very evil omen. 



Lastly, in a few cases other organisms, such as the typhoid 

 bacillus, may be found. 



Having these facts in view, the practitioner is recommended 

 to proceed to examine cases of purulent pleurisy in the fol- 

 lowing manner : The pus is to be withdrawn with a hypo- 

 dermic needle or exploring syringe, and a few drops deposited 

 at once on the surface of a culture-tube of agar, spread well 

 over the surface with a platinum loop, and incubated at the 

 temperature of the body. 



The microscopical examination is made in the manner de- 

 scribed for pus, a simple stain and also Gram's stain, with 

 dilute carbol fuchsin as a counterstain, being used. The 

 presence of streptococci, staphylococci, and pneumococci will 

 be revealed; bacilli may be present, and in this case it should 

 not be forgotten that the tubercle bacillus stains by Grain'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 submitted to 

 prolonged staining in hot carbol fuchsin and decolorization 

 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 pneumpcoccus 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; staphylococci form opaque white or 

 yellowish colonies which, after long incubation, spread out, 

 coalesce, and cover the surface of the agar with an even film 

 like a streak of paint ; and the tubercle bacillus does not de- 

 velop. Films should be made from the cultures, stained .and 

 examined. The cultural examination is of. great -value,, but 

 much can be made out by the examination of stained films 

 made directly from pus, and this should never be omitted. 



Vaccine Treatment. It is not advisable to trust to vaccine 



