THE URINE iig 



The catheter must be boiled, and the urinary meatus sterilized. 

 The first portion of the urine is to be rejected, and a small 

 quantity of the last part collected in a sterile test-tube, and 

 the plug immediately replaced. A small quantity only is re- 

 quired. 



Cystitis, Pyelitis, Etc.— These may be due to many organisms, 

 either pure or mixed, and there is but little practical interest in 

 their recognition, except in cases in which the vaccination treat- 

 ment is to be tried. 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. Coli. — This is perhaps the commonest form, and in cystitis 

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

 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. 



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

 suppuration, 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 

 present it is impossible to distinguish the one from the other, 

 either in a hanging-drop or in stained films. 



If it is necessary to know whether B. coli or B. typhosus is 

 present along with Proteus vulgaris in an ammoniacal urine, the 

 only method is to plate out some of the urine on gelatin 



