LUMBAR PUNCTURE I35 



(6) Pyogenic — 



Secondary to abscesses, etc., and occurring as a part of a general 

 infection. 

 Staphylococci. 

 Streptococci, etc. 



(c) Gonorrhceal — 



Secondary to gonorrhoea. 

 Gonococcus (rare). 



(d) Tuberculous- 



Secondary to tuberculosis of other regions. 

 Tubercle bacillus. 



(e) Miscellaneous — 



Secondary to typhoid fever. 



Typhoid bacillus (rare). 

 Secondary to influenza. 



Influenza bacillus (rare). 

 Secondary to anthrax, etc. 



Anthrax bacillus, etc. (rare). 



Of these, the organisms which are most likely to occur are : 



The tubercle bacillus ) . ,. , 



Meningococcus I ^'^^"""""g f^'^ ^^out 90 per cent, of cases. 



The pneumococcus. 



Streptococci and staphylococci in secondary cases due to spread from 

 ear, etc. 



And this shows roughly the order of frequency. 



Preparation of Films. — If the fluid is thick and purulent, films 

 should be prepared, dried, and fixed in the ordinary way. If the 

 fluid is thin and watery, it should be centrifugalized or allowed 

 to stand for some hours. A certain amount of coagulation will 

 take place, and the sediment which collects will contain the bulk 

 of micro-organisms. The clear fluid should be poured off and 

 used for testing chemically, and the sediment used for the pre- 

 paration of films, of which several will be required. The subse- 

 quent examination will depend to some extent upon the nature of 

 the organism which is probably present ; for general purposes 

 stain one or more films with Lofiler's methylene blue (two 

 minutes), wash, dry, mount, and examine. 



Streptococci and staphylococci will be readily recognised by 

 their morphological characters. If diplococci are present they 

 may be pneumococci, Weichselbaum's diplococci, or gonococci. 

 Stain a film by Gram's method and couriterstain in dilute carbol 

 fuchsin in the method described for the gonococcus. Pneumococci 

 will retain the violet stain, while Weichselbaum's organism and 

 gonococci will be coloured red. 



