138 CLINICAL BACTERIOLOGY AND H.EMATOLOGY 



in their recognition, except in cases in which the vaccination 

 treatment is to be used. There is, unfortunately, no method of 

 distinguishing between cystitis and pyelitis by the examination 

 of the urine. The chief bacteria causing suppuration in the 

 urinary passages are : 



B. Co//.— This is by far the commonest form, and in cystitis 

 or pyelitis due to it the urine remains acid unless other organishis 

 gain access. 



The organism can usually be identified with a fair amount of 

 certainty by an examination of an unstained hanging-drop prepara- 

 tion, when numerous short bacilli will be seen in active movement, 

 and the fluid will be found to contain pus cells. Follow this 

 examination by making a film of the urine, staining by Gram and 

 counterstaining by dilute carbol fuchsin, when the bacilli will be 

 seen stained red. These appearances in an acid urine raise 

 strong presumptive evidence of B. coli, but are not conclusive, as 

 the typhoid bacillus is almost identical. Where cocci or other 

 organisms are present, the urine may be alkaline in spite of the 

 presence of B. coli. Urinary infections due to B. coli are not 

 necessarily associated with suppuration, the organism being the 

 chief cause of bacilluria or bacteriuria, in which there is no pus, 

 or practically none ; but the urine contains enormous numbers of 

 micro-organisms. 



B. coli infections of the urinary passages are frequently most 

 resistent to ordinary treatment, and often yield to vaccines. 

 An autogenous preparation should be used in all cases, as the 

 organism is so variable that stock vaccines are usually useless. 

 The dose should vary from 25 to 250 millions, or even more ; 

 some cases do well on very minute doses (i to 5 millions), fre- 

 quently repeated. The effect seems to be increased by rendering 

 the urine slightly alkaline by means of citrate or acetate of soda. 



Proteus Vulgaris. — This is one of the common organisms of 

 suppuration of the urinary tract, and produces cystitis with an 

 alkaline urine. It often occurs in conjunction with B. coli, and 

 the urine is alkaline in this case also, the proteus being more 

 powerful as a producer of alkali (by the ammoniacal decomposition 

 of urea) than the B. coli is of acid. 



It closely resembles B. coli in appearance, and is motile ; the 

 chief points of difference are that it is more irregular in size and 

 forms longer threads, and that some of the bacilli often fail to 

 decolorize by Gram. In cases where the two organisms are 



