Am.  Jour.  Pharm. 
May,  1914. 
Autogenous  Vaccines. 
213 
their  recovery  in  pilre  culture,  as  judged  from  the  findings  on  the 
first  direct  examination. 
Cultures  taken  from  boils,  or  from  infected  sinuses,  from  acne 
pustules,  from  tonsillar  follicles,  and  the  like,  should  be  made  only 
after  thorough  appropriate  cleansing  and  disinfection  of  surface 
relations,  and  then  taken  from  a  second  or  third  portion  of  the 
material,  discarding  the  first,  by  means  of  a  platinum  wire  or  a 
sterile  capillary  glass  pipette  inserted  well  within  the  cavity. 
Cultures  from  eye,  ear,  or  nose  should  have  appropriate  measures 
to  secure  success. 
Blood  specimens  should  always  be  obtained  from  a  vein,  pref- 
erably at  the  bend  of  the  elbow,  by  means  of  an  all-glass  sterilized 
syringe  of  a  capacity  not  less 'than  5  c.c.  It  is  rarely  necessary 
to  cut  down  on  a  vein,  but  the  arm  should  be  thoroughly  sterilized 
by  tincture  of  green  soap  and  water,  by  5-10  per  cent,  lysol,  by 
absolute  alcohol,  and  finally  by  ether;  personally  I  prefer  not  to  use 
iodine.  It  is  better  to  moderately  tourniquet  the  upper  arm  before 
sterilizing  the  field  in  order  to  prevent  thin- walled  veins  from  col- 
lapsing under  the  pressure.  The  blood  should  be  immediately  plated 
and  flasked  in  peptone  and  dextrosed  broth. 
In  Pulmonary  Abscesses:  In  suitable  cases  material  may  be 
obtained  by  lung  puncture  in  the  following  way :  After  sterilizing 
the  chest  wall  in  the  same  manner  as  for  blood  cultures,  the  needle 
attached  to  an  all-glass  syringe,  containing  3  c.c.  of  peptone  broth, 
should  be  plunged  into  the  lung  at  the  proper  point,  as  determined 
beforehand  by  clinical  means,  and  1  c.c.  of  the  broth  introduced 
and  then  reaspirated  as  far  as  possible  and  tubed.  This  measure 
will  yield  results  in  many  cases  properly  selected  clinically. 
After  getting  suspected* infected  material,  direct  examination  by 
means  of  variously-stained  slide  specimens  should  be  made  to 
determine  morphologically  and  by  staining  reactions  and  relations 
whether  one  or  more  types  of  organisms  are  present,  and,  if  the 
latter,  how  many  and  what  types,  and  then,  aided  by  this  knowledge, 
proceed  to  utilize  the  various  culture  media  that  will  best  ensure 
recovery  of  each  organism  in  pure  culture.  Here  is  where  the 
thoroughly-trained  bacteriologist  will  succeed  and  in  the  shortest 
time.  It  is  often  exceedingly  difficult  to  recover  a  shyly-growing 
streptococcus  or  tubercle  bacillus  occurring  in  small  numbers,  let  us 
say  from  a  urine  practically  alive  with  the  Bacillus  coli.  This  may 
be  accomplished  by  inhibiting  or  attenuating  the  growth  of  the 
