DIAGNOSIS 



209 



smears and by culture at any time. In such cases gonococci, staphylococci, 

 pseudodiphtheria bacilli, the colon bacillus or the diphtheria bacillus may be 

 present. 



INFECTION OF THE URINARY BLADDER 



Bacteriologically, infection of the urinary bladder can only be determined 

 with accuracy by microscopic and cultural examination of urine obtained 

 through a sterile catheter under conditions which preclude the possibility of 

 bacteria entering the urine outside the bladder. 



INFECTION OF THE KIDNEYS 



Bacteriologically, renal infection can only be detected by microscopic and 

 cultural examination of urine obtained through ureteral catheter. 



Any of the organisms that may infect the urethra can infect the bladder or 

 kidney. The colon bacillus is probably the most frequent invader of the 

 bladder and kidney. 



When urine is to be examined for bacteria other than tubercle bacilli the 

 examination should be made immediately after removal from the body. The 

 technique described on pages 116 and 117 should be employed; in addition, 

 plants on plain agar, or better, on blood-agar, should also be made. 



For the tubercle bacilli see page 98. 



There is a wide difference of opinion as to the significance of tubercle bacilli 

 found in urine, also as to whether or not acid-fast organisms found in urine may 

 properly be considered tubercle bacilli. 



The results of extensive laboratory studies conducted by Prof. R. C. Rosen- 

 berger and the coordinated clinical and laboratory findings of Dr. Charles 

 Bonney and the writer may be summarized as follows: 



First, acid-fast bacteria (which are similar to, but which are not tubercle or 

 leprosy bacilli, such as occur at times in sputum, smegma, feces, urine and 

 water), occasionally resist decoloriza'tion and remain red after immersion in 

 Pappenheim's solution for 2 minutes. Rarely, indeed, less than once in a 

 hundred times, do such organisms remain red after twenty minutes' immersion 

 in Pappenheim's solution. 



Second, we have never found red bacilli in urine from clinically non- tubercu- 

 lous individuals when (a) the external genital organs are carefully cleansed prior 

 to micturition or catheterization, (b) the urine is collected in sterile containers 

 and protected from extra corporeal contamination, and (c) the smears made for 

 microscopic examination are immersed in Pappenheim's solution for 20 minutes 

 or more, after carbol f uchsin staining. 



Third, whenever we have found red bacilli, identified as tubercle bacilli, in 

 urine, there has been at the time, or later, conclusive evidence of active tuber- 

 culosis of one or both kidneys, usually, but not always, associated with distinct 

 physical signs of latent or active pulmonary tuberculosis. 



