130 BACTERIOLOGICAL DIAGNOSIS. 
the staining method has been appropriate, by the pre- 
sence in its protoplasm of minute granules which stain 
with eosin. The fluid may also contain red blood 
corpuscles and shreds of fibrin. 
This examination is hardly necessary except in cases 
in which a tubercular origin is suspected. 
c. Chemical.—Cerebro-spinal fluid removed from a 
person who is not suffering from meningitis contains a 
very minute amount of albumen, while when the 
meninges are inflamed the quantity is greatly increased. 
The method of testing these small amounts of albumen. 
are hardly within the reach of practitioners; if a con- 
siderable amount of fluid has been obtained a small 
quantity should be tested by heat and acetic acid and 
the amount of opacity noted. 
d. Bacteriological The chief organisms which cause 
acute meningitis are given in the following table, which 
is modified from one given by Osler :— 
Primary (i.e. not dependent on an obvious lesion elsewhere in the 
body). 
1. Cerebro-spinal fever— 
:. Heine Weichselbaum’s diplococcus. 
2. Pneumococcic— 
a. Pneumococcic infection of meninges alone 
not dependent on disease of distant parts of 
the body. Pneumococ- 
b, Pneumococcic infection of meninges occurring cus. 
as part of a general septicemia without 
obvious primary lesion. 
Secondary. 
A. To direct extension from local disease of the cranium, middle 
ear, fossze, spinal column, &c. 
Pneumococcus. 
Staphylococci. 
Streptococci, &c. 
