THE PLEURA. 121 
origin is suspected) a considerable quantity of the fluid— 
an ounce or more—should be enclosed in a bottle which 
has been sterilised by boiling, and forwarded at once. 
Where the diagnosis is to be made by cultural 
methods, and the cultures are not to be made on the 
spot, the fluid is best stored or sent to a laboratory in 
pipettes. These are to be filled from the syringe direct ; 
the needle is to be removed and the end of the pipette 
(sterilised by being passed through the flame) is passed 
into the fluid and filled by gentle suction at the other 
end. Each end is then sealed in a flame, care being 
taken not to heat the fluid. Two or three such tubes 
should be sent. 
Cleary fluid from the chest rarely, if ever, shows any 
micro-organisms on microscopical examination. Cul- 
tures are usually sterile; where streptococci or pneu- 
mococci are found the inflammation is likely to pass on 
into suppuration. The great majority of these cases of 
‘‘simple’’ acute pleurisy are really due to the tubercle 
bacillus, but their true nature can only be demonstrated 
by inoculation experiments. 
Where any question arises as to the nature of a case 
of simple pleurisy the practitioner is recommended not 
to attempt the examination himself, but to send samples 
of the fluid in pipettes to a laboratory; if animal experi- 
ments are necessary a larger quantity of fluid should be 
sent in a sterilised bottle. 
Puvulent pleurisies (empyemata) may be caused by 
many organisms, the most common being the pnemo- 
coccus, streptococci, staphylococci, and the tubercle 
bacillus. 
The pneumococcus is readily demonstrated by a 
microscopical examination, the method to be employed 
being the same as that previously described. 
