CHAPTER VII

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.

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.

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.

_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.

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.

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.

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.

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).]

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.

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

_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.

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.

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.

* * * * *

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

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).

_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.

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