A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
[Illustration: FIG. 53.--Spermatozoa in urine (Ogden).]
[Illustration: FIG. 54.--Micrococcus ureæ (after von Jaksch).]
6. Bacteria.--Normal urine is free from bacteria in the bladder, but
becomes contaminated in passing through the urethra. Various
non-pathogenic bacteria, notably _Micrococcus ureæ_ (Fig. 54), are
always present in decomposing urine. In suppurations of the urinary
tract pus-producing organisms may be found. In many infectious
diseases the specific germs may be eliminated in {127} the urine
without producing any local lesion. Typhoid bacilli have been known to
persist for months and even years after the attack.
Bacteria produce a cloudiness which will not clear upon filtration.
They are easily seen with the one-sixth objective in the routine
microscopic examination. Ordinarily, no attempt is made to identify
any but the tubercle bacillus and the gonococcus.
Tubercle bacilli are nearly always present in the urine when
tuberculosis exists in any part of the urinary tract, but are often
difficult to find, especially when the urine contains little or no
pus.
* * * * *
Detection of Tubercle Bacilli in Urine.--The urine should be obtained
by catheter after careful cleansing of the parts.
(1) Centrifugalize thoroughly, after dissolving any sediment of urates
or phosphates by gentle heat or acetic acid. Pour off the supernatant
fluid, add water, and centrifugalize again. Addition of one or two
volumes of alcohol will favor centrifugalization by lowering the
specific gravity.
(2) Make thin smears of the sediment, adding a little egg-albumen if
necessary to make the smear adhere to the glass; dry, and fix in the
usual way.
(3) Stain with carbol-fuchsin, steaming, for at least three minutes.
(4) Wash in water, and then in 20 per cent. nitric acid until only a
faint pink color remains.
(5) Wash in water.
(6) Soak in alcohol fifteen minutes or longer. This decolorizes the
smegma bacillus (p. 35), which is often present in the urine, and
might easily be mistaken for the tubercle bacillus. It is unlikely,
however, to be present in catheterized specimens. It is always safest
to soak the smear in alcohol for several {128} hours or over night,
since some strains of the smegma bacillus are very resistant.
(7) Wash in water.
(8) Apply Löffler's methylene-blue solution one-half minute.
(9) Rinse in water, dry between filter-papers, and examine with the
one-twelfth objective.
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