MISCELLANEOUS EXAMINATIONS
PUS
Pus contains much granular débris and numerous more or less
degenerated cells, the great majority being polymorphonuclear
leukocytes--so-called "pus-corpuscles." Eosinophilic leukocytes are
common in gonorrheal pus and in asthmatic sputum. Examination of pus
is directed chiefly to detection of bacteria.
When very few bacteria are present, culture methods must be resorted
to, but such methods do not come within the scope of this work. When
considerable numbers are present, they can be detected and often
identified in cover-glass smears. Several smears should be made,
dried, and fixed as described under Sputum (p. 32). One of these
should be stained one-fourth to one-half minute with Löffler's
methylene-blue, rinsed well with water, dried, mounted, and examined
with an oil-immersion lens. This will show all bacteria except the
tubercle bacillus, and often no other stain is necessary for their
identification. In many cases special stains must be applied.
_Gram's method_ (p. 40) is a very useful aid in distinguishing certain
bacteria. The more important organisms react to this staining method
as follows: {262}
GRAM STAINING GRAM DECOLORIZING
(Deep purple). (Colorless, unless a counterstain is used).
Staphylococcus. Gonococcus.
Streptococcus. Meningococcus.
Pneumococcus. Bacillus of influenza.
Bacillus diphtheriæ. Typhoid bacillus.
Bacillus tuberculosis. Bacillus coli communis.
Bacillus of anthrax. Spirillum of Asiatic cholera.
Bacillus of tetanus. Bacillus pyocyaneus.
Bacillus aërogenes capsulatus. Bacillus of Friedländer.
Koch-Weeks bacillus.
Bacillus of Morax-Axenfeld.
[Illustration: FIG. 113.--Staphylococcus pyogenes albus from an
abscess of the parotid gland (Jakob).]
The most common pus-producing organisms are _staphylococci_ and
_streptococci_. They are both cocci, or spheres, their average
diameter being about 1 µ. Staphylococci are commonly grouped in
clusters, often compared to bunches of grapes (Fig. 113). There are
several varieties, which can be distinguished only in cultures.
Streptococci are arranged side by side, forming chains of variable
length (Fig. 114). Sometimes there are only three or four individuals
in a chain; sometimes a chain {263} is so long as to extend across
several microscopic fields. Streptococci are more virulent than
staphylococci, and are less common.
[Illustration: FIG. 114.--Streptococcus pyogenes from a case of
empyema (Jakob).]
Should bacteria resembling _pneumococci_ be found, Buerger's method
(p. 37) should be tried. When it is inconvenient to stain before the
smears have dried, capsules can be shown by the method of Hiss. The
dried and fixed smear is covered with a stain composed of 5 c.c.
saturated alcoholic solution gentian-violet and 95 c.c. distilled
water, and heated until steam rises. The preparation is then washed
with 20 per cent. solution of copper sulphate, dried, and mounted in
Canada balsam.
Pneumococci may give rise to inflammations in many locations. When
they form short chains, demonstration of the capsule is necessary to
distinguish them from streptococci.
If tuberculosis be suspected, the smears should be stained by one of
the methods for the _tubercle bacillus_ (pp. 32 and 127), or
guinea-pigs may be inoculated. {264} The bacilli are generally
difficult to find in pus, and bacteria-free pus would suggest
tuberculosis.
[Illustration: FIG. 115.--Diplococcus pneumoniæ from ulcer of cornea
(obj. one-twelfth oil-immersion) (study through courtesy of Dr. C. A.
Oliver) (Boston).]
[Illustration: FIG. 116.--Gonococci in urethral pus (McFarland).]
_Gonococci_, when typical, can usually be identified with sufficient
certainty for clinical purposes in the smear stained with Löffler's
methylene-blue. They are coffee-bean-shaped cocci which lie in pairs
with their flat surfaces together (Fig. 116). They lie for the most
part within pus-cells, an occasional cell being filled with them,
while the surrounding cells contain few or none. A few are {265} found
outside of the cells. It is not usual to find gonococci when many
other bacteria are present, even though the pus is primarily of
gonorrheal origin. Whenever the identity of the organism is at all
questionable, Gram's method should be tried. In rare instances it may
be necessary to resort to cultures. The gonococcus is distinguished by
its failure to grow upon ordinary media.
Gonococci are generally easily found in pus from untreated acute and
subacute gonorrheal inflammations,--conjunctivitis, urethritis,
etc.,--but are found with difficulty in pus from chronic inflammations
and abscesses, and in urinary sediments.
PERITONEAL, PLEURAL, AND PERICARDIAL FLUIDS
The serous cavities contain very little fluid normally, but
considerable quantities are frequently present as a result of
pathologic conditions. The pathologic fluids are classed as
transudates and exudates.
_Transudates_ are non-inflammatory in origin. They contain only a few
cells, and less than 2.5 per cent. of albumin, and do not coagulate
spontaneously. The specific gravity is below 1018. Micro-organisms are
seldom present.
_Exudates_ are of inflammatory origin. They are richer in cells and
albumin, and tend to coagulate upon standing. The specific gravity is
above 1018. Bacteria are generally present, and often numerous. The
amount of albumin is estimated by Esbach's method, after diluting the
fluid. Bacteria are recognized by cultures, animal inoculation, or
stained smears.
Exudates are usually classed as serous, serofibrinous, seropurulent,
purulent, putrid, and hemorrhagic, which {266} terms require no
explanation. In addition, chylous and chyloid exudates are
occasionally met, particularly in the peritoneal cavity. In the
chylous form the milkiness is due mainly to the presence of minute
fat-droplets, and is the result of rupture of a lymph-vessel. Chyloid
exudates are milky chiefly from proteids in suspension, or fine débris
from broken-down cells. These exudates are most frequently seen in
carcinoma and tuberculosis of the peritoneum.
Cytodiagnosis.--This consists in a differential count of the cells in
a transudate or exudate, particularly one of pleural or peritoneal
origin.
[Illustration: FIG. 117.--Cytodiagnosis. Polymorphonuclear leukocytes
and swollen endothelial cells from acute infectious non-tuberculous
pleuritis (Percy Musgrave; photo by L. S. Brown).]
The fresh fluid, obtained by aspiration, is centrifugalized for at
least five minutes; the supernatant liquid is poured off; and
cover-glass smears are made and dried in the air. The smears are then
stained with Wright's blood-stain, to which one-third its volume of
pure methyl-alcohol has {267} been added. Cover the smear with this
fluid for one-half minute, then dilute with eight or ten drops of
water, and let stand about two minutes. Wash gently in water, and
{268} dry by holding the cover-glass between the fingers over a flame.
Mount in balsam and examine with a one-twelfth objective.
[Illustration: FIG. 118.--Cytodiagnosis. Lymphoid cells from pleural
fluid; case of tuberculous pleuritis (Percy Musgrave; photo by L. S.
Brown).]
[Illustration: FIG. 119.--Cytodiagnosis. Endothelial cells from
transudate or mechanical effusion (Percy Musgrave; photo by L. S.
Brown).]
Predominance of polymorphonuclear leukocytes (pus-corpuscles) points
to an acute infectious process (Fig. 117).
Predominance of lymphocytes (Fig. 118) generally signifies
tuberculosis. Tuberculous pleurisy due to direct extension from the
lung may give excess of polymorphonuclears owing to mixed infection.
Predominance of endothelial cells, few cells of any kind being
present, indicates a transudate (Fig. 119). Endothelial cells
generally predominate in carcinoma, but are accompanied by
considerable numbers of lymphocytes and red blood-corpuscles.
CEREBROSPINAL FLUID
Examination of the fluid obtained by lumbar puncture is of value in
diagnosis of certain forms of meningitis.
_Tubercle bacilli_ can be found in the majority of cases of
tuberculous meningitis. The sediment, obtained by thorough
centrifugalization or by coagulation and digestion (p. 128) is spread
upon slides and stained by one of the methods already given. A
considerable number of smears should be examined. In doubtful cases,
inoculation of guinea-pigs must be resorted to.
The _Diplococcus intracellularis meningitidis_ is recognized as the
cause of epidemic cerebrospinal fever, and can be detected in the
cerebrospinal fluid of most cases, especially those which run an acute
course. Cover-glass smears from the sediment should be stained by the
method for the gonococcus. The meningococcus is an intracellular
diplococcus which often cannot be distinguished {269} from the
gonococcus in stained smears (Fig. 120). It, also, decolorizes by
Gram's method. The presence of such a diplococcus in meningeal
exudates is, however, sufficient for its identification.
[Illustration: FIG. 120.--Diplococcus intracellularis meningitidis in
leukocytes. X2000 (Wright and Brown).]
Various organisms have been found in other forms of meningitis--the
pneumococcus most frequently. In some cases no micro-organisms can be
detected even by culture methods.
ANIMAL INOCULATION
Inoculation of animals is one of the most reliable means of verifying
the presence of certain micro-organisms in fluids and other material.
Clinically, it is applied almost exclusively to demonstration of the
tubercle bacillus when other means have {270} failed or are uncertain.
The guinea-pig is the most suitable animal for this purpose. When the
suspected material is fluid and contains pus, it should be well
centrifugalized, and one or two cubic centimeters of the sediment
injected by means of a large hypodermic needle into the peritoneal
cavity or underneath the loose skin of the groin. Fluids from which no
sediment can be obtained must be injected directly into the peritoneal
cavity, since at least 10 c.c. are required, which is too great an
amount to inject hypodermically. Solid material should be placed in a
pocket made by snipping the skin of the groin with scissors, and
freeing it from the underlying tissues for a short distance around the
opening. When the intraperitoneal method is selected, several animals
must be inoculated, since some are likely to die from peritonitis
caused by other organisms before the tubercle bacillus has had time to
produce its characteristic lesions.
The animals should be killed at the end of six or eight weeks, if they
do not die before that time, and a careful postmortem examination
should be made for the characteristic pearly-gray or yellow tubercles
scattered over the peritoneum and through the abdominal organs,
particularly the spleen, and for caseous inguinal and retroperitoneal
lymph-glands. The tubercles and portions of the caseous glands should
be crushed between two slides, dried, and stained for tubercle
bacilli. The bacilli are difficult to find in the caseous material.
THE MOUTH
Micro-organisms are always present in large numbers. Among these is
_Leptothrix buccalis_ (Fig. 121), which is especially abundant in the
crypts of the tonsils and the {271} tartar of the teeth. The whitish
patches of _pharyngomycosis leptothrica_ are largely composed of these
fungi. They are slender, segmented threads, which generally, but not
always, stain violet with Lugol's solution, and are readily seen with
a one-sixth objective. At times they are observed in the sputum and
stomach fluid. In the former they might be mistaken for elastic
fibers; in the latter, for Boas-Oppler bacilli. In either case, the
reaction with iodin will distinguish them.
[Illustration: FIG. 121.--Gingival deposit (unstained): _a_, Squamous
epithelial cells; _b_, leukocytes; _c_, bacteria; _d_, Leptothrix
buccalis (Jakob).]
Thrush is a disease of the mouth seen most often in children, and
characterized by the presence of white patches upon the mucous
membrane. It is caused by the thrush fungus, _Oïdium albicans_. When a
bit from one of the patches is pressed out between a slide and cover
and examined with a one-sixth objective, the fungus is seen to consist
of a network of branching segmented hyphæ with numerous spores, both
within the hyphæ and in the meshes between them (Fig. 122). The meshes
also contain leukocytes, epithelial cells, and granular débris.
{272} [Illustration: FIG. 122.--Thrush fungus (Oïdium albicans)
(Jakob).]
[Illustration: FIG. 123.--Bacillus diphtheriæ, from culture on
blood-serum. X1000 (Fränkel and Pfeiffer).]
Acute pseudomembranous inflammations, which occur chiefly upon the
tonsils and nasopharynx, are generally caused by the diphtheria
bacillus, but may result from streptococcic infection. In many cases
diphtheria {273} bacilli can be demonstrated in smears made from the
membrane and stained with Löffler's methylene-blue or 2 per cent.
aqueous solution of methyl-green. They are straight or curved rods,
which vary markedly in size and outline, and stain very irregularly
(Fig. 123). A characteristic form is a palely tinted rod with several
deeply stained granules (metachromatic bodies), or with one such
granule at each end. They stain by Gram's method. It is generally
necessary, and always safer, to make a culture upon blood-serum,
incubate for twelve hours, and examine smears from the growth.
[Illustration: FIG. 124.--Bacillus and spirillum of Vincent, from case
of ulcerative stomatitis. Stained (obj. one-twelfth oil-immersion;
X1000) (Boston).]
Vincent's angina is a chronic pseudomembranous and ulcerative
inflammation of pharynx and tonsils. It is probably caused by two
micro-organisms living in symbiosis--one a fusiform bacillus, the
other a long spirillum (Fig. 124). They can readily be demonstrated in
smears stained with Löffler's methylene-blue. The bacillus is spindle
shaped, more or less pointed at the {274} ends, and about 6 to 12 µ
long. The spirillum is a very slender, wavy thread, about 30 to 40 µ
long.
Tuberculous ulcerations of mouth and pharynx can generally be
diagnosed from curetings made after careful cleansing of the surface.
The curetings are well rubbed between slide and cover, and the smears
thus made are dried, fixed, and stained for tubercle bacilli. Since
there is much danger of contamination from tuberculous sputum, the
presence of tubercle bacilli is significant only in proportion to the
thoroughness with which the ulcer was cleansed. The diagnosis is
certain when the bacilli are found within groups of cells which have
not been disassociated in making the smears.
THE EYE
[Illustration: FIG. 125.--Conjunctival secretion from acute contagious
conjunctivitis; polynuclear leukocytes with the bacillus of Weeks; P,
phagocyte containing bacillus of Weeks (one-twelfth oil-immersion;
ocular iii) (Morax).]
_Staphylococci_, _pneumococci_, and _streptococci_ are probably the
most common of the bacteria to be found in nonspecific conjunctivitis
and keratitis. The usual cause of acute infectious conjunctivitis,
especially in cities, seems to be the _Koch-Weeks bacillus_. This is a
minute, slender rod, which lies within and between the pus-corpuscles
(Fig. 125), and is negative to Gram's stain. In smears it cannot be
{275} distinguished from the influenza bacillus, although its length
is somewhat greater. The _diplobacillus of Morax and Axenfeld_ gives
rise to an acute or chronic blepharo-conjunctivitis without follicles
or membrane, for which zinc sulphate seems to be a specific. It is
widely distributed geographically, and is common in many regions. The
organism is a short, thick diplobacillus, is frequently intracellular,
and is Gram-negative (Fig. 126). A delicate capsule can sometimes be
made out.
[Illustration: FIG. 126.--The diplobacillus of Morax and Axenfeld
(from a preparation by Dr. Harold Gifford).]
Early diagnosis of gonorrheal ophthalmia is extremely important, and
can be made with certainty only by detection of _gonococci_ in the
discharge. They are easily found in smears from untreated cases. After
treatment is begun they soon disappear, even though the discharge
continues.
Pseudomembranous conjunctivitis generally shows either _streptococci_
or _diphtheria bacilli_. In diagnosing diphtheric conjunctivitis, one
must be on his guard against the {276} _xerosis bacillus_, which is a
frequent inhabitant of the conjunctival sac in healthy persons, and
which is identical morphologically with the diphtheria bacillus. The
clinical picture is hence more significant than the microscopic
findings.
Various micro-organisms--bacteria, molds, protozoa--have been
described in connection with trachoma, but the specific organism of
the disease is not definitely known.
THE EAR
By far the most frequent exciting causes of acute otitis media are the
pneumococcus and the streptococcus. The finding of other bacteria in
the discharge generally indicates a secondary infection, except in
cases complicating infectious diseases, such as typhoid fever,
diphtheria, and influenza. Discharges which have continued for some
time are practically always contaminated with the staphylococcus. The
presence of the streptococcus should be a cause of uneasiness, since
it much more frequently leads to mastoid disease and meningitis than
does the pneumococcus. The staphylococcus, bacillus of Friedländer,
colon bacillus, and Bacillus pyocyaneus may be met in chronic
middle-ear disease.
In tuberculous disease the tubercle bacillus is present in the
discharge, but its detection offers some difficulties. It is rarely
easy to find, and precautions must always be taken to exclude the
smegma and other acid-fast bacilli (p. 35), which are especially
liable to be present in the ear. Rather striking is the tendency of
old squamous cells to retain the red stain, and fragments of such
cells may mislead the unwary.
{277} PARASITIC DISEASES OF THE SKIN
Favus, tinea versicolor, and the various forms of ring-worm are caused
by members of the fungus group. To demonstrate them, a crust or a hair
from the affected area is softened with a few drops of 20 per cent.
caustic soda solution, pressed out between a slide and cover, and
examined with a one-sixth objective. They consist of a more or less
dense network of hyphæ and numerous round or oval refractive spores.
The cuts in standard works upon diseases of the skin will aid in
differentiating the members of the group.
MILK
A large number of analyses of human and cow's milk are averaged by
Holt as follows, Jersey milk being excluded because of its excessive
fat:
HUMAN MILK. COW'S MILK.
Normal variations, Average, Average,
per cent. per cent. per cent.
Fat 3.00 to 5.00 4.00 3.50
Sugar 6.00 to 7.00 7.00 4.30
Proteids 1.00 to 2.25 1.50 4.00
Salts 0.18 to 0.25 0.20 0.70
Water 89.82 to 85.50 87.30 87.00
------ ------ ------ ------
100.00 100.00 100.00 100.00
The reaction of human milk is slightly alkaline; of cow's, neutral or
slightly acid. The specific gravity of each is about 1.028 to 1.032.
Human milk is sterile when secreted, but derives a few bacteria from
the lacteal ducts. Cow's milk, as usually sold, contains large numbers
of bacteria. Microscopically, human milk is a fairly homogeneous
emulsion of fat, and is practically destitute of cellular elements.
[Illustration: FIG. 127.--Holt's milk-testing apparatus.]
Chemic examination of milk is of great value in solving {278} the
problems of infant feeding. The sample examined should be the middle
milk, or the entire quantity from one breast. The fat and proteid can
be estimated roughly, but accurately enough for many clinical
purposes, by means of Holt's apparatus, which consists of a 10 c.c.
cream gage and a small hydrometer (Fig. 127). The cream gage is filled
to the 0 mark with milk, allowed to stand for twenty-four hours at
room temperature, and the percentage of cream then read off. The
percentage of {279} fat is three-fifths that of the cream. The proteid
is then approximated from a consideration of the specific gravity and
the percentage of fat. The salts and sugar very seldom vary
sufficiently to affect the specific gravity, hence a high specific
gravity must be due to either an increase of proteid or decrease of
fat, or both, and vice versâ. With normal specific gravity the proteid
is high when the fat is high, and vice versâ. The method is not
accurate with cow's milk.
For more accurate work the following methods, applicable to either
human or cow's milk, are simple and satisfactory.
* * * * *
[Illustration: FIG. 128.--Tube for milk analysis.]
Fat.--_Leffmann-Beam Method_.--This is essentially the widely used
Babcock method, modified for the small quantities of milk obtainable
from the human mammary gland. The apparatus consists of a special tube
which fits the aluminum shield of the medical centrifuge (Fig. 128)
and a 5 c.c. pipet. Owing to its narrow stem, the tube is difficult to
fill and to clean. Exactly 5 c.c. of the milk are introduced into the
tube by means of the pipet, and 1 c.c. of a mixture of equal parts of
concentrated hydrochloric acid and amyl-alcohol is added and well
mixed. The tube is filled to the 0 mark with concentrated sulphuric
acid, adding a few drops at a time and agitating constantly. This is
revolved in the centrifuge at 1000 revolutions a minute for three
minutes, or until the fat has separated. The percentage is then read
off upon the stem, each small division representing 0.2 per cent. of
fat.
{280} Proteids.--_T. R. Boggs' Modification of the Esbach
Method_.--This is applied as for urinary albumin (p. 74), substituting
Boggs' reagent for Esbach's. The reagent is prepared as follows:
(1) Phosphotungstic acid 25 gm.
Distilled water 125 c.c.
(2) Concentrated hydrochloric acid 25 c.c.
Distilled water 100 c.c.
When the phosphotungstic acid is completely dissolved, mix the two
solutions. This reagent is quite stable if kept in a dark glass
bottle.
Before examination, the milk should be diluted according to the
probable amount of proteid, and allowance made in the subsequent
reading. For human milk the optimum dilution is 1:10; for cow's milk,
1:20. Dilution must be accurate.
Lactose.--The proteid should first be removed by acidifying with
acetic acid, boiling, and filtering. Purdy's method may then be used
as for glucose in the urine (p. 79); but it must be borne in mind that
lactose reduces copper more slowly than glucose, and longer heating
is, therefore, required; and that 35 c.c. of Purdy's solution is
equivalent to 0.0268 gm. lactose (as compared with 0.02 gm. glucose).
* * * * *
It is frequently desirable to detect formalin, which is the most
common preservative added to cow's milk. Add a few drops of dilute
phenol solution to a few cubic centimeters of the milk, and run the
mixture gently upon the surface of some strong sulphuric acid in a
test-tube. If formaldehyd be present, a bright-red ring will appear
{281} at the line of contact of the fluids. This is not a specific
test for formaldehyd, but nothing else likely to be added to the milk
will give it.
SYPHILITIC MATERIAL
[Illustration: FIG. 129.--Spirochæte pallida: _a_ and _b_, Typical
pallida; _c_ and _d_, atypical curves in pallida; _e_, thick pallida,
apparently splitting into three; _f_, two pallida partly so closely
coiled as to resemble thick portion of _e_ (X1800) (Goldhorn).]
In 1905 Schaudinn and Hoffmann described the occurrence of a very
slender, spiral micro-organism in the lesions of syphilis. This they
named _Spirochæte pallida_, because of its low refractive power and
the difficulty with which it takes up staining reagents. Its etiologic
{282} relation to syphilis is now almost universally admitted. It is
not found in tertiary lesions.
_Spirochæte pallida_ is an extremely slender, spiral, motile thread,
with pointed ends. It varies considerably in length, the average being
about 7 µ, or the diameter of a red blood-corpuscle; and it exhibits
three to twelve, sometimes more, spiral curves, which are sharp and
regular and resemble the curves of a corkscrew (Fig. 129). It is so
delicate that it is difficult to see even in well-stained
preparations; a high magnification and careful focusing are,
therefore, required. Upon ulcerated surfaces it is often mingled with
other spiral micro-organisms, which adds to the difficulty of its
detection. The most notable of these is _Spirochæte refringens_, which
is distinguished by being coarser and having fewer curves of wider and
less sharp contour (Fig. 130).
[Illustration: FIG. 130.--Spirochæte refringens (X1800) (Goldhorn).]
_Spirochæte pallida_ is most easily demonstrated in chancres and
mucous patches, although the skin lesions--papules, pustules,
roseolous areas--often contain large numbers. Tissue-juice from the
deeper portions of the lesions is the most favorable material for
examination, because the organisms are commonly more abundant than
upon ulcerated surfaces and are rarely accompanied by other
micro-organisms. After cleansing the surface a superficial incision
with a scalpel or sharp needle is made at the edge of a lesion, or the
surface is gently scraped away with a curet, and a drop of blood and
serum is expressed. The less blood the better, because the {283}
corpuscles may hide the spirochæte. Very thin cover-glass smears are
then made.
Goldhorn's stain gives very good results. It can be purchased ready
prepared from E. Leitz, New York. The unfixed smear is covered with
the stain for four or five seconds. The excess of stain is poured off,
and the preparation introduced _slowly, with the film side down_, into
distilled water. It is held in this position for four or five seconds,
and is then washed by shaking about in the water. By this method the
_Spirochæte pallida_ appears of a violet color, which can be changed
to bluish black by flooding with Gram's iodin solution for fifteen or
twenty seconds. The preparation is then washed, dried, and mounted.
SEMEN
Absence of spermatozoa is a more common cause of sterility than is
generally recognized. In some cases they are present, but lose their
motility immediately after ejaculation.
Semen must be kept warm until examined. When it must be transported
any considerable distance, the method suggested by Boston is
convenient. The fresh semen is placed in a small bottle to the neck of
which a string is attached. This is then suspended from a button on
the trousers so that the bottle rests against the skin of the inguinal
region. It may be carried in this way for hours. When ready to
examine, place a small quantity upon a warmed slide and apply a cover.
The spermatozoa are readily seen with a one-sixth objective (Fig. 53).
Normally, they are abundant and in active motion.
Detection of semen in stains upon clothing, etc., is {284} often
important. The finding of spermatozoa, after soaking the stain for an
hour in normal salt solution or dilute alcohol and teasing in the same
fluid, is absolute proof that the stain in question is semen, although
it is not possible to distinguish human semen from that of the lower
animals in this way.
[Illustration: FIG. 131.--Seminal crystals (medium size) (X750) from a
stain on clothing. A single thread one-eighth inch long was used in
the test, the stain being three years and four months old (Peterson
and Haines).]
Florence's Reaction.--The suspected material is softened with water,
placed upon a slide with a few drops of the reagent, and examined at
once with a medium power of the microscope. If the material be semen,
there will be found dark-brown crystals (Fig. 131) in the form of
rhombic platelets resembling hemin crystals, or of needles often
grouped in clusters. These crystals can {285} also be obtained from
crushed insects, watery extracts of various internal organs, and
certain other substances, so that they are not absolute proof of the
presence of semen. Negative results, upon the other hand, are
conclusive, even when the semen is many years old.
The reagent consists of iodin, 2.54 gm.; potassium iodid, 1.65 gm.;
and distilled water, 30 c.c.
{286}
APPENDIX
I. APPARATUS AND REAGENTS
The apparatus and reagents listed here are sufficient for all the
tests described in the text. Those in smaller type are less frequently
required. For ordinary routine work a much smaller list will suffice.
A. APPARATUS
Beakers and flasks, several sizes, preferably of Jena glass.
Blood lancet, or some substitute (Fig. 64).
Bunsen-burner or alcohol lamp.
Buret, 25 c.c. capacity; preferably with Schellbach stripe.
Buret and filter-stand combined.
Centrifuge--hand, electric, or water-power (Figs. 16 and 17). With the
last two a speed indicator is desirable. Radius of arm when in motion
should be six and three-fourth inches. Plain and graduated tubes
accompany the instrument; milk-tubes (Fig. 128) must be purchased
separately. When sedimentation only is desired, the torfuge (Fig. 31)
is a cheap and convenient substitute.
Cigaret-paper, "Zig-zig" brand, or some similar thin paper.
Corks, preferably of rubber, with one and two holes.
Cover-glasses, No. 2 thickness--seven-eighth-inch squares are most
convenient.
{287} Cover-glass forceps.
Esbach's tube (Fig. 23).
Evaporating dish.
Filter-paper: ordinary cheap paper for urine filtration; "ashless"
quantitative filter-paper for chemic analyses.
Glass funnels.
Glass rods and tubing of sodium glass: for stirring rods, urinary
pipets, etc.
Glass slides: the standard 1- by 3-inch size will answer for all work,
although a few larger slides will be found convenient; those of medium
thickness are preferable.
Graduates, cylindric form, several sizes.
Granite-ware basin.
Hemoglobinometer: see pp. 143 to 147 for descriptions of the different
instruments.
Hemocytometer: either Türk or Zappert ruling is desirable (Figs. 69,
70, and 72).
Labels for slides and bottles.
Litmus paper, red and blue, Squibb's preferred.
Microscope (Fig. 1): should have Abbé condenser, 1- and 2-inch
eye-pieces, and two-thirds, one-fifth, or long focus one-sixth and
one-twelfth inch objectives. A one-half inch eye-piece, a micrometer
eye-piece, and an attachable mechanical stage are very useful
additions.
Petri dish or cleaned photographic plates for sputum examination.
Stomach-tube.
Test-glass, conic, one side painted half white, half black.
Test-tubes, rack, and cleaning brush.
Ureometer, Doremus-Hinds' pattern (Fig. 20).
Urinometer, preferably Squibb's (Fig. 14).
* * * * *
{288} Blood-fixing oven, or Kowarsky's plate (Fig. 77).
Copper-foil and gauze.
Holt's cream gage and hydrometer (Fig. 127).
Horismascope (Fig. 22).
Pipets, graduated, 5 c.c. to 50 c.c. capacity.
Ruhemann's tube for uric-acid estimation (Fig. 21).
Saccharimeter (Fig. 25).
Strauss' separatory funnel for lactic-acid test (Fig. 87).
Suction filter.
Urinopyknometer of Saxe (Fig. 15).
Widal reaction outfit: either living agar cultures of the typhoid
bacillus, or the dead cultures with diluting apparatus, which are sold
under various trade names.
Water-bath.
B. REAGENTS AND STAINS
All stains and many reagents are best kept in small dropping bottles.
Formulæ are given in the text.
Acid, glacial acetic. Other strengths can be made from this as
desired.
Acid, hydrochloric, concentrated (contains about 32 per cent. by
weight of absolute hydrochloric acid). Other strengths can be made as
desired.
Acid, nitric, strong, colorless.
Acid, nitric, yellow. Can be made from colorless acid by adding a
splinter of pine, or allowing to stand in sunlight.
Acid, sulphuric, concentrated.
Alcohol, ethyl (grain-alcohol). This is ordinarily about 93 to 95 per
cent., and other strengths can be made as desired.
Aqua ammoniæ fortior (sp. gr. 0.9).
Bromin or Rice's solutions (p. 67), for urea estimation.
{289} Chloroform.
Diluting fluid for erythrocyte count (p. 154).
Diluting fluid for leukocyte count (p. 165).
Dimethyl-amido-azobenzol, 0.5 per cent. alcoholic solution.
Distilled water.
Esbach's reagent (p. 74).
Ether, sulphuric.
Ferric chlorid: saturated aqueous solution and 10 per cent. aqueous
solution.
Haines' (or Fehling's) solution (p. 78).
Lugol's solution (_Liquor Iodi Compositus_, U.S.P.). Gram's iodin
solution (p. 38) can be made from this by adding fourteen times its
volume of water.
Obermayer's reagent (p. 64).
Phenylhydrazin, pure.
Phenol.
Phenolphthalein, 1 per cent. alcoholic solution.
Purdy's (or Fehling's) solution (p. 80).
Robert's reagent (p. 73).
Sodium chlorid (table-salt), saturated aqueous solution.
Sodium hydroxid (caustic soda), 40 per cent. solution; other strengths
can be made from this as desired.
Sodium hydroxid, decinormal solution. This is best purchased ready
prepared.
Sodium nitrite, 0.5 per cent. solution for diazo reaction. Must be
freshly prepared.
Sulphanilic acid solution for diazo reaction (p. 91).
Stains:
Carbol-fuchsin (p. 33).
Eosin, saturated aqueous solution.
Gabbet's stain (p. 34). {290}
Löffler's alkaline methylene-blue solution (p. 38).
Stain for fat: Sudan III, saturated solution in 70 per cent.
alcohol; or 1 per cent. aqueous solution osmic acid.
Wright's stain for blood.
Tincture of guaiac, diluted to a light sherry-wine color (keep in a
dark-glass bottle).
Turpentine, "ozonized" (p. 89).
* * * * *
Acid, boric, for preserving urine (p. 48).
Acid, oxalic.
Acid, salicylous (salicyl aldehyd), 10 per cent. alcoholic solution.
Alcohol, amylic.
Alcohol, ethyl, absolute.
Alcohol, methyl (pure).
Barium chlorid mixture (p. 62).
Benzol.
Boas' reagent or Günzburg's (p. 219).
Boggs' reagent (p. 280).
Calcium chlorid, 1 per cent. solution.
Canada-balsam in xylol: necessary only when permanent microscopic
preparations are made.
Carbon disulphid.
Charcoal, animal.
Chromium trioxid.
Congo-red, strong alcoholic solution.
Copper sulphate.
Diluting fluid for blood-platelet count (p. 167).
Egg-albumen discs in glycerin (p. 221).
Ether, acetic, pure.
Florence's reagent (p. 285).
Formalin (40 per cent. solution of formaldehyd gas).
{291} Iodin crystals.
Iron sulphid.
Lead acetate (sugar of lead); used in 10 per cent. solution to clarify
urine.
Lead acetate, tribasic.
Lime-water.
Magnesium carbonate.
Müller's fluid saturated with mercuric chlorid (p. 37).
Pepsin, U.S.P.
Phenylhydrazin hydrochlorid.
Potassium ferrocyanid, 10 per cent. solution.
Potassium persulphate.
Ruhemann's reagent (p. 69).
Silver-nitrate crystals; also dram to the ounce aqueous solution, and
"ammoniated" solution (p. 68).
Sodium alizarin sulphonate, 1 per cent. aqueous solution.
Sodium carbonate.
Sodium chlorid, 2 per cent. solution; from this, normal salt solution
(0.8 per cent.) can be made as desired.
Sodium hyposulphite.
Sodium nitroprussid.
Sodium sulphate.
Stains:
Anilin-gentian violet (p. 38).
Bismarck-brown, saturated aqueous or alcoholic solution.
Ehrlich's triple stain for blood.
Eosin, 0.5 per cent. alcoholic solution for blood.
Fuchsin, weak solution; can be made when desired by adding a little
carbol-fuchsin to a test-tube of water.
Gentian-violet, saturated alcoholic solution.
Goldhorn's spirochæte stain (p. 283).
Methylene-blue and borax solution (p. 193).
Methylene-blue, saturated aqueous solution for blood.
Sulphur, powdered.
{292} Trichloracetic acid solution (p. 71).
Uranium nitrate, 5 per cent. aqueous solution.
Xylol.
Zinc, arsenic free.
II. WEIGHTS, MEASURES, ETC., WITH EQUIVALENTS
METRIC
Meter (unit of length): Millimeter (mm.) = 1/1000 meter.
Centimeter (cm.) = 1/100 meter.
Kilometer = 1000 meters.
Micron (µ) = 1/1000 millimeter.
Gram (unit of weight): Milligram (mg.) = 1/1000 gram.
Kilogram (kilo.) = 1000 grams.
Liter (unit of capacity): Cubic Centimeter = 1/1000 liter. Same as
milliliter (ml.).
1 Millimeter = 0.03937 (1/25 approx.) in.
1000 microns.
1 Centimeter = 0.3937 (2/5 approx.) in.
0.0328 feet.
1 Meter = 39.37 in.
3.28 feet.
1 Micron (µ) = 1/25000 in.
0.001 millimeter.
1 Gram = 15.43 grains.
0.563 dram (Avoir.).
0.035 ounce (Avoir.).
0.0022 pound (Avoir.).
0.257 dram (Apoth.).
0.032 ounce (Apoth.).
0.0027 pound (Apoth.).
1 Kilogram = 35.27 ounce (Avoir.).
2.2 pound (Avoir.).
1 Liter = 1.056 (1 approx.) quart.
61.02 cu. inches.
1000 cu. centimeters.
1 Sq. Millimeter = 0.00155 sq. in.
1 Sq. Centimeter = 0.1550 sq. in.
1 Sq. Meter = 1550 sq. in.
1 Sq. Meter = 10.76 sq. feet.
1 Cu. Millimeter = 0.00006 cu. in.
1 Cu. Centimeter = 0.0610 cu. in.
1 Cu. Centimeter = 0.001 liter.
1 Cu. Meter = 35.32 cu. feet.
1 Cu. Meter = 61025.4 cu. in.
1 Inch = 25.399 millimeters.
1 Sq. Inch = 6.451 sq. centimeters.
1 Cu. Inch = 16.387 cu. centimeters.
1 Foot = 30.48 centimeters.
1 Sq. Foot = 0.093 sq. meter.
1 Cu. Foot = 0.028 cu. meter.
AVOIRDUPOIS WEIGHT
1 Ounce = 437.5 grains.
1 Ounce = 16 drams.
1 Pound = 16 ounces.
1 Grain = 0.065 (3/50 approx.) grams.
1 Dram = 1.77 (1¾ approx.) grams.
1 Ounce = 28.35 (30 approx.) grams.
1 Pound = 453.59 (500 approx.) grams.
1 Pound = 27.7 cu. inches.
1 Pound = 1.215 lb. Troy.
APOTHECARIES' MEASURE
1 Dram = 60 minims.
1 Ounce = 8 drams.
1 Pint = 16 ounces.
1 Gallon = 8 pints.
1 Dram = 3.70 cu. centimeters.
1 Ounce = 29.57 cu. centimeters.
1 Pint = 473.1 cu. centimeters.
1 Gallon = 3785.4 cu. centimeters.
1 Gallon = 231 cu. inches.
{293} APOTHECARIES' WEIGHT
1 Scruple = 20 grains.
1 Dram = 3 scruples = 60 grains.
1 Ounce = 8 drams = 480 grains.
1 Pound = 12 ounces.
1 Grain = 0.065 grams.
1 Dram = 3.887 grams.
1 Ounce = 31.10 grams.
1 Pound = 373.2 grams.
To convert _minims_ into _cubic centimeters_ multiply by 0.061
" " _fluidounces_ " _cubic centimeters_ " " 29.57
" " _grains_ " _grams_ " " 0.0648
" " _drams_ " _grams_ " " 3.887
" " _cubic centimeters_ into _minims_ " " 16.23
" " _cubic centimeters_ " _fluidounces_ " " 0.0338
" " _grams_ " _grains_ " " 15.432
" " _grams_ " _drams_ " " 0.257
TEMPERATURE
Centigrade. Fahrenheit. Centigrade. Fahrenheit.
110° 230° 37° 98.6°
100 212 36.5 97.7
95 203 36 96.8
90 194 35.5 95.9
85 185 35 95
80 176 34 93.2
75 167 33 91.4
70 158 32 89.6
65 149 31 87.8
60 140 30 86
55 131 25 77
50 122 20 68
45 113 15 59
44 111.2 10 50
43 109.4 +5 41
42 107.6 0 32
41 105.8 -5 23
40.5 104.9 -10 14
40 104 -15 +5
39.5 103.1 -20 -4
39 102.2 -------------------
38.5 101.3 0.54° = 1°
38 100.4 1 = 1.8
37.5 99.5 2 = 3.6
2.5 = 4.5
To convert Fahrenheit into Centigrade subtract 32 and multiply by
0.555.
To convert Centigrade into Fahrenheit multiply by 1.8 and add 32.
{295}
INDEX
Absorptive power of stomach, 233
Acarus scabiei, 259
Accidental albuminuria, 70
Acetanilid in urine, 95
Acetic acid in gastric contents, 219
Acetone in urine, 82, 83. See also _Acetonuria_.
Acetonuria, 82, 83
after anesthesia, 83
Gunning's test in, 84
Lange's test in, 85
Legal's test for, Lange's modification, 85
Lieben's test in, Gunning's modification, 85
tests, 84-86
Trommer's test in, 86
Achard and Castaigne's methylene-blue test for urine, 56
Achlorhydria, 225
Achylia gastrica, gastric contents in, 231
Acid intoxication, cause, 83
Acid-albumin, 213
Acid-fast bacilli, 35
Acidophilic structures of blood, 172
Actinomyces bovis in sputum, 31
Active hyperemia, urine in, 132
Agglutination, 196
Agglutinins, 196
Air-bubbles in urine, 132
Albumin, acid-, 213
in urine, 69. See also _Albuminuria_.
Albuminometer, Esbach's, 74
Albuminuria, 69
accidental, 70
centrifugal estimation of albumin, 74
Esbach's estimation of albumin, 74
estimation of albumin in, quantitative, 74
false, 70
from blood changes, 70
from kidney changes, 70
functional, 70
heat and nitric acid test in, 73
test in, Purdy's, 73
nitric acid test in, 73
Purdy's centrifugal method, 74
heat test in, 73
table after centrifugation, 75
renal, 70
Robert's test in, 73
tests, 71-75
trichloracetic acid test in, 71
Albumoses in urine, 76
Albumosuria, 76
Alkaline methylene-blue, Löffler's, 38
Alveolar cells in sputum, 43
Ameboid movements of malarial parasites, 187
Amidobenzol test for free hydrochloric acid, 219
Ammoniated silver nitrate solution, 68
Ammoniomagnesium phosphate crystals in urine, 109
Ammonium urate crystals in urine, 112
Amoeba coli dysenteriæ, 244
in feces, 235
Amorphous phosphates in urine, 50, 61, 111
in mass, 120
urates in urine, 50, 67, 105
in mass, 120
Anæmia infantum pseudoleukæmica, 211
Anemias, 203
aplastic, 207
blood-plaques in, 166
color index in, 156
degeneration of Grawitz in, 176
erythroblasts in blood in, 177
erythrocytes in, 175
from uncinaria, 256
lymphocytes in, 179
myelocytes in, 184
oligocythemia in, 150
pernicious, 205
polychromatophilia in, 176
primary, 205
secondary, 204
blood picture, 204
splenic, 208
table of blood changes in, 212
Anesthesia, acetonuria after, 83
Angina, Vincent's, 273
Anguillula aceti in urine, 129
Anilin dyes for blood-films, 171
Anilin-gentian-violet stain, 38
Animal inoculation, 269
parasites, 244. See also _Parasites, animal_.
Anopheles, 189
Antipyrin in urine, 95
Anuria, 49
Aplastic anemia, 207
Apothecaries' measure, 292
weight, 293
Apparatus, 286
Appendicitis, leukocytosis in, 160
Arsenic in urine, 95
poisoning, anemia from, 204
Arthropoda, 259
Ascaris lumbricoides, 253
Asthma, bronchial, eosinophilia in, 183
sputum in, 45
Atrophic gastritis, gastric contents in, 231
Atropin in urine, 96
Avoirdupois weight, 292
Babcock estimation for fat in milk, 279
Bacillus, acid-fast, 35
Boas-Oppler, in gastric contents, 229
diphtheriæ in eye affections, 275
in mouth, 272
Koch-Weeks, in conjunctivitis, 274
mucosus capsulatus in sputum, 38
of Friedländer in otitis, 276
in sputum, 38
of influenza in sputum, 39
pyocyaneus in otitis, 276
smegma, 35, 127
tuberculosis in cerebrospinal fluid, 268
in feces, 242
in otitis, 276
in pus, 263
in sputum, 32
examination, 24
Gabbet's method for, 32
methods for, 32-35
in urine, 127
typhosus in urine, 127
Bacteria in feces, 241
stains for, 242
in gastric contents, 229
in pus, 261
in sputum, 32
in urine, 51, 126
Bacterial casts in urine, 119
vaccines, Wright's, 201
Balantidium coli, 246
Basophilic granular degeneration, 176
leukocytes, 183
stippling, 176
structures of blood, 172
Beef tape-worm, 247, 248
Bile acids in urine, 87
tests, 88
in feces, 239
in gastric contents, 217
in urine, 87
Gmelin's test for, 87
Smith's test for, 87
tests, 87, 88
Bile-pigment in urine, 87
Bilifuscin in urine, 87
Biliousness, indican in urine in, 63
Bilirubin in urine, 87
Biliverdin in urine, 87
Blepharoconjunctivitis, 275
Blood, 139
acidophilic structures of, 172
basophilic structures of, 172
blood-plaques in, 165
changes, albuminuria from, 70
in blood diseases, table, 212
color index, 155
constituents, 139
count, 149
diluting fluids for, 154
Thoma-Zeiss hemocytometer for, 150, 151
diseases, blood changes in, table, 212
Ehrlich's triple stain for, 172
eosin and methylene-blue for, 172
eosinophilic structures of, 172
erythrocytes in, number, 149
filaria nocturna in, 194
sanguinis hominis in, 194
guaiac test for, 202
hemin test for, 202
in anemia, 203
secondary, 204
in chlorosis, 207
in feces, 238, 241
in gastric contents, 217, 228
test for, 223
in leukemia, 208
in urine, 51
Jenner's stain for, 174
leukocytes in, number, 156
neutrophilic structures of, 172
obtaining of, for blood-count, 152
for coagulation test, 140
oxyphilic structures of, 172
parasites, 186
pathology, special, 203
plasmodium malariæ in, 187
recognition of, tests, 202
stained, plasmodium malariæ in, 192
study of, 168, 175
stains, 168
for films, 168, 171
Wright's, in cytodiagnosis, 266
Teichmann's test for, 202
triple stain for, Ehrlich's, 172
trypanosoma hominis in, 195
unstained, plasmodium malariæ in, 191
Wright's stain for, 173
Blood-casts in urine, 118
Blood-corpuscles, red, 139
in sputum, 43
in urine, 124
white, 139
Blood-dust of Müller, 140
Blood-films, 168
anilin dyes for, 171
chemic fixation of, 170
cigarette-paper method, 169
drying, 170
Ehrlich's two-cover method, 168
fixing, 170
heat fixation for, 171
Kowarsky's plate for fixing, 171
making, 168
plasmodium malariæ in, 192
spreading, 168
stain for, 168, 171
stained, study of, 175
staining, 168, 171
two-slide method, 168
Blood-lancet, 141
Blood-plaques, 139
counting of, 166
diluting fluid in counting, 167
enumeration, 165
in anemia, 166
in infections, 166
in leukemia, 166
in purpura hæmorrhagica, 166
Kemp-Calhoun-Harris estimation, 166
stained, study of, 185
variation in number, 166
Blood-platelets, 139. See also _Blood-plaques_.
Blood-serum, 140
reactions, 196
Boas' reagent, 219
test for free hydrochloric acid, 219
test-breakfast, 215
Boas-Oppler bacilli in feces, 242
in gastric contents, 229
Boggs' modification of Esbach's method for proteids in milk, 280
reagent, 280
Boston's method of keeping semen for examination, 283
Bothriocephalus latus, 247, 249
Brick-dust deposit in urine, 50, 106
Bromids in urine, 96
Bronchial asthma, eosinophilia in, 183
sputum in, 45
Bronchiectasis, sputum in, 44
Bronchitis, sputum in, 43, 44
Buerger's method for pneumococcus capsules, 37
in pus, 263
Butyric acid in gastric contents, 219
Cabot's classification of pathologic polymorphonuclear leukocytosis,
160
Calcium carbonate crystals in urine, 112
oxalate in urine, 106
phosphate crystals in urine, 110
Calculi in feces, 238
Calculus, renal, urine in, 134
vesical, urine in, 137
Cammidge's pancreatic reaction, 91
technic, 92
Capsules of pneumococcus, Buerger's method for, 37
stains for, 37
Carbol-fuchsin, 33
Carcinoma, gastric, bacteria in feces in, 242
stomach contents in, 232
Casts in sputum, 30
in urine, 113
Cedar oil for oil-immersion objective, 21
Cells, alveolar, in sputum, 43
cylindric, in sputum, 42
epithelial, in sputum, 41
in sputum, 40, 42
stains for, 40
Centigrade and Fahrenheit scales, 293
Central illumination of microscope, 18
Centrifuge for albumin in urine, 74
for chlorids in urine, 58
Purdy's table, 60
for phosphates in urine, Purdy's, 61
for sulphates in urine, Purdy's, 62
Purdy's, 57
tubes, Purdy's, 59
water-motor, 58
Cercomonas hominis, 246
Cerebrospinal fever, epidemic, cerebrospinal fluid in, 268
fluid, bacillus tuberculosis in, 268
examination, 268
Cestoda, 247
Charcot-Leyden crystals in feces, 243
in sputum, 29, 30
Chemic fixation for blood-films, 170
Chemotaxis, 157
Chlorids in urine, 56
estimation, quantitative, 57, 59
Purdy's centrifuge methods, 58
table, 60
in nephritis, 56
Chlorosis, 207
color index in, 156
lymphocytes in, 179
oligocythemia in, 150
Cholesterin crystals in sputum, 30
Chyluria from filaria sanguinis hominis infection, 109
Cigarette-paper method for blood-films, 169
Cirrhosis of liver, anemia from, 204
Clover-leaf nucleated erythrocytes, 177
Coagulation, 140
time, 140
Cochin China diarrhea, 258
Coffin-lid crystals in urine, 110
Color index in chlorosis, 156
in pernicious anemia, 156
Combined hydrochloric acid, Töpfer's test, 226
Compsomyia macellaria, 260
Concretions in feces, 238
Congo-red test for free acids in gastric contents, 218
Conjunctivitis, acute infectious, 274
bacteria of, 274
blepharo-, 275
diphtheric, 275
gonorrheal, 275
pseudomembranous, 275
Cook's method for purin bodies, 68
Corpuscles, blood-, red, 139
in sputum, 43
in urine, 124
white, 139
pus-, 181, 261
in feces, 241
in gastric contents, 229
in sputum, 40
in urine, 123
Corrections for objectives, 21
Cotton fibers in urine, 120, 131
Cows' milk, 277
Croupous pneumonia, sputum in, 45
Cryoscopy, 55
Crystals, Charcot-Leyden, in sputum, 29, 30
in feces, 243
in sputum, 30
Culex, 189
Curschmann's spirals in sputum, 29
Cylindric cells in sputum, 42
Cylindroids in urine, 119
Cystin crystals in urine, 108
Cystitis, urine in, 136
Cytodiagnosis, 266
Daland's blood-lancet, 141
Dare's estimation of hemoglobin, 146
hemoglobinometer, 146
Degeneration of Grawitz, 176
Dextrose in urine, 76. See also _Glycosuria_.
Diabetes insipidus, urine in, 137
mellitus, urine in, 138
Diacetic acid in urine, 86
Gerhardt's test for, 86
Lindemann's test for, 86
tests, 86
Diarrhea, polycythemia in, 149
Differential count of leukocytes, 178
Digestion, stomach, 213
Dilatation of stomach, gastric contents in, 230
Diluting fluid for blood count, 154
in leukemia, 165
for blood-plaque count, 167
Diazo reaction, 89
in measles, 91
in tuberculosis, 90
in typhoid fever, 90
technic, 91
substances in urine, 89
Diphtheria of nasopharynx, 272
of tonsils, 272
Diplobacillus of Morax and Axenfeld, 275
Diplococcus intracellularis meningitidis, 268
of Fränkel in sputum, 35
Distilling apparatus, 84
Distoma hæmatobium in urine, 128
Donné's test for pus in urine, 50
Doremus-Hinds' ureometer, 66
Drugs, effect on urine, 50, 95
leukocytosis from, 161
Drunkard's pneumonia, sputum in, 25
Dry objective, 21
Dysentery, tropical, parasite of, 244
Ear, 276
Earthy phosphates in urine, 111
Echinococcus disease, 247, 251
anemia from, 204
eosinophilia in, 183
parasite of, 247, 251
Edema, pulmonary, sputum in, 45
Egyptian hematuria, 128
Ehrlich's diazo reaction, 89
technic, 91
triple stain for blood, 172
two-cover method for blood-films, 168
Einhorn's saccharimeter, 81
Elastic fibers in sputum, 27
Enteroliths in feces, 238
Envelope crystals in urine, 106
Eosin and methylene-blue for blood, 172
Eosinophiles, 182
in sputum, 41
Eosinophilia, 182
in bronchial asthma, 183
in echinococcus disease, 183
in filariasis, 183
in menstruation, 182
in myelogenous leukemia, 183
in parasitic infections, 183
in scarlet fever, 183
in skin diseases, 183
in trichinosis, 183
in uncinariasis, 183
in worm infection, 183
Eosinophilic leukocytes, 182
in sputum, 41
leukocytosis, 159
structures of blood, 172
Epidemic cerebrospinal fever, cerebrospinal fluid in, 268
Epithelial casts in urine, 118
cells in feces, 241
in sputum, 41
in urine, 121, 122
Erythroblasts, 177
Erythrocytes, 139
counting of, 150, 151
decrease of, 150
enumeration of, 149
in anemias, 175
in feces, 241
in gastric contents, 228
in leukemia, 175
in pernicious anemia, 175
increase of, 149
nucleated, 177
shape of, 175
size of, 175
stained, study of, 175
staining properties of, variations in, 176
structure, 175
variations in, 177
Thoma-Zeiss instrument for counting, 150, 151
Esbach's albuminometer, 74
estimation of proteids in milk, Boggs' modification, 280
method for albumin in urine, 74
reagent for albumin, 74
Estivo-autumnal parasite, 187, 188, 194
Ewald's salol test for gastric motor power, 234
test-breakfast, 215
Exudates, 265
Eye, 274
Eye-pieces, micrometer, 23
microscopic, 20
Fahrenheit and Centigrade scales, 293
False albuminuria, 70
Fat in feces, 241
in milk, estimation, 279
needles in sputum, 30
Fat-droplets in urine, 131
Fat-globules in urine, 109
Fatty casts in urine, 117
Favus, 277
Feces, 235
amoeba coli in, 235
animal parasites in, 238
bacillus tuberculosis in, 242
bacteria in, 241
stains for, 242
bile in, 239
blood in, 238, 241
Boas-Oppler bacilli in, 242
calculi in, 238
chemic examination of, 238
color, 236
concretions in, 238
consistence, 236
crystals in, 243
detection of occult hemorrhage, 239
enteroliths in, 238
epithelial cells in, 241
erythrocytes in, 241
examination of, 235
chemic, 238
macroscopic, 236
microscopic, 239
specimen for, 235
fat in, 241
food particles in, 240
form, 236
frequency of passage, 236
gall-stones in, 238
macroscopic examination, 236
microscopic examination, 239
milk curds in, 241
mucus in, 237
muscle-fibers in, 240
normal, 235, 240
odor, 237
parasites in, animal, 238
ova of, 243
pus-corpuscles in, 241
quantity, 236
starch-granules in, 240
tape-worms in, 238
vegetable cells in, 240
fibers in, 240
Fehling's estimation of glucose in urine, 81
test for glucose, 78
Fermentation method of estimating glucose in urine, 81
Fibers, elastic, in sputum, 27
in urine, extraneous, 120, 131
of cotton in urine, 120, 131
of linen in urine, 120, 131
of silk in urine, 120, 131
of wool in urine, 120, 131
Fibrinous casts in sputum, 30
in urine, 117
Filaria nocturna, 194
sanguinis hominis, 194, 254
infection, chyluria from, 109
in urine, 128
Filariasis, 194
eosinophilia in, 183
parasite of, 254
Filariform embryos of strongyloides intestinalis, 258
Fish tape-worm, 247, 249
Fixation, chemic, for blood-films, 170
heat, for blood-films, 171
of blood-films, 170
Kowarsky's plate for, 171
Flaws in slides as source of error, 132
Flies, 260
Floaters in urine, 128
Florence's reaction for detection of semen, 284
reagent, 285
Focusing microscope, 19
Food particles in feces, 240
in gastric contents, 217, 228
Formaldehyd in milk, test for, 280
Formalin in milk, test for, 280
Fränkel's diplococcus in sputum, 35
Free hydrochloric acid, 213. See also _Hydrochloric acid, free_.
Freezing-point of urine, 55
Friedländer's bacillus in otitis, 276
in sputum, 38
Fruit-sugar in urine, 82
Functional albuminuria, 70
Fungi in urine, 131
Gabbet's method for bacillus tuberculosis in sputum, 32
stain, 34
Gall-stones in feces, 238
Gametes in malaria, 188
staining of, 193
Gangrene of lung, sputum in, 44
Gastric carcinoma, bacteria in feces in, 242
gastric contents in, 232
contents, acetic acid in, 219
bacilli in, 229
bacteria in, 229
bile in, 217
blood in, 217, 228
test for, 223
Boas-Oppler bacillus in, 229
butyric acid in, 219
chemic examination, 218
constituents, 213
erythrocytes in, 228
examination, 213
chemic, 218
microscopic, 228
physiology, 217
routine, 214
food particles in, 217, 228
free acids in, Congo-red test for, 218
tests for, 218
hydrochloric acid in, 213. See also _Hydrochloric acid_.
in achylia gastrica, 231
in atrophic gastritis, 231
in carcinoma, 232
in dilatation, 230
in disease, 230
in gastritis, 231
in gastrosuccorrhea, 231
in neuroses, 231
in ulcer, 232
lactic acid in, 219. See also _Lactic acid_.
leptothrix buccalis in, 230
microscopic examination, 228
mucus in, 217
obtaining, 214
organic acids in, 219
quantitative test, 226
pepsin in, Hammerschlag's test, 227
quantitative test, 227
tests for, 221
pepsinogen in, test for, 221
physical examination, 217
pus-corpuscles in, 229
reaction, 217
rennin in, test for, 222
renninogen in, test for, 223
sarcinæ in, 229
tests, qualitative, 218
quantitative, 223
tissue bits in, 218
total acidity, 223
tests, 223
Töpfer's test, 223
withdrawal, 215
yeast-cells in, 229
juice, stimulation, for specimen, 214
test-meals to stimulate, 214
neuroses, stomach contents in, 231
ulcer, gastric contents in, 232
Gastritis, gastric contents in, 231
Gastro-intestinal diseases, anemia from, 204
Gastrosuccorrhea, gastric contents in, 231
Gerhardt's test for diacetic acid, 86
Globular sputum, 46
Glucose in urine, 76. See also _Glycosuria_.
Glycosuria, 76
estimation of glucose, 79
Fehling's quantitative estimation, 81
test in, 78
fermentation method of estimating, 81
Haines' test in, 77
Kowarsky's test in, 78
persistent, 77
phenylhydrazin test in, 78
Purdy's estimation of glucose, 79
tests, 77-82
transitory, 76
Gmelin's test for bile, 87
Goldhorn's stain for spirochæte pallida, 283
Gonococcus in ophthalmia, 275
in pus, 264
in urine, 128
Gonorrheal ophthalmia, 275
threads in urine, 128
Gram's iodin solution, 38
method for bacillus influenza in sputum, 39
for bacteria in feces, 242
for pus, 261
Granular casts in urine, 117
degeneration, basophilic, 176
Granule epithelial cells in urine, compound, 122
Granules, lycopodium, in urine, 132
starch, in urine, 131
Gravel in urine, 104
Grawitz's degeneration, 176
Guaiac test for blood, 202
for hemoglobin, 89
Gunning's test for acetone, 84
Gutzeit's test for arsenic, 95
Haines' solution, 78
test for glucose, 77
Hairs in urine, 120
Hammerschlag's estimation of hemoglobin, 146
test for pepsin, 227
Häser's method for total solids in urine, 55
Hayem's diluting fluid for blood count, 154
hematoblasts, 185
Hay's test for bile acids, 88
Heart disease, anemia from, 204
polycythemia in, 149
Heart-failure cells in sputum, 27, 43, 44
Heat and nitric acid test for albumin, 73
fixation for blood-films, 171
test for albumin, Purdy's, 73
Hematoblasts of Hayem, 185
Hematocrit, 151
Hematoidin crystals in sputum, 30
Hematuria, 125
Egyptian, 128
hemoglobinuria and, differentiation, 88
Hemin crystal test for blood, 202
Hemocytometer, diluting fluids for, 154
Thoma-Zeiss, 150, 151
cleaning instrument, 155
sources of error, 155
technic, 152
Hemoglobin, 142
Dare's estimation, 146
decrease of, 142. See also _Oligochromemia_.
estimation, 143-149
Hammerschlag's estimation, 146
in urine, 88. See also _Hemoglobinuria_.
increase of, 142. See also _Hyperchromemia_.
Sahli's estimation, 144
Tallquist's estimation, 147
von Fleischl's estimation, 143
Hemoglobinometer, Dare's, 146
Sahli's, 144, 145
Tallquist's, 147, 148
von Fleischl's, 143
Hemoglobinuria, guaiac test in, 89
hematuria and, differentiation, 88
paroxysmal, 89
Teichmann's test in, 89
tests, 89
Hemorrhage, anemia from, 204
leukocytosis after, 161
occult detection in feces, 239
Hemosporidia, 187, 247
Herapathite, 100
Hip-roof crystals in urine, 110
Hiss's method for pneumococci in pus, 263
Hodgkin's disease, 208, 211
Holt's milk-testing apparatus, 278
Horismascope, 72, 73
Human milk, 277
Hyaline casts in urine, 114
stage of plasmodium malariæ, 187
Hydatid disease, 247, 251
parasite of, 247, 251
Hydrochloric acid, combined, 213
Töpfer's test, 226
free, 213
absence, 225
amidobenzol test for, 219
amount, 224
Boas' test for, 219
decrease, 225
increase, 224
tests for, 218
quantitative, 224
Töpfer's test for, 225
secretion, 213
Hydrogen sulphid generator, 98
Hyperchlorhydria, 225
Hyperchromemia, 142
Hyperemia, active, urine in, 132
passive, urine in, 133
renal, urine in, 132
Hyphæ of molds in urine, 121
Hypobromite method for urea in urine, 66
Hypochlorhydria, 225
Illumination for microscope, 17
Immersion objective, 21
Indican in urine, 63
from decomposition of exudates, 63
in biliousness, 63
in diseases of small intestine, 63
in diseases of stomach, 63
Obermayer's test for, 64
tests for, 64
Infection, phagocytosis and, 200
blood-plaques in, 166
leukocytosis in, 160
Infectious diseases, secondary anemia from, 204
Inflammations, leukocytosis in, 160
pseudomembranous, of mouth, 272
Influenza bacillus in sputum, 39
Inoculation, animal, 269
Intestines, small, diseases of, indican in urine in, 63
Intoxication, acid, cause, 83
Iodin in urine, 96
reaction of leukocytes, 182
solution, Gram's, 38
Iodoform crystals from Gunning's test, 85
Iodophilia, 182
Irregular epithelial cells in urine, 122
Itch-mite, 259
Jenner's stain for blood, 174
Kemp-Calhoun-Harris estimation of blood-plaques, 166
Keratitis, bacteria of, 274
Kidney, changes in, albuminuria from, 70
permeability of, tests for, 55, 56
Koch-Weeks bacillus in conjunctivitis, 274
Kowarsky's plate for fixing blood, 171
test for glucose, 78
Lactic acid in gastric contents, 219
Strauss' test for, 220
Uffelmann's test for, 220
Lactose in milk, estimation, 280
in urine, 82
Lancet, blood, 141
Lange's test for acetone, 85
Lead in urine, 96
Lead-poisoning, anemia from, 204
chronic, degeneration of Grawitz in, 176
Lederer's test for lead, 96
Leffmann-Beam estimation of fat in milk, 279
Legal's test for acetone, Lange's modification, 85
Lenses, 20
Leprosy, secondary anemia from, 204
Leptothrix buccalis, 270
in gastric contents, 230
in sputum, 28
Leucin in urine, 107
Leukemia, 157, 162, 208
blood-plaques in, 166
degeneration of Grawitz in, 176
diluting fluids for count, 165
erythroblasts in, 177
erythrocytes in, 175
leukocyte count in, 162, 163
lymphatic, 210
lymphocytes in, 179
myelogenous, 208
eosinophilia in, 183
erythroblasts in, 177
mast-cells in, 184
myelocytes in, 184
oligocythemia in, 150
polychromatophilia in, 176
Todd's estimation of leukocytes in, 164
Türk's ruling for blood count in, 162, 163
Zappert ruling for blood count, 162
Leukocytes, 139
abnormal varieties, 184
atypical forms, 184
basophilic, 183
counting, in leukemia, 162, 163
decrease in, 156
differential count of, 178
enumeration, 156
eosinophilic, 182. See also _Eosinophiles_.
increase in, 157
absolute, 178
relative, 178
iodin reaction of, 182
irritation forms, 185
mononuclear, large, 179
non-phagocytic, 159, 161
normal, 179
polymorphonuclear, 158
neutrophilic, 180
polynuclear, 180
stained, study of, 178
transitional, 180
Leukocytosis, 157
absolute, 178
eosinophilic, 159
mononuclear, 159
myelocytes in, 184
phagocytic, 159
polymorphonuclear, 159
from drugs, 161
from infections, 160
from inflammations, 160
in malignant disease, 160
pathologic, 160
physiologic, 159
post-hemorrhagic, 161
toxic, 161
relative, 178
Leukopenia, 156
lymphocytes in, 179
Levulose in urine, 82
Lieben's test for acetone, Gunning's modification, 84
Lindemann's test for diacetic acid, 86
Linen fibers in urine, 120, 131
Liver, cirrhosis of, anemia from, 204
Löffler's alkaline methylene-blue, 38
for gonococci in pus, 264
methylene-blue for pus, 261
Louse, 259
Lung, gangrene of, sputum in, 44
Lycopodium granules in urine, 132
Lymphatic leukemia, 210
Lymphocytes, 179
Lymphocytosis, 159, 161
Macrocytes, 175
Magnification, microscopic, 20
Malaria, basophilic stippling in, 177
irregular, 188
large mononuclear leukocytes in, 180
organism of, 187. See also _Plasmodium malariæ_.
polychromatophilia in, 176
secondary anemia from, 204
transmission of, by mosquitos, 189
Malignant disease, leukocytosis in, 160
tumors, anemia from, 204
Mast-cells, 183
McFarland's method for Widal reaction, 198
Measles, diazo reaction in, 91
Measures, 292
Megaloblasts, 177
Megalocytes, 175
Meningitis, tuberculous, cerebrospinal fluid in, 268
Menstruation, eosinophilia during, 182
Mercury in urine, 98
Merozoites of plasmodium malariæ, 187
Methylene-blue and eosin for blood, 172
Löffler's, 38
for gonococci in pus, 264
for pus, 261
test for urine, 56
Metric system, 292
Microblasts, 177
Micrococcus ureæ in urine, 126
Microcytes, 175
Micrometer eye-piece for microscope, 23
stage, 23
Micron, 23
Microscope, 17
care of, 21
cleaning, 22
eye-pieces for, 20
focusing, 19
illumination for, 17
lenses for, 20
care of, 22
magnification by, 20
method of carrying, 22
micrometer eye-piece for, 23
objectives for, 20
corrections, 21
use, 17
Microscopic objects, measurement, 22
Milk, 277
analysis of, 277
tube for, 279
chemic examination of, 277
curds in feces, 241
examination of, chemic, 277
fat in, estimation, 279
formalin in, test for, 280
lactose in, estimation, 280
proteids in, estimation, 280
reaction, 277
Milk-sugar in urine, 82
Milk-testing apparatus, Holt's, 278
Mixed infection, 35
Mold fungi in urine, 131
Molds, hyphæ of, in urine, 121
in sputum, 32
Mononuclear leukocytes, large, 179
leukocytosis, 159
Morax and Axenfeld's diplobacillus, 275
Morphin in urine, 99
Mosquitos in transmission of malaria, 189
Motor power of stomach, 233
Mouth, diseases of, 270
organisms of, 270
Mucin in urine, 76
Mucous threads in urine, 119
Mucus in feces, 237
in gastric contents, 217
Müller's blood-dust, 140
fluid, 37
Muscle-fibers in feces, 240
Myelocytes, 184
Myelogenous leukemia, 208
eosinophilia in, 183
erythroblasts in, 177
mast-cells in, 184
myelocytes in, 184
Nasopharynx, diphtheria of, 272
Nematoda, 253
Nephritis, anemia from, 204
chlorids in urine in, 56
urine in, 132, 134, 135
Neuroses, gastric, stomach contents in, 231
Neutrophilic leukocytes, polymorphonuclear, 180
structures of blood, 172
Newton's rings, 153
Nitric acid test for albumin, 73
Nonphagocytic leukocytes, 159
Normoblasts, 177
Nucleo-albumin in urine, 76
Nutrition, poor, secondary anemia from, 204
Obermayer's reagent, 64
test for indican in urine, 64
Objectives, dry, 21
immersion, 21
microscopic, 20
oil-immersion, 21
Oblique illumination of microscope, 18
Occult hemorrhage, detection in feces, 239
Oïdium albicans, 271
Oil-immersion objective, 21
Oligochromemia, 142
Oligocythemia, 150
in anemias, 150
in chlorosis, 150
in leukemia, 150
in pernicious anemia, 150
Oliguria, 49
Ophthalmia, gonorrheal, 275
Opsonic index, 201
Opsonins, 200
measuring amount of, 200
Wright's method for measuring, 200
Organic acids in gastric contents, 219
quantitative test, 226
Otitis, 276
bacteria of, 276
tuberculous, 276
Oxalate, calcium, in urine, 106
Oxybutyric acid in urine, 87
Oxyphilic structures of blood, 172
Oxyuris vermicularis, 253
Pancreatic reaction, 91
flasks for, 93
in pancreatitis, 91
technic, 92
Pancreatitis, pancreatic reaction in, 91
Paramoecium coli, 246
Parasites, animal, 244
anemia from, 204
arthropoda, 259
in feces, 238
in urine, 128
infection with, eosinophilia in, 183
protozoa, 244
vermes, 247
blood, 186
causing skin diseases, 277
ova of, in feces, 243
Paroxysmal hemoglobinuria, 89
Passive hyperemia, urine in, 133
Pavement epithelial cells in urine, 122
Pediculus capitis, 259
corporis, 259
vel pubis, 259
Pepsin, 213
in gastric contents, quantitative test, 227
tests for, 221
Pepsinogen, 213
in gastric contents, test for, 221
Pericardial fluid, examination, 265
Peritoneal fluid, examination, 265
Permeability of kidneys, tests, 55, 56
Pernicious anemia, 205
blood-plaques in, 166
color index in, 156
degeneration of Grawitz in, 176
erythroblasts in blood in, 177
erythrocytes in, 175
lymphocytes in, 179
myelocytes in, 184
oligocythemia in, 150
polychromatophilia in, 176
Pertussis, leukocytosis in, 161
lymphocytes in, 179
Phagocytes, 158
Phagocytic index, 201
leukocytosis, 159
Phagocytosis and infection, 200
Pharyngomycosis leptothrica, 271
Pharynx, tuberculosis of, 274
ulceration of, 273
Phenacetin in urine, 95
Phenol in urine, 99
Phenolphthalein in urine, 99
Phenylglucosazone crystals, 78
Phenylhydrazin test for glucose, 78
Phloridzin test for urine, 56
Phosphate crystals in urine, ammoniomagnesium, 109
calcium, 110
triple, 110
in urine, 60, 109
amorphous, 50, 61, 111
in mass, 120
earthy, 61, 111
estimation, 61
Purdy's centrifuge method, 61
quantitative, 61
Purdy's table for, after centrifugation, 61
Phosphorus poisoning, anemia from, 204
Pin-worms, 253
Piroplasma hominis, 247
Pirosoma bigeminum, 247
Plasmodium malariæ, 187
ameboid movements of, 187
asexual cycle of, 187
cycles of, 187
detection, 191, 192
estivo-autumnal, 187, 188, 194
gametes in blood with, 188
hyaline stage of, 187
life histories, 187
merozoites of, 187
mosquitos as host, 189
quartan, 188, 194
Ruge's method for, 192
segmentation of, 187
sexual cycle, 188
spores of, 187
stains for, 192
tertian, 188, 194
Wright's stain for, 192, 193
Pleural fluid, examination, 265
Pneumococcus capsules, Buerger's method for, 37
stains for, 37
in eye affections, 274
in otitis, 276
in pus, 263
in sputum, 35
Smith's method, 37
Pneumonia, croupous, sputum in, 45
drunkard's, sputum in, 25
Poikilocytes, 175
Polychromatophilia, 176
Polycythemia, 149
idiopathic, 142, 149
in diarrhea, 149
in heart disease, 149
Polyhedral epithelial cells in urine, 121
Polymorphonuclear leukocytes, 158
leukocytosis, 159. See also _Leukocytosis, polymorphonuclear_.
neutrophilic leukocytes, 180
Polynuclear leukocytes, 180
Polyuria, 49
Pork tape-worm, 247, 249
Potassium indoxyl sulphate in urine, 63. See also _Indican in urine_.
urate in urine, 105
Pregnancy, urine in, 133, 134
Primary anemia, 205
Progressive pernicious anemia, 205
Proteids in milk, estimation, 280
in urine, 69
Protozoa, 244
Prune-juice sputum, 25
Pseudo-casts in urine, 120
Pseudoleukemia, 208, 211
Pseudomembranous inflammations of mouth, 272
Pulmonary edema, sputum in, 45
gangrene, sputum in, 44
tuberculosis, sputum in, 45
Purdy's centrifugal estimation of albumin, 74
of chlorids, 58
of phosphates, 61
of sulphates, 62
centrifuge tubes, 59
electric centrifuge, 57
estimation of glucose in urine, 79
of lactose in milk, 280
heat test for albumin, 73
solution for glucose test, 80
table for estimation of albumin, 75
of chlorids, 60
of phosphates, 61
of sulphates, 62
Purgen in urine, 99
Purin bodies in urine, 67
Cook's method, 68
Purpura hæmorrhagica, blood-plaques in, 166
Pus, bacillus tuberculosis in, 263
bacteria in, 261
examination of, 261
gonococci in, 264
Gram's method for, 261
in urine, 50, 123
Donné's test, 50
Löffler's methylene-blue for, 261
pneumococci in, 263
staphylococci in, 262
streptococci in, 262
Pus-casts in urine, 119
Pus-corpuscles, 181, 261
in feces, 241
in gastric contents, 229
in sputum, 40
in urine, 123
Pyelitis, urine in, 136
Pyuria, 123
Quartan parasite, 188, 194
Quinin in urine, 100
Ray-fungus in sputum, 31
Reagents, 288
Red blood-corpuscles, 139
in sputum, 43
in urine, 124
sand in urine, 104
Reinsch's test for arsenic, 95
Relapsing fever, spirillum of, 186
Renal albuminuria, 70
calculus, urine in, 134
circulation, changes in, albuminuria from, 70
hyperemia, urine in, 132
tuberculosis, urine in, 134
Rennin, 213
in gastric contents, test for, 222
Renninogen, 213
in gastric contents, test for, 223
Resinous drugs in urine, 100
Rhabditiform embryos of strongyloides intestinalis, 258
Rheumatism, secondary anemia from, 204
Rice's solution, 67
Ring-worm, 277
Robert's test for albumin, 73
Round epithelial cells in urine, 121
worms, 253
Ruge's method for plasmodium malariæ, 192
Ruhemann's method for uric acid, 69
reagent, 69
uricometer, 68
Rusty sputum, 25, 26
Saccharimeter, Einhorn's, 81
Sahli's estimation of hemoglobin, 144
hemoglobinometer, 144, 145
Salicylates in urine, 100
Salol in urine, 100
test, Ewald's, for gastric motor power, 234
Sarcinæ in gastric contents, 229
Saxe's urinopyknometer, 53
Scarlet fever, eosinophilia in, 183
Scratches on slide as source of error, 132
Screw-worm, 260
Secondary anemia, 204
Secretory ability of kidneys, tests, 55, 56
Sediments, urinary, 100. See also _Urinary sediments_.
Segmentation of plasmodium malariæ, 187
Semen, examination of, 283
on clothes, detection, 283
Florence's reaction for, 284
Separatory funnel for Strauss' lactic acid test, 221
Serum reactions, 196
Serum-albumin in urine, 69
Serum-globulin in urine, 69
Shadow cells in urine, 125
Silk fibers in urine, 120, 131
Silver nitrate solution, ammoniated, 68
Skin diseases, eosinophilia in, 183
parasitic diseases of, 277
Sleeping sickness, 196
Small intestine, diseases of, indican in urine, 63
Smegma bacillus, 35, 127
Smith's method for pneumococcus in sputum, 37
test for bile, 87
Sodium urate in urine, 105
Specific gravity of urine, 51
Spermatozoa, absence of, 283
in urine, 125
Spirillum of relapsing fever, 186
Spirochæte pallida, 281, 282
refringens in syphilis, 282
Splenic anemia, 208
Spores of plasmodium malariæ, 187
Sputum, 24
actinomyces bovis in, 31
alveolar cells in, 43
bacillus mucosus capsulatus in, 38
of Friedländer in, 38
of influenza in, 39
tuberculosis in, 24, 32
bacteria in, 32
cells in, 40
stains for, 40
Charcot-Leyden crystals in, 29, 30
cholesterin crystals in, 30
color, 25
consistence, 25
crystals in, 29, 30
Curschmann's spirals in, 29
cylindric cells in, 42
diplococcus of Fränkel in, 35
elastic fibers in, 27
eosinophilic leukocytes in, 41
epithelial cells in, 41
examination, 24
microscopic, 26
physical, 25
fat needles in, 30
fibrinous casts in, 30
Fränkel's diplococcus in, 35
globular, 46
heart-failure cells in, 27, 43, 44
hematoidin crystals in, 30
in bronchial asthma, 45
in bronchiectasis, 44
in bronchitis, 43, 44
in disease, 43
in gangrene of lung, 44
in pneumonia, croupous, 45
in pulmonary edema, 45
gangrene, 44
tuberculosis, 45
leptothrix buccalis in, 28
molds in, 32
pneumococcus in, 35
Smith's method for, 37
prune-juice, 25
pus-corpuscles in, 40
quantity, 25
ray-fungus in, 31
receptacle for, 24
red-corpuscles in, 43
rusty, 25, 26
squamous cells in, 42
stained, 32
staphylococcus in, 35
streptococcus in, 35
streptothrix actinomyces in, 31
tubercle bacillus in, 24, 32
unstained, 26
Squamous cells in sputum, 42
in urine, 122
Squibb's urinometer, 52
Stage micrometer, 23
Stained blood, 168
sputum, 32
Stains, 288
anilin, for blood-films, 171
anilin-gentian-violet, 38
carbol-fuchsin, 33
Ehrlich's triple, for blood, 172
eosin and methylene-blue, for blood, 172
for bacillus influenza in sputum, 39
tuberculosis in sputum, 32
for bacteria in feces, 242
in sputum, 32
for blood, 168
Wright's, in cytodiagnosis, 266
for blood-films, 168, 171
for cells in sputum, 40
for gametes, 193
for plasmodium malariæ, 192
for pneumococcus capsules, 37
for pus, 261
Gabbet's, 34
Goldhorn's, for syphilis, 283
Gram's iodin solution, 38
iodin, for leukocytes, 182
solution, Gram's, 38
Jenner's, for blood, 174
Löffler's alkaline methylene-blue, 38
methylene-blue, for gonococci in pus, 264
for pus, 261
methylene-blue and eosin, for blood, 172
Ruge's, for plasmodium malariæ, 192
Stirling's anilin-gentian-violet, 38
triple, for blood, 172
Wright's, for blood, 173
in cytodiagnosis, 266
for plasmodium malariæ, 192, 193
Staphylococci, 262
in eye affections, 274
in otitis, 276
in sputum, 35
Starch paper, 233
Starch-granules in feces, 240
in urine, 131
Sterility, 283
Stippling, basophilic, 176
Stirling's anilin-gentian-violet stain, 38
Stomach, 213
absorptive power of, 233
contents of, 213. See also _Gastric contents_.
digestion, 213
dilatation of gastric contents in, 230
diseases of, indican in urine in, 63
motor power of, 233
position of, determination, 234
size of, determination, 234
Stomach-tube, 215, 216
Stools, 235. See also _Feces_.
Strauss' test for lactic acid, 220
Streptococci, 262
in eye affections, 274, 275
in otitis, 276
in sputum, 35
Streptothrix actinomyces in sputum, 31
Strongyloides intestinalis, 257
Sugars in urine, 76
Sulphates in urine, 62
estimation, Purdy's centrifuge method, 62
quantitative, 62
Purdy's table after centrifugation, 62
Sulphuric acid in urine, 62
Syphilis, examination of material, 281
Goldhorn's stain for, 283
micro-organism of, 281, 282
secondary anemia from, 204
spirochæte pallida in, 281, 282
refringens in, 282
Tænia echinococcus, 247, 251
in urine, 128
mediocanellata, 247, 248
saginata, 247, 248
solium, 247, 249
Tallquist's estimation of hemoglobin, 147
hemoglobinometer, 147, 148
Tannin in urine, 100
Tape-worms, 247
beef, 247, 248
fish, 247, 249
in feces, 238
pork, 247, 249
Teichmann's test for blood, 202
in hemoglobinuria, 89
Temperature, 293
Tertian parasite, 188, 194
Test-breakfast, Boas', 215
Ewald's, 215
Test-meals, 214, 215
Boas', 215
Ewald's, 215
Texas fever, parasite of, 247
Thorn-apple crystals in urine, 112
Thoma-Zeiss hemocytometer, 150, 151
cleaning instrument, 155
sources of error, 155
technic, 152
Thread-worm, 253
Thrush, 271
Tick fever, parasite of, 247
Tinea versicolor, 277
Tissue bits in gastric contents, 218
Todd's estimation of leukocytes in leukemia, 164
Toisson's diluting fluid for blood count, 154
Tonsils, diphtheria of, 272
ulceration of, 273
Töpfer's test for free hydrochloric acid, 225
for total acidity, 223
Torfuge, Wetherill's, 101
Toxic leukocytosis, 161
Transitional leukocytes, 180
Transudates, 265
Trichina spiralis, 255
infection, eosinophilia in, 183
Trichinella spiralis, 255
Trichiniasis, 255
eosinophilia in, 183
parasite of, 255
Trichloracetic acid test for albumin, 71
Trichocephalus dispar, 258
trichiurus, 258
Trichomonas vaginalis, 245
Triple phosphate crystals in urine, 110
stain, Ehrlich's, for blood, 172
Trommer's test for acetone, 86
Tropical dysentery, parasite of, 244
Trypanosoma hominis, 195
Trypanosomiasis, 195
Tube-casts in urine, 113
Tubercle bacillus. See _Bacillus tuberculosis_.
Tuberculosis, animal inoculation in, 270
diazo reaction in, 90
of mouth, 274
of pharynx, 274
pulmonary, sputum in, 45
renal, urine in, 134
secondary anemia from, 204
Tumors, anemia from, 204
Türk's ruling for blood count in leukemia, 162, 163
Two-slide method for blood-films, 168
Typhoid fever, diazo reaction in, 90
lymphocytes in, 179
secondary anemia from, 204
Widal reaction in, 90, 197
Tyrosin crystals in urine, 107, 108
Uffelmann's test for lactic acid, 220
Ulcer, gastric, stomach contents in, 232
Ulcerations of mouth, 274
of pharynx, 273
of tonsils, 273
Uncinaria Americana, 256
duodenalis, 256
Uncinariasis, anemia from, 204
eosinophilia in, 183
Unstained sputum, 26
Urate crystals in urine, ammonium, 112
Urates in urine, amorphous, 50, 67, 105
in mass, 120
Urea in urine, 64
decreased, 65
estimation, quantitative, 66
increased, 64
tests, 66
Ureometer, Doremus-Hinds', 66
Uric acid in urine 67
Cook's method, 68
decreased, 68
estimation, quantitative, 68
increased, 67, 68
Ruhemann's method, 69
Uric-acid crystals in urine, 104
Uricometer, Ruhemann's, 68
Urinary albumin, 69
crystals, 104
sediment, examination, 100
organized, 113
transference to slide, 101
unorganized, 103
in acid urine, 103, 104
in alkaline urine, 104, 109
Urine, 47
acetone in, 82, 83. See also _Acetonuria_.
acetanilid in, 95
acid, 51
unorganized sediments in, 103, 104
air-bubbles in, 132
albumin in, 69. See also _Albuminuria_.
albumoses in, 76
alkaline, unorganized sediments in, 104, 109
alkalinity of, 51
fixed, 51
volatile, 51
ammoniacal decomposition, 51
ammoniomagnesium phosphate crystals in, 109
ammonium urate crystals in, 112
anguillula aceti in, 129
animal parasites in, 128
antipyrin in, 95
arsenic in, 95
atropin in, 96
bacillus typhosus in, 127
tuberculosis in, 127
bacteria, 51, 126
bacterial casts in, 119
bile acids in, 87
test, 88
bile-pigment in, 87
bilifuscin in, 87
bilirubin in, 87
biliverdin in, 87
blood in, 51
blood-casts in, 118
blood-corpuscles in, 124
brick-dust deposit in, 50, 106
bromids in, 96
calcium carbonate crystals in, 112
oxalate in, 106
phosphate crystals in, 110
casts in, 113
chemic examination, 56
chlorids in, 56. See also _Chlorids in urine_.
coffin-lid crystals in, 110
color, 49
composition, 47
constituents of, 47
abnormal, 69
normal, 56
cylindroids in, 119
cystin crystals in, 108
decreased, 49
dextrose in, 76. See also _Glycosuria_.
diacetic acid in, 86. See also _Diacetic acid in urine_.
diazo substances in, 89
distoma hæmatobium in, 128
effect of drugs on, 50, 95
envelop crystals in, 106
epithelial casts in, 118
cells in, 121, 122
examination, 49
chemic, 56
microscopic, 100
physical, 49
extraneous structures in, 130
fat-droplets in, 131
fat-globules in, 109
fatty casts in, 117
fibers in, extraneous, 120, 131
of cotton in, 120, 131
of linen in, 120, 131
of silk in, 120, 131
of wool in, 120, 131
fibrinous casts in, 117
filaria sanguinis hominis in, 128
floaters in, 128
freezing-point, 55
fruit-sugar in, 82
functional tests for, 55
glucose in, 76. See also _Glycosuria_.
gonococci in, 128
gonorrheal threads in, 128
granular casts in, 117
granule cells in, compound, 122
gravel in, 104
hairs in, 120
hemoglobin in, 88. See also _Hemoglobinuria_.
hip-roof crystals in, 110
hyaline casts in, 114
hyphæ of molds in, 121
in calculus, renal, 134
vesical, 137
in chyluria, 109
in cystitis, 136
in diabetes insipidus, 137
mellitus, 138
in disease, 132
in hyperemia, 132, 133
in nephritis, 132, 134, 135
in pregnancy, 133, 134
in pyelitis, 136
in renal hyperemia, 132
tuberculosis, 134
increased, 49
indican in, 63. See also _Indican in urine_.
iodin in, 96
irregular epithelial cells in, 122
lactose in, 82
lead in, 96
leucin crystals in, 107
levulose in, 82
lycopodium granules in, 132
mercury in, 98
methylene-blue test for, 56
microscopic examination, 100
micrococcus ureæ in, 126
milk-sugar in, 82
mold fungi in, 131
morphin in, 99
mucin in, 76
mucous threads in, 119
normal constituents, 56
nucleo-albumin in, 76
oxybutyric acid in, 87
phenacetin in, 95
phenol in, 99
phenolphthalein in, 99
phloridzin test for, 56
phosphates in, 60, 109. See also _Phosphates in urine_.
physical examination, 49
pigments in, 49
removal of, 48
polyhedral epithelial cells in, 121
potassium indoxyl sulphate in, 63. See also _Indican in urine_.
potassium urate in, 105
pavement epithelial cells in, 122
proteids in, 69
pseudo-casts in, 120
purgen in, 99
purin bodies in, 67, 68
pus in, 50, 123
pus-casts in, 119
pus-corpuscles in, 123
quantity, 49
quinin in, 100
reaction, 51
red blood-corpuscles in, 124
sand in, 104
resinous drugs in, 100
round epithelial cells in, 121
salicylates in, 100
salol in, 100
serum-albumin in, 69
serum-globulin in, 69
shadow cells in, 125
sodium urate in, 105
solids in, total, 53
Häser's method, 55
specific gravity, 51
spermatozoa in, 125
squamous epithelial cells in, 122
starch-granules in, 131
sugars in, 76
sulphates in, 62. See also _Sulphates in urine_.
sulphuric acid in, 62
suppression, 49
tænia echinococcus in, 128
tannin in, 100
thorn-apple crystals in, 112
total solids in, 53
Häser's method for, 55
transparency, 50
triple phosphate crystals in, 110
tube-casts in, 113
tubercle bacilli in, 127
tyrosin crystals in, 107, 108
urate crystals in, ammonium, 112
urates in, amorphous, 50, 67, 105
in mass, 120
urea in, 64. See also _Urea in urine_.
uric acid in, 67. See also _Uric acid in urine_.
uric-acid crystals in, 104
vinegar eel in, 129
volatile alkalinity of, 51
waxy casts in, 116
yeasts cells in, 130
Urinometer, Squibb's, 52
Urinopyknometer, Saxe's, 53
Vaccine treatment, 201
Vaccines, bacterial, Wright's, 201
Vegetable cells in feces, 240
fibers in feces, 240
Vermes, 247
Vesical calculus, urine in, 137
Vincent's angina, 273
Vinegar eel in urine, 129
Vogel's scale. See _Frontispiece_.
Von Fleischl's estimation of hemoglobin, 143
hemoglobinometer, 143
Water-motor centrifuge, 58
Waxy casts in urine, 116
Weights, 292
Wetherill's torfuge, 101
Whip-worm, 258
White blood-corpuscles, 139
Widal reaction, 197
in typhoid fever, 90
macroscopic, 199
microscopic, 198
Wool-fibers in urine, 120, 131
Worms, 247
eosinophilia as symptom, 183
pin-, 253
round-, 253
screw-, 260
tape-, 247
thread-, 253
whip-, 258
Wright's bacterial vaccines, 201
blood stain, 173
in cytodiagnosis, 266
method for measuring opsonins, 200
stain for plasmodium malariæ, 192, 193
Xerosis bacillus in eye, 276
Yeast-cells in gastric contents, 229
in urine, 130
Zappert ruling for count in leukemia, 162
Zymogens, 213