104 LOCALIZED INFECTIONS OF PUS NATURE 



moreover, be included among the transmissible infec- 

 tions because it appears in epidemics, and definite 

 instances of communication directly from the sick to 

 the well are known. 



By reason of the spread of pneumococci through the 

 blood, complications in the form of involvement of 

 nearly every tissue in the body may result. The 

 interior of the heart, the pleura, and the meninges 

 are most commonly affected. These organisms may 

 also cause conjunctivitis, tonsillitis, otitis, and arthritis. 



For diagnosis bacteriologically, cultures are made 

 from the sputum, selecting the blood-streaked speci- 

 mens, and of the blood. Sputum should be dis- 

 infected by receiving it directly in 5 per cent, car- 

 bolic solution. Not only must care be used to collect 

 sputum, but the lips and checks of the patient should 

 be kept clean, and all attendants should rinse their 

 nose and throat frequently with hydrogen peroxide or 

 Dobell's solution. Pneumococci do not live long on 

 objects, but may be transferred by persons in the hair 

 and nasopharynx, in which places the germs are pro- 

 tected from light and drying. After pneumonia it is 

 not common for patients to remain as carriers, but 

 attendants may be accidental carriers. 



The coccus belongs properly to the streptococci, 

 since it divides only in one plane, and its cultures may 

 appear in chains. It has the peculiarities of growing in 

 an oval shape in pairs, with the distal ends pointed 

 (lance-shape), and being surrounded by a capsule. 

 This shape and envelope are quite characteristic, and 

 almost determinative. The coccus grows very slightly 

 on ordinary culture media, but best when blood or 



