110 CLINICAL BACTERIOLOGY AND HEMATOLOGY 



can be readily differentiated from the bactenal filaments which may 

 occur in the mouth (leptothrix, etc.) by its relatively enormous size. 

 When cultivated for a day or two on ordinary media mycelium 

 formation does not take place, or only to a very limited extent, 

 and the oval or spherical spores are often mistaken for yeasts. 



Syphilitic Angina may be recognised by the identification of 

 the Spirillum pallida, but some caution is necessary, since non- 

 pathogenic spirilla are frequently present in the healthy hiouth. 

 The films stained by Giemsa's stain must be very carefully 

 compared with others stained by simple dyes (thionin or methylene 

 blue), to make sure that the organism found is not coloured by 

 ordinary means. 



THE BACTERIOLOGICAL EXAMINATION OF THE 

 NOSE AND ACCESSORY CAVITIES 



In health the nasal mucous membrane is sterile except for that 

 portion in close proximity to the orifices ; the vibrissas are 

 especially contaminated with air-borne organisms, and contact 

 with them must be avoided if cultures are being taken. 



Methods. — In most cases a simple microscopical examination of 

 the mucus, muco-pus, or pus from the nose is sufficient, and the 

 material may be taken from the patient's pocket-handkerchief 

 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. 151, 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. 



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 



