BACTERIOLOGICAL EXAMINATION OF THE NOSE, ETC. 129 



immediately after he has blown his nose. Where cultures are 

 required the methods are more difficult, and the material must be 

 collected as near as possible to the region where it is secreted ; 

 this is especially the case in the examination of the pus from 

 cases of empyema of the antrum, frontal sinus, etc. I have 

 found the most convenient instrument is a long capillary pipette 

 of rather wide calibre, and bent to an angle of about 135 degrees, 

 at a point some 4 inches from its tip, which must be carefully 

 rounded in the flame, so as not to injure the mucous membrane. 

 It is provided with an indiarubber nipple, and is readily prepared 

 from one of the straight pipettes described on p. 34, by heating 

 it gently in a spirit-lamp, at a point about 4 inches from the tip, 

 until the glass is just softened, and then allowing the distal end 

 to fall until the proper angle is reached. The pipette may be 

 sterilized by passing it rapidly through the flame, taking care not 

 to melt it. 



Fig. 26. Angled Pipette for Collecting Pus from the Nose. 



To use it, seat yourself opposite to the patient, insert a nasal 

 speculum sterilized in carbolic acid or in the flame, and examine 

 the nose in the ordinary way by means of a beam of light 

 directed up the nose from a laryngoscope mirror. Insert the tip 

 of the pipette, taking great care not to touch the vibrissse or the 

 mucous membrane near the orifice, and pass it upward until it 

 comes in contact with the pus. Then squeeze the nipple and 

 allow it to expand again, slightly moving the tip of the pipette 

 about in the pus, and taking care not to bring it in contact with the 

 mucous membrane. In most cases you will be able to suck up 

 a few drops of pus ; sometimes it is very thick and turbid, and will 

 not enter the pipette, and in this case you must use a platinum 

 loop, which is not nearly so efficacious or so easy to use. But in 

 most cases the angled pipette will be found available after a very 

 little practice. 



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