Diagnostic methods, chemical, bacteriological and microscopical; a text-book for students and practitioners

Front matter

Class Book

GopyrightN q\U

COPYRIGHT DEPOSIT;

Preface To The Fourth Edition

Although, less than a year has elapsed since the appearance of the third edition of this work, the author has felt justified in adding considerable new material in this revision. This has come about largely through the suggestions of teachers and general practitioners regarding the inclusion of certain subjects not hitherto discussed.

Thus, the new matter embraces, among other subjects, a discussion of the Negri bodies recently successfully cultivated by Noguchi; Weisz's test for urochromogen; Dorrance's method for coagulation of the blood; Kowarsky's method for glucose in the blood; Levaditi and Manouelian's as well as Noguchi' s methods for staining spirochete in tissue; Lange's colloidal-gold test for congenital syphilis; a discussion of the organism of anterior poliomyelitis recently cultivated by Flexner and Noguchi. The Wassermann test has been brought up to date by inclusion of considerable new matter; while the complement-fixation test in gonorrhea has been elaborated. The Herman-Perutz reaction for syphilis is fully described. The application of Abderhalden's dialyzation method to the diagnosis of cancer and dementia precox has been freely discussed. Further, an entirely new chapter on Clinical Bacteriology has been added, in which are discussed the differentiation of the more important pathogenic organisms and, also, the methods of preparation of vaccines. The subject matter throughout the text has been brought up to date by the inclusion of a large number of references to the original literature.

The author wishes to express his great satisfaction at the reception of the third edition of his work and, also, his full appreciation of the kind suggestions offered him regarding the general matter of the book. He wishes, especially, to thank his colleagues Drs. T. L. Dagg and C. C. Croy for their many valuable suggestions and criticism.

Ralph W. Webster. 25 E. Washington St., Chicago.

IX

Preface To The First Edition

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 properly to 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 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

Xll PREFACE.

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.

CHAPTER I. The Sputum

Page

I. General Considerations i

II. Physical and Chemical Characteristics 2

Consistency 2

Odor 4

Character 4

Chemistry 5

III. Macroscopic Examination 6

Cheesy masses 6

Dittrich's plugs 6

Curschmann's spirals 7

Fibrinous casts 8

Concretions 8

Bronchiolitis 8

Pneumoliths 8

Echinococcus membranes 9

Foreign bodies 9

IV. Microscopic Examination . 9

Pus-cells 10

Red blood-cells 11

Epithelial cells . . 11

Elastic tissue 12

Crystals . . 13

Bacteria 14

Saprophytes 14

Pathogenic types 17

Tubercle bacillus 17

Lepra bacillus 24

Smegma bacillus 24

Timothy bacillus 24

Pneumococcus 25

Friedlander's bacillus 25

Influenza bacillus 26

Bacillus pertussis 26

Bacillus typhosus 26

Staphylococcus and streptococcus pyogenes .... 26

Bacillus pestis 27

Bacillus anthracis 27

Bacillus mallei 27

Actinomyces hominis 27

xiii

Xiv TABLE OF CONTENTS.

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Animal parasites 28

Amebae 28

Flagellates 28

Cestodes 29

Trematodes 29

V. The Sputa in Disease 30

Pulmonary tuberculosis 30

Croupous pneumonia 3 1

Broncho-pneumonia 31

Acute bronchitis 31

Chronic bronchitis 32

Simple type 32

Putrid type 32

Fibrinous type 32

Bronchial asthma 33

Influenza 33

Gangrene of the lung 33

Abscess of the lung 3 s

Perforating empyema 34

Pneumonoconioses . 34

CHAPTER II. Oral, Nasal, Aural and Conjunctival Secretions

I. Oral Secretion 35

Pharyngomycosis leptothrica 38

Diphtheria 38

Vincent's angina 4°

Streptococcic sore throat 40

Gonorrheal stomatitis 4 1

Thrush 41

Oral endamebiasis 42

II. Nasal Secretion 44

Rhinitis 45

Hay fever 45

Meningitis 45

III. Aural Secretion 46

IV. Conjunctival Secretions 47

Diphtheritic conjunctivitis 47

Infectious conjunctivitis 47

Gonorrheal conjunctivitis 48

Trachoma 48

Vernal conjunctivitis 49

TABLE OF CONTENTS. XV

CHAPTER III. Gastric Contents

Page

II. Methods of Obtaining Gastric Contents 52

Stomach-tube 52

Test meals 54

Ewald meal 54

Boas meal 55

Riegel meal 55

Fischer meal 55

Salzer meal 56

Sahli meal 56

III. Macroscopic Examination 57

Odor 59

Consistency 59

Contents from fasting stomach 60

Vomitus 60

Contents after test meals 61

IV. Microscopic Examination 62

General 62

Food remnants 62

Boas-Oppler bacillus 62

Sarcinae ventriculi 63

Protozoa 63

Crystals 63

V. Chemical Examination 63

General 64

Total acidity 64

Free hydrochloric acid 65

Topfer's test 66

Giinzburg's test 66

Boas' test 67

Tropeolin test 67

Quantitative tests 67

Mintz's method 68

Topfer's method ' 68

Amount of free hydrochloric acid 69

Euchlorhydria 70

Hypochlorhydria 70

Ana-chlorhydria 70

Hyperchlorhydria 71

Combined hydrochloric acid 71

Method of Martius and Luttke . 71

Method of Topfer 7 2

Hydrochloric acid deficit 73

Organic acids 73

Total organic acids 73

Lactic acid 74

UfTelmann's test 75

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Kelling's test 75

Strauss' method 75

Butyric acid 76

Acetic acid . 77

Gastric ferments 77

Pepsin 77

Qualitative methods 78

Quantitative examination 79

Hammerschlag's method 79

Mett's method 79

Method of Thomas and Weber 80

Chymosin 81

Leo's method 81

Riegel's method 81

Lipase 82

Products of protein digestion 82

Products of carbohydrate digestion 82

Gases 83

Function of the stomach and contents 84

VI. Motility op the Stomach 84

Leube's method 85

Boas' method 85

Method of Ewald and Sievers 85

Winternitz' test 86

VII. Absorptive Power of the Stomach 86

Potassium iodide test 86

VIII. Indirect Examination of the Stomach Contents 87

Gunzburg's method 87

Sahli's desmoid reaction 87

IX. Gastric Juice in Disease 88

Hyperchlorhydria 88

Hypersecretion 89

Achylia gastrica 89

Acute gastritis 90

Chronic gastritis 90

Nervous dyspepsia 90

Ulcer of the stomach 91

Carcinoma of the stomach 91

Salomon's test 93

Neubauer and Fischer's test 93

Wolff and Junghans' test 95

CHAPTER IV. The Feces

Normal feces 99

Diet of Schmidt and Strasburger 100

Diet of Folin 101

Obtaining intestinal juice 101

Functions of the intestinal juice 102

Estimation of intestinal digestion 103

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Page

II. Macroscopic Examination 103

Consistency and form 105

Odor 106

Mucus in

Pus 113

Food remnants 113

Protein residues 114

Fat residues .' 115

Carbohydrate residues. 116

Biliary constituents 117

Intestinal sand and concretions 118

III. Microscopic Examination 119

Morphological elements 119

Crystals 120

IV. Chemical Examination 121

Total solids 121

Fat 123

Carbohydrates 123

Phenoltetrachlorphthalein test 125

V. Bacteriology of the Feces 128

Cholera spirillum 129

Typhoid bacillus 130

Method of Drigalski and Conradi ...130

Method of Kendall and Day . 131

Bacillus of Dysentery 132

Tubercle bacillus 132

VI. Parasitology of the Feces . . . 133

Protozoa 134

Rhizopoda 134

Amebina , 134

Ameba coli 134

Entameba coli 137

Sporozoa 137

Coccidium hominis . 137

Flagellata 137

Trichomonas intestinalis 137

Cercomonas hominis 138

Megastoma entericum 138

Infusoria 138

Balantidium coli . 138

Entozoa 139

Platodes. . . 139

Cestodes. 139

Taeniidae. . 140

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Taenia solium 140

Taenia saginata 141

Taenia cucumerina 141

Taenia nana 142

Taenia diminuta 142

Taenia echinococcus 143

Bothriocephaloidea 144

Bothriocephalus latus 144

Dibothriocephalus cordatus 144

Bothriocephalus sp. Ijima et Kurimoto . . 145

Trematodes 145

Nematodes 145

Ascaridae 145

Ascaris lumbricoides 145

Ascaris mystax 146

Oxyuris vermicularis 147

Angiostomidae 147

Strongyloides intestinalis 147

Trichotrachelidae 149

Trichiuris trichiura 149

Trichinella spiralis 149

Strongylidae 151

Uncinaria duodenalis 151

Uncinaria Americana 152

Pseudo-parasites 153

CHAPTER V. Parasites

II. Trematodes 156

Fasciolidae 157

Fasciola hepatica 157

Fasciolopsis Buski 158

Opisthorchis felineus 159

Opisthorchis sinensis 159

III. Nematodes 160

Eustrongylus gigas 160

IV. Parasites op the Skin 161

Arthropoda 161

Arachnoidea 162

Sarcoptes scabiei 162

Demodex folliculorum 162

Leptus autumnalis 162

Insecta 163

Hemiptera 163

Pediculus capitis 163

Pedi cuius vestimenti - 163

Pediculus pubis 163

Cimex lectularius 164

Diptera 165

Pulex irritans 165

Pulex penetrans 165

TABLE OF CONTENTS. XIX

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Vegetable Parasites 165

Achorion Schonleinii 165

Trichophyton megalosporon endothrix 166

Microsporon Audouini 167

Microsporon furfur 167

Microsporon minutissimum 169

Blastomycetes 169

Sporothrix Schenckii 171

Negri Bodies 172

CHAPTER VI. The Urine

Collection and preservation of the urine 176

II. Physical Properties 177

Quantity 177

Polyuria 178

Oliguria 179

Anuria 180

Appearance 180

Odor 183

Folin's method for total acidity 185

Free mineral and organic acidity 185.

Rough estimate of total solids 189

Optical activity 190

III. Chemical Properties 190

Normal composition 190

Total solids and total ash . . 192

Inorganic constituents . " 192

Chlorids . 192

Estimation of the chlorids 195

Volhard's method 195

Phosphates 198

Estimation of phosphates 202

Uranium method 202

Total phosphoric acid . 205

Sulphur compounds 206

Preformed sulphates 206

Ethereal sulphates 207

Neutral sulphur 208

Estimation of total sulphur 209

Determination of total sulphates 210

Folin's method 21a

XX TABLE OF CONTENTS.

Page

Determination of inorganic sulphates 210

Carbonates 211

Sodium and potassium 211

Calcium and magnesium 211

Iron 213

Organic constituents 213

Nitrogenous bodies 213

Kjeldahl's method 217

Urea 219

Determination of urea 221

Knop-Hufner method 222

Doremus ureometer 222

Morner-Sjoqvist method 225

Urease method .225

Ammonia 227

Method of Schlosing 229

Formalin method 231

Salkowski-Ludwig method 236

Method of Rudisch and Kleeberg . . . 237

Ruhemann's method 239

Purin bases 240

Creatinin 241

Weyl's test 243

Jaffa's test 243

Folin's methods 243

Undetermined nitrogen 246

Amino acids 246

Hippuric acid 248

Oxyproteic and alloxyproteic acids .... 248

Allantoin 248

Fatty acids 249

Oxalic acid 250

Baldwin's method 251

Ferments 251

Pepsin 251

Diastase 251

Lipase 252

Mucin-like bodies 252

Mucin. 252

Nucleo-albumin 252

Pigments and chromogens 254

Urochrome 254

Uroerythrin 254

TABLE OF CONTENTS. xxi

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Urobilin 255

Indican 256

Tests for indican 257

Jaffe's test 257

Obermayer's test 257

Rosenbach's test 258

Wang's method 259

Uroroseinogen 260

Abnormal Composition 260

Proteins 260

Serum-albumin 261

Albuminuria 261

Functional 261

Febrile 264

Traumatic 265

Hematogenous 265

Toxic 265

Neurotic 265

With definite renal lesions 265

Heat and acid test 267

Heller's nitric acid test 268

Ferrocyanide test 271

Sulpho-salicylic acid test 271

Spiegler's test 271

Quantitative methods 272

Scherer's method 272

Esbach's method 272

Method of Tsuchiya 273

Removal of albumin 2 74

Serum-globulin . . 274

Quantitative method 276

Proteoses 276

Primary proteoses 276

Bence- Jones' protein 276

Secondary proteoses . . 278

Tests 279

Bang's method 279

Clinical significance 279

Peptone 281

Heller's test 282

Donogany's test 282

Fibrin 283

Carbohydrates 283

Glucose 284

Glycosuria 284

Trommer's test 288

Xxiv TABLE OF CONTENTS.

Page

Hyaline casts . 356

Granular casts 357

Waxy casts 358

Fibrinous casts 359

Epithelial casts 359

Fatty casts 359

Blood-casts 359

Pus-casts 359

Cylindroids 360

Pseudo-casts 361

Cylindruria 361

Spermatozoa 363

Bacteria 363

Bacilluria 366

V. Calculi 367

Heller's table for analysis 368

Uric acid calculi 368

Calcium oxalate calculi 368

Phosphatic calculi 368

Calcium carbonate calculi 370

Cystin calculi 370

Xanthin calculi 370

Urostealith calculi 370

VI. Functional Diagnosis 370

Cryoscopy 371

Electric conductivity 371

Chlorid excretion 372

Methylene blue test 372

Phloridzin test 373

Phenolsulphonephthalein test 373

CHAPTER VIL Secretions of the Genital Organs.

I. Male Secretions . 376

Medico-legal aspects 378

• Florence's test 379

Barberio's test 379

II. Female Secretions 380

Vaginal secretions 380

Pathology 381

Blenorrhea 381

Purulent secretions 382

Fetid secretions 382

Uterine secretions 382

Menstruation 382

The lochia 383

TABLE OF CONTENTS. XXV

Page

Amniotic fluid 383

Abortion 384

Vesicular mole 384

Carcinoma 384