Diagnostic methods

Front matter

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I iinniininttniuinimmntmrttrirmi

Preface

In the present work the writer has attempted to bring together, for the use of the student and practitioner, the generally accepted facts regarding the various phases of clinical medicine, which may be rather more closely studied by the application of laboratory methods than without their use. It is to be especially emphasized that laboratory work must go hand in hand with the more direct clinical examination of the patient, as the former can be interpreted only in the light of the latter. While it is true that, in some cases, the laboratory findings may be of even more value than those of physical examination, yet it is to be understood that the function of the Clinical Laboratory is, more largely, perhaps, an accessory one, the application of methods of physical diagnosis usually pointing out the way toward a successful solution of the clinical problem by special laboratory methods, which yield numerous confirmatory or differential points not at all clearly defined by the methods of direct clinical examination.

The aim of the author has been to present the direct bearing, of the various methods outlined upon the clinical history of the case and to point out the special interpretation of the findings in any given examination. Particular attention has been directed to the selection of methods, both for the simpler clinical and more complex scientific requirements. As no method, no matter how exact it may be or how sound its basic principle, will yield reliable results in the hands of the inexperienced, the writer has paid much attention to the details of such methods and has endeavored to direct the thought of the worker to the possible obstacles to be overcome before he is able to properly perform these examinations and interpret his results.

The writer makes no claim for originality except, possibly, in the matter of arrangement of subject-matter and selection of methods and ideas, which have been established by others after years of earnest research. His endeavor has been to be as catholic as possible in his reading and as selective as his judgment permitted, to the end that the student or practitioner be saved the burden of sifting the wheat from the chaff.

Numerous text-books, monographs, and special articles have been freely used in the preparation of the text, the writer attempting in each case to give due credit for such reference. It is possible that some direct use of material has been made which has not received deserved recognition. If so, the writer,

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Vlll PREFACE.

here acknowledges his indebtedness to them as well as to those whom he has directly quoted.

It has seemed desirable to omit extensive reference to the literature, as a bibliography to be of working value must be much more extensive and complete than is possible within the scope of this book. The writer has, however, inserted at the end of each chapter a list of the more important larger works, which he has found useful in correlating the general subjects included in the several sections.

In conclusion, the writer wishes to express his deep obligation to his colleagues for their many valuable suggestions as to the subject-matter of the text: to Prof. W. S. Haines for assistance in revising the section on Urine; to Dr. J. M. Washburn for many additions and revisions of the section on Blood; to Dr. O. J. West for many practical points throughout the whole work; to Dr. W. A. Pusey for photographs of Blastomycetes under various conditions; to Dr. Brown Pusey for slides showing various organisms in the conjunctival exudates; and to Dr. N. Gildersleeve, of the University of Pennsylvania, for illustrations of megalosporon and microsporon. Further, the writer wishes to express his thanks to Miss Hill for the excellent work done by her in preparing the original drawings which appear throughout the work.

Ralph W. Webster. ioo State St., Chicago,

CHAPTER I. The Sputum

PAGE

I. General Considerations i

II. Physical and Chemical Characteristics 2

Consistency 2

Odor 4

Character 4

Chemistry 5

I I. Macroscopic Examination 6

Cheesy masses . . ' 6

Dittrich's plugs 6

Curschmann's spirals 7

Fibrinous casts 8

Concretions 8

Bronchiolitis 8

Pneumoliths '9

Echinococcus membranes ..'■.* 9

Foreign bodies 9

Pus-cells 10

Red blood-cells 11

Elastic tissue 12

Bac eria 15

Saprophytes 15

Pathogenic types 18

Tubercle bacillus 18

Lepra bacillus 23

Smegma bacillus 23

Timothy bacillus 24

Pneumococcus 24

Friedlander's bacillus 25

Influenza bacillus 25

Bacillus pertussis 25

Bacillus typhosus 26

Staphylococcus and streptococcus pyogenes . 26 ix

Contents

PAGE

Bacillus pestis . 26

Bacillus anthracis . 26

CHAPTER II. Oral, Nasal, Aural, and Conjunctival Secretions

I. Oral Secretions . 34

Pharyngomycosis leptothrica 37

Diphtheria 37

Vincent's angina 39

Catarrhal stomatitis 39

Gonorrheal stomatitis 39

Thrush 40

II. Nasal Secretion ■ 40

Hay fever 41

Meningitis 41

III. Aural Secretion 42

CONTENTS. XI

PAGE

IV. Conjunctival Secretions 42

Diphtheritic conjunctivitis 43

Infectious conjunctivitis 43

Gonorrheal conjunctivitis 43

Trachoma 43

CHAPTER III. Gastric Contents

II. Methods of Obtaining Gastric Contents 47

Stomach-tube 47

Test meals 49

Ewald meal 49

Boas meal v 50

Riegel meal 50

Fischer meal 50

Salzer meal 51

Sahli meal 51

III. Macroscopic Examination 52

Odor 54

Consistency 54

Contents from fasting stomach 55

Vomitus 55

Contents after test meals 57

General 57

Food remnants 57

Boas-Oppler bacillus 57

Sarcinas ventriculi 58

Protozoa 58

Tissue f agments 58

V. Chemical Examination 59

General 59

Total acidity 59

Free hydrochloric acid 60

Topfer's test 61

, Giinzburg's test 61

Boas' lest 62

Tropeolin test 62

Xll CONTENTS.

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Quantitative tests . . . . 62

Mintz's method 63

Topfer's method 63

Amount of free hydrochloric acid '. 64

Euchlorhydria 65

Hypochlorhydria 65

Ana-chlorhydria . 66

Hyperchlorhydria 66

Combined hydrochloric acid 66

Method of Martius and Liittke 66

Method of Topfer 67

Hydrochloric acid deficit . . ' 68

Organic acids 68

Total organic acids 68

Lactic acid 69

Uffelmann's test 70

Kelling's test 70

Strauss' method . ." , 71

Butyric acid 72

Acetic acid 72

Gastric ferments 73

Qualitative methods 73

Quantitative examination 74

Hammerschlag's method 75

Mette's method 75

Method of Thomas and Weber ..... 76

Chymosin 76

Leo's me hod ' 77

Riegel's method . 77

Lipase ! 77

Products of protein digestion 78

Products of carbohydrate digestion ......... 78

Blood 78

Function of the stomach and contents ........ 79

VI. Motility of the Stomach „ 80

Boas' method .... 81

Method of Ewald and Severs . . . . .< . -. .. ... 81

Winternitz' test ..-.,. 82

VII. Absorptive Power of the Stomach v , 82

Potassium iodide test >..... 82

VIII. Indirect Examination of the Stomach Contents .... 83

Glinzburg's method 83

Sahli's desmoid reaction . . : . . . t 8^

IX. Gastric Juice in Disease * r . . ,„ 84

Hyperchlorhydria . . . .-•?: . 84

CONTENTS. XI 1 1

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Hypersecretion ... 85

Achylia gastrica 85

Acute gastritis 86

Chronic gastritis 86

Nervous dyspepsia 86

Ulcer of the stomach 87

Carcinoma of the stomach 87

Salomon's test 89

Gluzinski's test 89

CHAPTER IV. The Feces

Normal feces 91

Diet of Schmidt and Strasburger 92

Diet of Folin . 93

Obtaining intestinal juice 94

Functions of the intestinal juice 94

Estimation of intestinal digestion 95

II. Macroscopic Examination 96

Consistency and form 97

Odor 98

Blood ico

Mucus 103

Pus 105

Food remnants 105

Protein residues . . . .' 107

Fat residues 108

Carbohydrate residues 109

Biliary constituents 109

Intestinal sand and concretions in

Tissue fragments , 1 1 1

III. Microscopic Examination ' . . in

Morphological elements 112

IV. Chemical Examination • 113

Fat 116

V. Bacteriology of the Feces 118

XIV CONTENTS.

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Cholera spirillum 120

Typhoid bacillus 120

Method of Drigalski and Conradi . 121

Method of Hiss 122

Bacillus of Dysentery 123

Tubercle bacillus ' 123

VI. Parasitology of the Feces 124

Protozoa 124

Rhizopoda 125

Amebina 125

Ameba coli 125

Entameba coli ■-• 127

Sporozoa 127

Coccidium hominis 127

Flagellata . . ' 128

Trichomonas intestinalis 128

Cercomonas hominis 128

Megastoma entericum 128

Infusoria 129

Balantidium coli 129

Entozoa 129

Platodes 129

Cestodes 129

Taeniidae : 131

Taenia solium 131

Taenia saginata 131

Taenia cucumerina 132

Taenia nana 132

Taenia diminuta 133

Taenia echinococcus 133

Bothriocephaloidea 134

Bothriocephalus latus . 134

Dibothriocephalus cordatus .... 135

Bothriocephalus sp. Ijima et Kurimoto 135

Trematodes 135

Nematodes 136

Ascaridae . 136

Ascaris lumbricoides 136

Ascaris mystax 137

Oxyuris vermicularis 137

Angiostomidae 138

Strongyloides intestinalis 138

Trichotrachelidae 140

Trichiuris trichiura 140

Trichinella spiralis 140

Strongylidae 142

Uncinaria duodenalis 142

Uncinaria Americana . 143

Pseudo-parasites 145

CONTENTS. XV

CHAPTER V. Parasites

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II. Trematodes 146

Fasciolidae 147

Fasciola hepatica 147

Fasciolopsis Buski 148

Opisthorchis felineus 149

Opisthorchis sinensis 149

III. Nematodes 150

Eustrongylus gigas 1 50

IV. Parasites of the Skin 151

Arthropoda #• • • I 5 I

Arachnoidea 152

Sarcoptes scabiei 152

Demodex folliculorum 1 53

Leptus autumnalis 153

Insecta 153

Hemiptera 1 53

Pediculus capitis 153

Pediculus vestimenti 1 53

Pediculus pubis 1 53

Cimex lectularius 1 54

Diptera 155

Pulex irritans 155

Pulex penetrans 155

Vegetable Parasites 155

Achorion Schonleinii 155

Trichophyton megalosporon endothrix 156

Microsporon Audouini 157

Microsporon furfur 159

Microsporon minutissimum 159

Blastomycetes 159