THE PNEUMOCOCCUS, PNEUMONIA, ETC. 53 



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 pneumonia, 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 bronchial 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 is placed on a clean slide, 

 another slide pressed upon it, and the two are slid apart. The 

 films thus obtained are allowed to dry, and fixed by heat in the 

 usual way. 



One is then stained by Gram's method, and counterstained by 

 dilute carbol fuchsin for about a quarter of a minute, washed, 

 dried, and mounted, and the other with undiluted carbol fuchsin. 



The pneumococcus is a diplococcus— «.«., the individual cocci 

 are arranged in pairs. Each coccus has usually an oval or lancet 

 shape, the sharp ends of the two germs pointing away from one 

 another (Plate I., Fig. 3, and Plate III., Fig. 4). Abnormal 

 forms (round cocci, short bacilli, etc.) are frequent. The pneumo- 

 coccus has a capsule when it occurs in the living body or in patho- 

 logical exudates, but not in most cultures. This capsule does not 

 stain readily, and appears in a properly-stained specimen as a 

 clear halo round the two cocci. 



