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HEBilEm . p 


Gfft of 







[L«iU ContlnpjiUI Micntveu^ wJlh AJjUBUblr Rvvulviiig SUge.] 



Clinical Microscopy 
AND Chemistry 



Dr. Hermann J^enhautz 

Puranm or Midigdii asd DtftMrrov or Hoaj-rrtL at Baiuduo, rrc, rrc 



he:nry t. brookö, m.d, 

riOrUHB or HjVntUXT AWf P/inOulcr it the HiV rOHl F«T-aiADUA» HEUirAL SCVODL 

AtP Hatfirm.; Mihiui or ni Htw Tdik Ac^pbit Or STepiCikb. etc., btc. 

With 148 Illuotbations in the Text and Colored Plates 




COPYttJCiHT. 1311. 

|I}«ililnTd ■) Slmlloneii' H^11. London EftB,| 

PtillxlriplitA. Pa„tJ-S.A, 

Titr Mtdlcal Bullnin PiinilniE-hrkiiv. 


\90 + 



ACADEJIir OF Mkdjcmk, KTC^ 

In RECOQNmojr of Hi» Hanv Attainventr ant> Ceaselesb Etfostb 

TO Elevate the SciENnnc and Ethical Status of the 

Medical Pbofebsiom in America. thfAhekican 

Edittom of this Work is 


BT Tn 




The great favor accorded to three German editions of this 
well-knoim work, the eimplicity in arrangement and presenta- 
tion of the BDbject-matter, and the adaptability to the needs of 
the general practitioner and undergraduate student have in- 
duced me to undertake, amidst many other arduous duties, the 
rather laborious task of preparing an English edition — a task 
which only those who have had a similar experience can really 
appreciate. The more adequately to meet the requirements of 
the busy general practitioner and specialist, whose time is too 
much occupied with the routine of medical practice to consult 
larger, more complex, and technical treatises on the subject, I 
haTe> wherever it eeemcd to me necessary, inserted notes and 
illustrations vhich to the expert may appear superfluous- As 
regards these additions, ten years' experience in teaching many 
hundreds of graduate students of medicine has convinced me 
of the necessity of emphasizing points in examinations which 
might, at first glance, seem to he self-evident- All such addi- 
tions are indicated by brackets [ ]. Furthermore, the value 
of :the present edition has been greatly enhanced by notes and 
additions, kindly furnished by the author in advance from the 
nev fourth German edition, shortly to be issued. Among the 
author's additions are sections on the molecular concentration 
of the blood and urine (cryoscopy), the bacillus dysenteris 
(Shiga), the paratyphoid bacillns (Schottmüller), a new method 
for staining the blood, and addenda to the section on the Widal 
reaction. This edition, therefore, reflects the essence of nearly 
a quarter of a century of practical experience of one of the fore- 
most diagnosticians of Germany — the country in which diag- 


noBiB by laboratory methods has become an art. Notwithstand- 
ing the elementary character of the book, the different subjecta 
have been bo carefully prepared by the author that I may be 
pardoned for aefiuming that even the profeBeional laboratory 
worker may now and then find a bint which will aid him to tho 
Solution of BOme problem, A copious index has been added to 
facilitate ready reference. 

In concluBion^ I wish to thank the F. A. Davia Company 
for the courtesy and conaideratioD they have shown to me^ and 
Drs. H, B. ShefBeld and S. D, Jacobeon, — the former for unself- 
ish aid in proofreading and suggestiona, the latter for aid in 
certain portions of the text. 

H, 1\ B, 

New Yohk, February, 1004. 


To MT great Batiafaction my test-book met with such wide ^ 
favor after my departure from the University of Leipzig that 
it can now appear in a third edition. 

I have sabmitted it to a thorough revieioD in accordance 
with the present status of our science. The number of figured 
in the text has beep increoi^ed, and several illuatrationä of the 
two previous editions have been replaced by new ones. Four 
new illnstr&tiona (acute leukeniia and malaria) have also been 
added to the colored platea- 

May the present edition serve to disseminate the methods 
of examination discussed I 

Hermann Lenüartz. 



It was my endeaTOr to offer to phyaiciaus and Btndentfl a 
book which vould not only instruct them in clinical microscopic 
and cheinic methods of examination, but alao aid them in inter-* 
preting their diagnostic significance in practice. For some time 
Tontine ezcrciseB hearing upon our auhject have but aeldom been 
carried out in the majority of uoiveraitica, and consequently 
their practical value haa been underestimated by the practi- 
tioner. Their application, however, is daily growing more 
necesaary, the more the material relative thereto increases. 
This has already become too voluminous to be adequately 
treated in a clinical or propedeutic manner. It ia only by 
practical erercise^, such as have long been customary in other 
sciences, that students can acquire the knowledge requisite in 
practice. From this standpoint I have for many years arranged 
and conducted this special course iu the Leipzig clinic. 

The lectures here given in augmented form arc the result 
of my work aa a teacher. The abundant material of this 
cliniCj with which I have been almost constantly associated since 
the beginning of my assiatantahip under the guidance of Ernst 
Wagner in 1379, has afforded me the opportunity, especially in 
recent years, to devote particular attention to the aubjecta here 
discussed. I should not^ therefore, omit to thank Geheimrath 
Curechmann for the clinical material which he placed at my 

Ä glance at the table of contents will show the divisiona of 
the book. It may also be remarked that in the microscopic part 
I have considered only the examination of freah and dried im- 
pression and teased prcparationa^ bccauae the more complicated 



examination of sections, eta, belongB to the domain of patho- 
logic anatomy. The microscopic description has in all inetancea 
been preceded by a careful macroicopic rewme. 

Chemistry has received detailed consideration especially in 
connection with examination of the urine, while in thoee sec- 
tiona devoted to the study of the blood and gastric contenta 
only the practical teets, including forensic examination of blood- 
stains, have been discussed. 

In the first section of the book the vegetable and animal 
parasites have been briedy dealt with. In this way only was it 
possible uniformly to present parasitology in its important 
bearing upon pathologic processes, and to avoid frequent repe- 
titions in the subsequent sections. The greater space devoted 
to a description of the vegetable parasites can readily be under- 
stood at the present day. As regards many questions in thid 
connection, I have consulted especially Baumgarten^a "Mykol- 
ogie" and Leuckart's classical treatise on parasitology, which 
reflect the accumulated knowledge in this domain. 

In examinations of the blood the studies pursued by Ehrlich 
and others upon analytic staining have been thoroughly dis- 
cussed; that many questions in this direction still await ex- 
planation will be admitted by anyone familiar with the subject. 

The discussion of the sputum and urine has, I believe, been 
handled in a comprehensive, though somewhat brief, manner; 
here, however, I have constantly kept in mind the interests of 
the practitioner, and have, therefore, in all instances thor- 
oughly considered questions of diagnostic importance. 

Owing to the text-book character of the treatise, I have 
omitted all references to literature; on the other hand, how- 
ever, when of historic interest, I have included in the text the 
names of authors who have elaborated the subjects. 

Hrkhank Lenuartz. 


iBtrodnetloa: CoOBtruction, Selection, and Manipulation of the 

Hicroacope; Beagentfl and Appai^tUB. . , -■-..- 1 


(A> VesetAble Pu-AiltcL 

1. Bacteria 14 

GenenJ remAik« upon the morphology and biologic chara^terH of 
bacteria and their detection by culture methods. 
Microscopic examination in hanging drop and in dried 

preparations. Staining methods 10 

tJpedal description of the pathogenic bacteria, ...-...-..-..-.... 3ft 

L Micrococci .,,...,...,... 37 

1. In the various auppurations (staphylococcus and strepto- 
coccus) ..-....-..-.-.--...... ^ .. - - 37 

£. In croupous pneumonia (Friedliinder's and Frunkel's dip- 

lococcus) .... -...,- 30 

3. Diplococcus [ntraccllutaria (Weichsclbaum) 43 

4. In gonorrhea ..,,.,,,,. ■ ■ , . 44 

II. Bax^lli 47 

1, In tuberculosis ,........,.,.,, , 47 

Pseudotubercle, or smegma^ bscLltij micrococcus tetra- 

genus -.,...,. .,.,.. .53-54 

£. In leprosy , &4 

3. In anthrax , 65 

4. In glandere 59 

5. In typhus abdominalis. BO 

6. In tctajius 67 

7. In cholera Asiatica 69 

8. In diphtheria 72 

9. In influenza 7ö 

10. In oriental bubonic pJuguc 77 

Appendix: Bacterium coli commune 79 

Bacterium loctis a^rogenes ...,....,. 79 

In dysentery .,...,.., 80 

III. Spirilla 81 

Spirochsta Obermeicri oi recurrent fever. ..,,.., 61 




9. atreptotbrlxl» 82 

Actinomycea ..,..,,.,., 62 

S. Budding-, or Teajt, Funyt 85 

4. Holdi, or Thread Panffl 85 

ABporgllluH fujQtgatus, mucor corymbifer, oldium laetin et alU- 
GuUj achorion SchKnlcmii, trichophyton tonsuranA, 

DJLcroaporon fnrfur .S5-9i 

Appendix: Leptothrix buccali», ...-...- 91 

(B) Animal Paraaltei. 

I> SotoptJViltei 95 

Argns reflexuB, pbtliLriue pubis, a^^arua folliculormn, naruoptea 

»caUei 95-07 

n. Sntopamitei 07-124 

1. Protozoa 87-107 

Malarial plaemodia , 97 

Anufiba coll , 104 

GregflTin« 105-107 

CercomonaB and trichomonas 105 

Megaatoma entericum- 107 

£. TifTEBTiTVAL Wonua 107-121 

(aj Nematodca 108 

Anguillulft inteatinalis^ oxyuris vcrmiculariB , , - 108-100 

Anchyloatomum duodenale 110 

TrichocepbftluB diapar , , Ill 

Trichina apiralia -....,. Ill 

Aaearia lunabrieoidea 113 

fHaria Bancroftii a. Haugumia homiuia , , . 114 

ß) CeatodflH 116 

Tsnüe solium» aaginaliLf and uaua^. .-..., 117-120 

Tffinia echinococcuB -,-,.. 120 

Bothrlocephalu» latus 121 

fc; Trematodes 121-124 

L Bilhartia hssmatobta (distomum hdenoatobium), . , 123 

2. Distomum pulmonale ^ ^. 124 


(A) The Blood la Health. 

Beaction, speciHc gravity, total quantjtyt compo«ition, and speetro- 

flcopic chaxaetejs ........................... 125-130 

Uicroscof^o examiufttion oi the blood 13 1 

Counting of blood-oorpuaclee (vith Thoma-ZoisB apparatus) 135 

Examination of the (relative) hemogloUn content according to 

ndach] and Gowers. 140 



Eitimatlon ol the dry rviduc. ,,....... 147 

Molecular conceutration of tha blttod; determiu&tion of the frecE- 

ing-point ..................................... — 147 

(B) The Blood In DI>«Aie, 

Preparation of dmd hlood-BpecimenB. ISO 

tituning of the blood- . - - 151 

ChanffM in the Blood In Dluue 156-102 

(a) Genebal Reuabkb., 156 

1. In the Red Blood-norpusüieit: PoikitocytoaiB, normoblasta and 
gigantabla«tfi, megalocytee^ mioroc^teef anemic de- 
generation 157-100 

t. In Me LcucfKyies: Eoainophile cells, DeulropbiJe cell», baso- 
phile or maet- cells^ percentage of these^ signiHcance 

of granulationa 100-163 

(bj IW SPtClAL AJTECTlONfl 163 

The AnemiM 164 

1. Simple primary aaemia» or chtorvifis- :...... 154 

2. Simple Mcondary anemia 165 

3. Prvereagivt pemidtnu anemia 165 

Leukemia 160 

Diagnosis of the special form from the blootl-ümüiigB 170 

Staining of dry specimens. ,.,..- 171 

Staining of fresh blood-Bpecimeiia 172 

IHagnoBtic difficulties 172 

Signifieance of the Bo-called marrow cells. 173 

^eufe Latkttnia 175 

Theorie« a« to the nature of leukemia 176 

LeutxtCifloHa 177 

L Physiologic form 177 

B. Pathologic form 170 

Pwevdolruketnia 183 

Hcraoglobinemia ., 1S4 

Carbonic OMd Püinoiiiui/ 1B6 

MicriHtrffanismt in the Blood 187 

rorenaio Detection of Blood-ipots 18B-192 


General signi6caDce of the fiputnm; ennential and iino^^aential eon- 

■tituenta 103 

Anatomic aketeh of the respiratory apparatus 104 

MacTo««oplo aad microieopio ezanlnattoa 1 IM I OH 

1. General remarks upon the quantity; color; division into 
mucoid, purulent^ serous, and bloody sputa; mixed 
forms ....,-....-.. 106 



Exftmiiution of the tenacity, odor, and reaction 197-lOn 


"Ldjuen," fibrin coagula (broacliiaJ trcen) , Ciirflchm nan's BpirnU, 
iXttrich's plugs, tÜBue-fragnients, lime concretions, 
etc IOD'202 

3. MiCBOSCOPIO ESAMUf AT105 - 202 

Red and colorlesa Mils; cpithelia, indudmg alveoliir opilhclia^ 

fatty detrltut, elastic fiber», fibrinouB L-oagula, 
Cnrschmann's spirals, Charcot- l^y den cryatjür«, fatty- 
Acid ciyabB-ls (necdlca and roaettes), Cholesterin, hern- 

atoTdin, tyroain, and leuctn. ......,,. .203 21:1 

VegetaWe and animal parasitefl in the eputiim , 213 

Appendix: pulmonary calcnli and foreign bodies 210 

Charaater of the Spntxun in Certain Dlieatei 217 

In acut« and cbronLc catarrh of the air-poesagee 217 

Id bronchoblennorrbea 217 

In bronchiectaai». 216 

In feud (putrid) broncliitia - , . , , 210 

In flbrinoua bronchitia HlU 

In acute croupous pneumonia 210 

DeviatLone in traumatic pneumonia and in drunkardd 221 

DeTiations in la grippe, icterus, und euppurations 221 

Itt infiammatory eilema. - - 222 

Id pulmonary gangrece , . 222 

In pulmonary abscesa . 224 

Id perforative empyema ....... 225 

Id pulmonary tuberculo^ii^ 225 

In bronchial aathma, ..-.--... 220 

Id polmonary edema 235 

In whooping-cough - , , - - 235 

In la grippe 23fl 

In heart-lesions and hemorrhagic pulmonary inlorctioa 230-241 

In hyatcrift 241 

In neoplasms ..,...,..,. ,,..,.. 242 


1. Anatomie Bemarka -.-..-..,.-...-... 244 

%. Examination of the Oral and Fharyngreal Cavltiea 245 

In soor depoaita, Bednar'a aphth», gonococci in the oral cavity, 
acute and chronic tonail^tia, cy at- forma tiona in the 
tonaila, tonaiUar and retropharyngcnl ob*«ceäs, diph- 

theriftt and tuberculosia , ,244-247 

9. Finding In DEieaaea of the Btomach 24B 


(If) Mac&OSCOpic AJn> MlCROBCOPio ExAiarvATion of vomited 
and fliphoned food-remnants, mucuB, blood, epithslia 
and glandular elements, vegetable aod animal para- 

Bitea, puft, accidental adraiiturea 348-240 

Charaoter of tho vomited or siphoned matters in certain die- 
eaaea: 1. In acut« and chronic gastric catarrh. 2. In 
ectaaia. 3, In ulciu rotundum. 4. In cai-cinoma of 
the eaophagua and atomach. 5- In acute phleg- 

monoUB gaatritlH 250-Z51 

Hi) Cbeuxcal Ex&uihation of the Gastric Contents 251 

Qualitfttive determination of free HCl with Congo red paper, 
methyl- violet solution, tropeeolin solittion, Günz- 

burg's reagent 252-255 

Quantitative estimation of HCL £59 

Quantitative efitimation of total acidity. .....-.-....- 255 

Quantitative eetimation of free HCl according to Mürner and 

Boas, Lenbarbi, Quintard, and Töpfer 257 

Efltimation of lactic acid 260 

Estimation of pepein and lab ferment SftS 

Testing of the proteid digefiUon 264 

Detection of syntonin^ propepton, and pepton 204 

Testing the starch digestion- - , - . 204 

AchroMeitrin and erythrodcitrin and maltose 204 

(Cj Tebtiho Motiutt of tub StouaCH 205 

i. nndlugi la Intestinal AfTections 266 

Macroscopic examination of intestinal dtachargea , £06 

Amount, form, color, mucus, blood, gall-stonca, and worms. .207-200 

Microscopic examination of intestinal dischargea £70 

In health: rcnmant« of food, crystals, epithelia, ba£t«ria £70 

In disease: undigested muscle-fibers and undissolved atarcb, 

Charcot- Ley den crystals, "yellow mucous granulea". 270 
Character of the Dejecta in Certain Diseases: — 

h In acute enteritis £73 

2. In chronic enteritis .., 273 

3> In nervoua diarrhea , . , .,,,...,,. .£73 

4. In enteritis membranaoea (membranoua or tubular enteritis) . 274 

fi. In inteatinal ulceration.. 274 

0. In intestinal atrophy , - . . , , 275 

7. In icterus catarrhalia. ..,.,. 275 

8. In fatty or ajnyloid degeneration of the liver and cirrhoais. . . £75 

9. In intestinal tuberculoais ..,,,... 275 

10. In djMutery 270 

11. In typhus abdominalj'« 270 

12. In cholera £77 

13- In intestinal syphiliF- 278 



U. Tn cancer of rectum , 278 

15. In intuaBUBception and the like. , , . - - 27S 


1. The properties of normal urine ...,,.,...,.... 279 

'L Character of the urine in diaeaM - 281 

MacroBcopic chanj^ in quantity, appearance, etc ...,.,,... 2B1 

Molecular concentration of the urine. . 2BS 

Chemli: Examination of the Urine - 283 

1- Detection of the Nooual CoNBTiTUENTa of the Ubire. . . . 283 

Urea, demonstration of nitrate of urea 283 

Uric acid, murexid teat, quantitative estimation. 280 

Estimation of purin . - 287 

Creatinin, detection 201 

Hippuric acid.. 201 

Sodium chtorid and its detection. Jncreaee and diminution of 

the Chlorids 291 

Phosphatea, detection .............]...... . SOl 

tiulpbatee (preformed and combinedj ...,.- 292 

2. Chemic Tests for Patuoloqic Constititenta. 202 

Ammoniacat fermentation 202 

Albuminuria, physiologic (cyclic) and pathologic forms - £03 

Qualitative DeiecOon of Proteid Bodies S03 

Test for serum-albumin , £06 

1. Heller's nitric acid teat Z»5 

S. Nitric add and heat test , , 296 

3, Acetic acid and potasnium ferrocysnid test 2M 

4- Teats vith acetic acid and saturated solution of sodium 

Chlorid or Glauber'^ HiUte 207 

A. Metaphosphoric acid teat. ^ ^ , . 207 

a. Picric acid test. 207 

7- Potassium sulphocyanate and ncetic acid test 297 

8. Spieglcr'a teat . - 298 

Test for globulin 298 

Test for propepton snd pepton, -...., 208 

Test for fibrin and mucin 300 

Quantitative estimation of albun^in according to Eebach.. ..... 301 

lipuria, chyiuria 303 

Hematuria and hcmoglol^nurJa 303 

Chemic test for blood-coloring matter according to Heller and 

Almen .,.-,,- .,,-,- 304 

Bilft-cotoring matters in urine 304 

Test for bilirubin with chloroform, — Gmelin, Gmelin-Roacn- 

bach^ and RoHobach teats 305 

Test for urobilin. ^ - . ^ .................. . 305 


Biliary acids uid their detection in the urine - 300 

IndianuriiL uid detection of indicui according to Jaffa , 300 

Apparent melanuria due to indican. 307 

OccurrencB of indican in urine . . . , - 30S 

Genuine melanur ia. -,.....--,- 30B 

Allcaptonuria 308 

Pentosuria , , 309 



Phytiolßffic and Atimenlary Qtymauria 312 

Dichetea Mellitus: gc&eral character of the urine 313 

QualitativB detection of augar by: — 

1. Tronuncr'B test 315 

2. Fetling'a teat 316 

3. Moore'» teet 3ltt 

4. Böttger'a teat ,.. 310 

6, Nylander'a test 31fl 

6- Phenylhydrann test of von Jaksch 317 

7. Hoppe- Seyler** method 317 

Qualitative and quantitative eetimation by: — 

8. Fermentation te*t (Einhom'a) 31B 

9, Polarization 321 

10. Fehling'e method 323 

11. The arm^-uecharometer of J. Schatz 325 

Reactions with the blood of diabetic patient« (Bremer and Wil- 

liamBon) 320 

Gerhardt'» test for aceto-acetic acid 327 

I^gafs test for aceton 327 

Ehrlieh'B diazo-reaction and Hosenbach'a Bur^ndy reaction 328 

Vlorotcoplo Eiamlnation of the Urine 32a 

L OaoAKiZED Sbdimekts 331 

Anatoipjc remarks -.,,,. 331 

1. Red blood-corpuaclcB in urinary sediment 332 

2. Lcucocytefl in urinary eediment ....,..,,,. 334 

3- Epithelia from the kidneys and urinary traet 335 

Fat-granule cells 336 

4. Caata: hyaline, granular, and waiy 337 

Their significance and origiD IHI 

Caita in coma diabeticum. 341 

Cylindroida 342 

G. Pus (and muootd coalescence of the aama} - 342 

e. Mucus 343 

7. Fibrin 343 

8. Fat 340 

9. Seminal confltituenta 343 


10, Pigment: hrmoeLderin and bematoldin, melftnin, fndigo- ^ - 343 
lU Fatty fragiDGnts in tuberculoHie 344 

12. Tiaaae and neoplaam fragments - 344 

13. ParaaiteB 345 

(aj Vegeto-ble: microooccua and bacterium urete, uirdna, 

leptolhrii and yeast mIU; pathogenic^ eBpeeialTy 
^nococci, tubercle bacilli, actiaomyceB, typhoid ba- 
cilli» Btreptococeu« and staphylococci!», proteus, colon 

bacillufl S4Ö 

(b) Animal : echinocoecus, diatomum and filaria, ojcyoria 
vermicularifl ; atfto trichomonas and cercomonaB 

form» 349 


Acid aodium urate aod uric acid, 350 

OtilIIc and hippuric acids. 351 

Cyatin, leucin and tyroHiji, Cholesterin 353 

Triple phosphate and ammonium urate, calcium carbonate 354 

Calcium sulphate ,..,,. 354 

Neutral calcium and magneaium phosphate 355 

Spectrobcopt of the Urine , , . . , 356 

1. Oxyhemoglobin in urin* 35fl 

2. Methemoglobin 356 

3. Urobilin 356 

4. Hematoporphyrin 356 

Character of the Vrlnc la CertRln SlBea*« 356 


1. Acute nc-phrili*<, a(?utc hi>morrhn|^c and noahemorrhagic 

forma 353 

Z- Chronic ncpliritis: — 

(a) Diffuse nephritis, "large, white kidney^*. 300 

(b) Chronic nephritis with cardiac hypertrophy 381 

1. Ordinary chronic Bright's disease. , 301 

And secondary contracted kidney ..,,.. ^ , 302 

£. Chronic bemorrbagic nephritis, "red or mottled kid- 
ney" 362 

3. Contracted kidney 363 

Amyloid kidney., .....,,.. 304 

Contuaions of the kidneya» hydronephrosis, and renal 
abacesa , . 365 

II. Diseases of the Uriwabt TaAcr 365 

Pyelitis, cystic kidney, cystitis, urethritis. 30;') 

Gonorrhea and gonorrheal shreds , . 300 

t^permatorrhea (micturition and defecation spermatorrhea) ... 371 

AzoÖspermatorrhea and prostatorrhea , 372 

Azounpermia and oligozouapemua 373 

CÜNTENm i-fiii 

Hemoglobinuria ,.-..-.,.,, , . . - 373 

NeoplaamB of tfae kidne; aod bladder , . . 374 

Calculi in the renal pelvis and bladder -.-.-., 375 

Appendix: £x&minatioii of tbe becretions of the breaaU and 
T»ginat colostrum, milk (testinfi^ of human and cove' 

milk) 375 

Vaginal fiecretiona, Loohia, and abortion hemorrhage. , . 380 


1. TranBudatea 3S3 

2. Exndatea 384 

(a) Serou» exudates 38& 

(h) Homorrhagic exudates-, 385 

In tuberculoaie and neoplaams .,.,.... - 3Sfi 

At^c cells in the latter (canrer-e^KaT) 386 

Villous frflgroenta of same ..,.-..,.. - 387 

Cholesterin and blood- coloring matters in hemorrhagic 

eiudatea 389 

(c) Purulent exudates 388 

(d) Putrid eiudatea 388 

3. Ecblnococcic cyat contentii -.,-.-.. 390 

4. Ovarian cjat» 392 

G- UydrooephroHiA -.-.-,.-..,.. 392 

6. Hjdrop» of the gall-bladder 393 

7. Aspiration of spinal canal (lumbar puncture) 393 

lu tubcTcnlHT and nontubercular cerebrospinal meuingitis 393 

In chloroaia, apopLeKj, and cerebral tumors ..^. ......... 395 


FROVTiapTBCB— Leitx Continental Microscope with AdjiutiLble 
Revolving Stage. 

1. Eyepiece , , , 1 

2. Eyepiece . , ...,..,. ..,.,.,....... I 

3. BauBcb k Loiab BB ContiiteutaL Microscope vith Fixed Stage, 2 

4. Double Abbe CondeoacT 3 

5. Triple Abbö CoDdeneer 3 

Ö. Irifl Diaphragm. ....,--. ..,,... 3 

1. Two-tbirds Objective 4 

S. One-§iitb Objective 4 

9. One-twelfth Oil-lmmerBion Objective, .-......-.-....-....-.. 4 

10. Double Noaepjece 5 

IL Triple Noscpiece. ....,-...., , 5 

12- Micrometer Kyepie« Viewed from Below. 6 

13. Drawing Eyepiece Ö 

14. Camera Luoida., 7 

15- BauBcb k Lomb Mechanical UicroBCOpe Stage 8 

10. Leit£ Double Geared HechAniul Microscope St^ge. 

17. BauBch & Lomb Mechanical Stage in Poaition on Microscope. . 10 

15. Organic Matters frequently Present in Dust. (After Edtz- 

won».) ,...., II 

19. Forms of Bacteria. (From Schmk.) lU 

£D. Forms of Bacilli showing Sporvft. (From Oertf^L) 17 

21. flauech k Lomb Phyaician's Incubator ,,.,.,... Si 

22. Meat-grinder 21 

23. Arnold Steam 8terili«r. 22 

24. Autoclave 23 

25. Hot-Air SteriliMT 24 

26a. Petri Double Dish , 25 

20. Hot-Water Funnel for f^tering Agar and Uelatin 25 

27. Wire Basket for Test'tubce 25 

28. Wire Basket lor Teat-tubea 25 

29. Plate Culture. (From Oeriel.) 27 

30. sub Culture. (Prom OcrtH.) 28 

31. Smear Culture. (From OffrtcL) 28 

32. Hanging- l>rop Preparation 2fl 

33. Friedinoder"» Pneumobacillus in Pneumonic Sputum. X 1000. 

(After Friinkd and Pfeiffer.) 3U 




34. DiplococcuH Pneumonie In the Heart's Blood of % Rabbit. 

X 1000. (Alter Fränkei and Pfeiffer.) 41 

35. Colony of Anthrax BactlJi, sliglttly Maf^ifled, (After Flüßgc.) fi7 

30. Stages in Widal Beaction. [Aftet- Robin.) 64 

3L Bacillua Tetani. X 1000. {Afier Fränkei nod Pfeiffer.) OS 

37a. Bacillua Diphthehs, X lOOO. (From dra-winf^ by E. L. Oat- 
man, itJ>.) 74 

38. Spirocbttttt Obermeieri. X 380 , SI 

30. AcUnom3'ccs HominiB (Lung). X 350. 33 

40. Molds. (Baumgarten.) (From OerteL) flO 

4L AfipoTgillna Fiimigalus. X 35ti 87 

42. Mucor Corymbifer. X 350 88 

43. Soor [Thrush] Fungus. X 350 89 

44. Achorion Schön] einJL X 400, (After ßi^^rero.) 91 

45. Trichophyton Tonsurans — Tlireads and Chain» of Spore«. 

X 400, (After Dizzo^^'ro.) . . . . 02 

46. MieroapoTon Furfur. X 3ri0 93 

47. Leptothrix and Oncomoima. X 3.'>0. From a Fr<?shly Opened 

Tonsillar Äbsceäs ,,..,,...,. 94 

48. ArgBS reflcxua. X 4. (After AtL) 00 

49. PhthiriuH Pubis [Crab-louse]. (Aft*r Ltittdois.) 90 

50. Acarua FoUiculorütn with Low Magnification 97 

fil. The Same witb High Magnification 97 

62. ßarcoples Scabiei. Female seen from Above and Below. 

(After Quddea.) 08 

53, Amfcba Coli. From Dysenteric Stool. Zei^s. T; oil immer- 

aion^ '/„ 104 

54. OjcyuriB Vermicularis. Female and Male. [Aflor Leuckart.) . lOD 

B5. AnchyloBtomum Duodonalc. (After Leuekfirt.) 109 

50. Egga of Nematodes. (After Leiickart) 110 

57. TriehocephaluB Diapar. (Alter Leucl-att.) 112 

58. Trichina Spiralis. (After Claus.) 112 

69. Filaria Embryos. (After von Jaksch.) , 114 

60. FJItiria Sanguinis Hominis in Human Blood. From Pboto- 

mierograph. X 500 115 

61. Tffinia Solium. (After Leuckart.) 117 

62. Tania Saginata. (Partly after Leuckart.) 113 

63. Tffinia Nana. (After Leuekart.) 1 10 

64. TiPnift Echinococeua of the Dog. (After Leacktirt.) , 110 

65. Bothriocephalus Latus. (After Lawkarl.) 122 

66. Bilharzia Iltematobia. (Alter Leackart.) 123 

07. Egg of Diatomum Pulmonale, Lid Sprung. Sputum Prejiara- 

tion , 123 

C8. Egga of Diatoraa from LTrinary Sediment. (After Purdf/.) . . 123 
630. Hemo-alkatimeter. (About one-half aetua] aii^e.) 126 


no. PAOB 

69. Browning Hand SpectroBCope, {Zeits.) 130 

70- Spectrum with the Zeitö Hand Bp«ctroftC(jpe 130 

71- LeukemU with Large 6pleen Tumor. X 350 132 

72- Thomft-Zeiaa Blood-couniing ApparatuH, 136 

73. Thoma-ZcJaB Counting Chamlwr 137 

74. Türck Counting Chamber 137 

75. Einhorn*« Btoodcorpus<^lB Cnunler 130 

76- Flciachl'a Hemoglobinomettr. .- - - 141 

77- GowerH*a HeEDoglohJiionieter. 142 

78. Bare^s Hemoglobinometor 143 

TO. Section of Dare^s Hemoglobin onietcr, - - - r . 144 

80. To FU\ the Automatic Pipette 145 

SI. Talquiat Hemoglobin Scale 146 

82. Copland Staining Dish 154 

83. PoikilocytoBiB Iö7 

84. Acute Leukemia 175 

85. Ciliated Epithelium (Obtained b; Careful Scraping of the 

Mucosa). X 3G0 194 

86. Coagulum in Cronpoua Bronchitis. Natural Size. ........... 200 

87. Elaetic Fibers from a Crushed Corpora Orizoidea. X 350 205 

88. Delicate Fibrin Coagulum (from Croupoua Pneumonia). X 350. 207 

89. Fat-crjstal Xeedles and Roeettea and MasAea of Coeci X 330. 200 

90. Fat'CryeUl Roaettc 210 

91. Cholesterin Ptatea. Crush Preparation. X 350.., 211 

9£. Hematoldia Crystals. Pulmonary Abscess. X 350 212 

93. Tyrosin and Leucin. (After Bi::zozri-o.) ..,,.,.....,-...-.., 213 

94. CuTHchmann'B Spiral. X HO 230 

95. Curschmann's Spiral with Central Thread. X 110 231 

90. Curschinann's Spiral, Composed of Delicately Twisted Mucous 

Threads and Spindle-shaped Cells, X ^50 232 

97. Fat-granule Sphcrulea in Pulmonary Carcinoma. X 350 243 

98, Gastric Contents. Coüective Microscopic Picture. X 3j0.-, 249 
90. Strauas'a Separating Funnei for Lactic Acid Test 281 

100. Stool, CoUeetivo Microscopic Picture, X 350. (Partly after 

Tfathnafffl.) 269 

101. Urinometer 280 

102. Doremus^s Ureometer 284 

103. Doremus'a Ureometer, Improved. 285 

103a- Colorless Uric Acid Crystals. X 350. (After Simon.) 280 

104. Ruhemann^B Uricometer '........ 287 

104ii. Purinometer 280 

105. Albumoscopfl £90 

lOfl. Esbach'fl Albuminometer. .,.,.,.. 301 

107. Improved Ksbach Albuminometer ........,,,..., 301 

108. ESnhom'a Fermentation Stecharometer 313 



Wta. TAO^ 

lOD. SUn'i Urinngliirnrir>mciUir,..t-> — - SW 

IIIX P^liriaiUon Ap[]Qialii» ,. 151 

111. ßcalc fur iVilarizalion ApimraLuf. . ....... ttS 

1X2. Epithelium from tb« Uruuiry Xnot lObt&mvd bjr Sdr^piag Um 

uuo»4>. X 3» tn 

113. AfUf HamonUmglo N«phr!tla, X ^^. . .133 

114. Severe AcitU {%t I^rql iVriilMlj' Hmt'irrhiLgii^} Xcplinlin 

whkh EnrlrJ PhUlly lu Pour W«ki. X 350 W 

115. "LAra* IVhH* Kiilnij." X 350.. »7 

116. Xurow Hvjilinp C^U. X 350, (AfUr rf^n.) . . . 838 
nT> Oirunlc fln£l>t^ DUmmc (Hiiunk Purvticli.viniilDit» and Inut^ 

Mitii»! Neplirilii). X »W »ai» 

na K|iUI>rrNLl t'a»t>. X 3A0. (Arur PfVff.i 310 

lift Hunrl tVnJrifty-r', Umiblf rSjiarrcl . . , . 3tA 

UO» M'Alor-MMor i;ch1rilu^ . . . . 3U 

ISlp Punly'ii ELei-Uio CL-atriTüffP, fÜDe^rourlh Aclmtl tiJjLC,) , 3-lfl 

jea. ITriti* rylin<l*r fßr r^llwtifrii of !^Lnu>nt 3*7 

ld3. UiprorOMUs IIt«*. X 600. (Aftflr con J«*-fA.l 348 

ISi. Ye*« Fimttiü. jAflcr ffarkw-) 348 

ISS. UrnE* nf Nail« »nd LYyfttalA of t^rif* Ac-ld, QtaIaI* qI Linw, 

■xiH O'lUn. X 360 W 

12fl. SodJuxo LVolB (>y>UU. X WO. (AUcc fegfrA 3» 

127. Hippiifk- AoLfl. Suaium Uralo, and Urlo Aeld In WhAttton*, 

DumlviTcU. nnti Uoil FV>rm. X 3A0, 341 

12B. OnHum (HaJhIp CryaUlp 1ti Urtnv. X 350 US 

I2S. F«at)i«rj Cr^aUU of l>ipto PfaoapbAtA. X BS9. (Aftw 

TlTMin.) SOS 

lao, Cr;«ti1i «f Triple PtioHphnte and AmTnoniiim tTralr x nm. AA* 
131- C»lduin C'arborulo, Caltiiun Sulphoto, Noutral CflHutii Pho» 

|]|iiiri\ hiitl Bfl»*"' MagneBia PlioHphnl« Crj^Ule, X 330. 

[AHi^r rim Jiikin'h,) . _ 3&a 

132. C*Hum Phoftpbktc &7«UU. X WO. lAlL« /^f&n-,).. 3Sa 

133. Mii^nrr^ML riif ihpli« If Trujii n Prir*U Frltii-Tp iipoti the SurfAO uf 

Vrintt ..«It*. 3ST 

134. gpcnnatarrhcn uid Proatatonrbu. X SAO 372 

in.'V n^miPtfl^tiiitLirlA , ,. . 3T3 

131}. Holt'» Milk ti«l ,p,., 377 

137. PewT'fl Iact->6C0pe - STS 

13ft DioTinnh VilH. frtim A Frruh AlxiriiAn (Law MA^YüBrAlian) . , ATD 

I3&. IXK-irhinl CiJl«, from r Krwh AbnrtiT>n- X fahoiit) SfiO 3*1 

140. Soilluiu CliluricI Crrstals l^iduc«! by CnrrfiiL SvAponillan of 

Echlnoropclp Pliild. >: Ä50 , . SHW 

HI. EcblncMock Hooklct« {ObUidcd by ABpiralion of a Cy>t). 

X 3!>0 3B0 

142. Ytota aa Echinocnwio C^rt. X SÄU , 101 



L VogerB Scale of Urin« Tints 279 

n. Uric-Acid Cryntikli. Normal Color. X 450. (After Peffcr.) 351 
ITL Uric-Acid Crjstals vith Amorphoiu Urate«- X 450. {After 

Pener.) 352 

IV. Sediment of Alkaline Fermentation. X 450. {After Ho/f- 

man and Ullzmann.) 354 

V- Ammonium Urate» »ho wing Bpherulea and Thom-apple- 

shaped CrystalB. X 450. (After Feffer.) 368 

VI. Cryetalfl of PhenjIglucoeazoDe. X 450. (After von Jak*c\.) 300 

Vn. VarietJea of Pathogenic Bacteria 412 

VnL VarietieB of Pathogenic Baot«na 412 

DL Blood-cells in Certain Diaeaaes 412 


Manual of Clinical Microscopy 
AND Chemistry. 



1. Tbe opilc pfirtton vf Ihr wicnj^mpe In pompowd o( tUfl ohfedicff, 
«rlrich b lervwad IdIo Ihe Ivw^r »iid at lli* ivhi-, «nu tb« ooulsr for 
•7«pfcv« (■« Hic». i. Ü, and 3, fi)] ^hJfli in iawrlpd mto tho "pptr 
opvnlii^. TIh* objrclivr j^iitn but u (iiD^'nifliHl invprtnl Lnm^, vhiati la 
nMlTvJ and ftirtbrr fnUrg«d t»; the ai-dlfti. Tho Hn\ |lh* objoott«« 

n^. J— |IJ^Tp|a:«. 

I'lg. !L— Kffpkeo. 

(Mf Ftir. J. ^, and Flp. T, S, vid B|J «fin«l<t» of ft «rttfin nf rrviffn< 
glsM cvnt-M^i^g ftdri flfnt-gtMs dlnrifing \ta*ca irhlk^h permit »t much 
«■ poii4htc llic cxitusiuD of ehratMiia ttfrcm'atitM. Tliv lullcr vmuM bc- 
r^m» in»Dif*tl with lli« im» of Init oh« !#«> ty m fliVHl^r nr Uu rmlutninn 
aa-l d»l4irtjan<« »f |l>« flvid of vwoa throuffb ih» «pp«anxi«o of a CAlor#t| 
Uiu|f&D^ EODCt bcpAUne ihe ny« compoiilni: iLc uhlle Lichl vauM not be 
iMttrnmly trfT^cifA. A liuih^r *oiirf f>f rililuTtiflnfo c| th^ Imag«— > 
nairtl^, iftfrf« A^frivfif>«— i« overeom« by ■ Jiuphr«|tiD pt4r<d within 
Lh« hit«. Thii arrcfi" lliv vcriithcrtl tay« of the onw ut liylit wLioh 
pMB«i thioufh'iba objetttTv, bihI bnagv thf» o«iklnl ny« Ia ■ focvft 




Tti* fl'M of »wriitRMi of Iho m^iTotPopa hai b*i>n ^rratly Mcl^ndod 

ID rriront ji'im ij the i n trod iifl Tun i^f intatfriii'in IrTMiV Hn<j tLe Abbfi 
mnik-u^irijj (ijiiritrufif«. Id ili« uw u£ "ilj/" kaxi«, vhlch la former 

jTMir« were the only <mc« employed, ihfl light wflcL-lwl fnim tlio iilaoc 
■»r coneKV« mirror U conBtantly nubjcot to tr>H. Thi« IH rliip In lliti 
dilTcrcaGa in rrfmcUvc index uf Iti« tiicdiu to be fciictcatcd. tui'h ai tba 



»Tid(v coni'fllnffl, and luylug jUkIijiii of jür Ulureu the piquuAhon 
nnil tfont Uew. ao t1i*t tbo ra.ifu of Ei^t tlwitp mifar partJftl T«in>otion 
in ihcir pAkUJiO Iq thr <ibjiit:tivCL In a Vri^Ht inHny tnxl&iH'c*, Mpr<ciiil1j 
in tbe atudy of Hil' t"tthn|;irnic Wclutin, tlit) ai>9i-l.-iiii:c olTercil bjr tJid 
nucRMCOp« I* 4l*ciiif4))j tvdiiovd b/ On* \at^ <fi light, Itrough th« 
(ntrodocllon of iiaincjsion Icdacb into micnacopy hy Kudi Ibo Iriu i>F 
llfiht Ift iTfliJii^l to a TiiEiLiniLim- Tl^c InUii^rtUluii of wil^r Wwron 
lb» from Jtfim tml tb>« pn^pvrHUQd Im^ fonri«i]y orTmcl niurtjr tiLvjin- 

-Ui>iU>Ji' Ai^ji- (JoQcLcruer* Fl^'. ."> —'lii[i\v A.UUC- 1 undi'jiäcr. 

tdffi*«, A mirh tr^Atrr in^TCAw in Ihr volumo of lisbt and m llif ilin 
LfnrinrH» ind (?1f4niPM of l^'' Itia^^ K Imw^r^, frnirrri by the une nf 
an Inimarvioii Uutcl wiiith, Mkn ovcliir-<>il, pon»«««« lb« a«»? rvfnic4lva 
inJ*ji ft« t-irotta glftu. by tW ra^KU« at[ tcCrkction of tb« m-y» of %ljl 
tii^^iTV thwy »iiliT Ihn übjnHivc b <n-oreonic, Tbfl v»lu» of Irninirtifiti 
IvDF» V« g^^^T oabfLm^oü by Iho JA£f ^ififnwrr. Th« laltn oon^UCir of 
a coniblDAlion oi two fdoiiblr <^OTtdfriitt] or thrto I«q»« [tripl« con 

Fig, fl-— [ii^ |jiA|iU[:i^rn. 

df**iir]. In Ui* dniibk oonilrnMHr *he fint tl**!*! I"* >■ p!ftn<i-ointfO<, 
Kfui the Kcond IhoUoml tiieanm ficc Flff^ 4Ji Id tba triple cnnilrnft^r 
Ihcr* tt, in addillDii lu th« tue Irnu« Jiui mitniloti^. & Trtiddlv i^cknaihri?- 
<B«tv« Un» |bfv Fljf. fi). TlkA «DhdHiMir b lo ptutU In Uio »IW be- 
Pnlh tbe ii»kro?co[ie <Ut;r llmt t1^ dflL mirfiki-c ul UK i1|I|>ct pfaao- 
riMTvv loiti U feVFl wtlh Ifie «Inpr. A jvtvriTTiLl cnno of llsflkt c^n Ihm 
bo c^i>nj^au«t(d upoQ tho apHimnL. Tho iiitcn"ily of th« li^t ia Tt^I' 
Utnl by ft ■*ri<'t uf i'ui^i.«utri(allj pvcf^JaLr^! dUk« pl*4<d in tho dU- 



ijljraipD'lioTUcir Th« li|chl i« tncio ciJiirrinrrilly coiili^ilkil lir iiii^aiu af 
thn Hn-nülftl *'lfiA dtajirtntifm." (pliicwvl umtrr <ir ovitr Uif äi»r1i'n*d>r or 
botb (iH>* Fi^- 3, ^)]h xrLich ptr-rntU rcad^ ac^ mj>id cl^tkngv in the «im 
of tk« ^iai'f II «KOI ftl AtL> iitouiviit. 

[For <lin-»ljllll7 IIn> fyllmliT^Hapliruirm »Hru'lim#Pt Willi romomfaU 
(■p» i« pirfrtiiJilv. ThpFW ffiHnvnblc fAp* niv ihäJi^ by l-riU, 9ponotr 
Lrnk Conipnn^'. DuutcU d Luinb. and Qij4'Cii A Co,, w^ih Hnti* tun o4 
Hpfrtur*. For yrun thi* tx'LTi inlftvivopo tl I', mn^lc frtr th« Xmeiivän 
ttf^v^. ha l>rrn *i|iii|i|ii'il with tliii form uf ilinplirA^ni only, tlir inj 
Iwiiii; vuiilliLtd Ic tlie undrr tuHuru of Ih? ^rpiiiulv AbUf^ i^rnuik'iuer 
a1tA«liQ)ciit, It It nnl^ ruocnlly Umt tKojr have inlrodix-pcl tlio tnt on 
tbo vU|{V elf lb? 1) (\ mi thin oiität id tup[)ti?d an «pei-ial oriirr, Foi 
in»iiy yrurti llii* niuai'li A. I^nilj 0[iLE<^1 Oninimtiy »hkI mil} lUi' An-cAlW 
"üiiüibk*' nr "i-iip" ilinplirflgTii; thi*/ thwi ntlnvhwi tlit iriit lo th« 
urta^, but their dch RliS mndrl^ artf aIao MLpplird with tLv cyUndvr 

Tig- T.— TnH-tlilnli Fiß. *.— Llnc-BiMii 

(JbjcctivH. Objective, 

Muny phynkinn» from VMrioiiK jmrfji of t}i« ociitntr/ Uhv« «xptoitMd 
to OS inmh dU*n»i"fiiHi«n rt'itb I.Tic iri» pprirnincntfy fiird to tlie fttom» 
In till' roHliiiP micniMfiipliT work nt ihi- Xoa' Yrrk I'ij^t. kukIuuIp Tjibnm- 
tory iimtrumpntt r^-itli urch aUndiiiiPiiti wi^r« long a^*t diut^ardvd. bc> 
cauDt, when ipcvbitni of Uquldt. nuvli a* atiric iwliiuh in mu>t <ift<.-u 
•MniEiinl liy Ihn |iliyhl<-tjint, ivcii« oxjiinirKil hy Xhu hUiIi* iiirüiml. nuw 
«icliihiv4»ly in tuv th«», the Evuvt« of thv duiplitiffir» bt^fiaiiir vivt, t'Vhtth 
qnmtly rustol, &nA wn thu> aduu iTndt'n'd umcIi^ta. Furtbernmrtj to« 
UB*tj OT forclhk lovi^rlng: of Uifi tiitx? may ihatlrr tho Iri« dlnpbnigin 
hy (u.rlnfl wjlh Uio HittftI CflKinn of tlw oUjftTlivc. Konfl of Ihono oüjce- 
Ltuns it[>p]if^4 i" tliL* cup EliA|tliiJ<j,'iiu ami If, Imn liri-n fiur ?x|ir(icnri?, oa 
well a« that fli tnjiny nthpth >vr liJtvp ron^iuiudn thjit i^rnp^'r ini'iipu'«* 
tlon of thü luLbtiii^fi icrow for triwuiiikg and ntUitig tW dJaphrngni at- 
conit^Unli«-* iiMinT tluifi i'uii Ix^ ti^cufi.«it by IrLcrvAtjiijt ijt dct^r^aaii^ tbe tit^ 
of th« a|M>rtitrc of «n IrU rlin^ihin^ fliDd to thif MiigJ\ TliLh. Vn har« 

i\"nG<iDüc'rüKV kij:uaiik& $ 

folinil, le purrjrufdrtjr iruv v^lh rrgird lo tmrvMnx lor ilrMmt», Mmnlt 
hyalin« and Aiulf gnnulftr nwU In <U*t urluci uilU aLpioat invUlllD 
*n1 imen de— B«CKrtt>u 1 

rr In llii- tfin-ttfin af a mf^ni/tftrpr rhi» jitI-i- nf Lhk> InmnimAiir. H 
•& imputtADt qu«lton. A](liou>:h It ii. a« a rule, A<ivi>4Uv not to bo 
Rpaibig LtJ outtaj. ll ahoi^Id be u^itd tlut. ttn tUif prictiLluna wli« «Iws 
HAt intii)'! tu innkD ■ tjiAcidl utoJ^ ai 111» liat-ti^rin, n Blmpl* Tnirrfivi>p0 
muinniE *" p'^rc from t4£ to fSO t* quitf« luffioicnL Kor Ihi- lunfriint 
bec«n oUaki «fiiiu viuii iLctU [lUnt^li & FiUoib. Sprucvr, i^r Que«a]l> 

Fig. 10. — |](iii1ilo Xi>hB|>iiv0, 

witk oculjtr« 1 Ko4 III II uid ain?h] «Dd objvctUc« 31 »nd T fV, ind 
Va!> 1»T mr-tnn of whiih TiiAj^intAllon« up tu CiOU itidmctcM c&n b« 
•tvun-i. Bciddp* Ihr «jmSnaUon ol th*» »puiiitn, uiiin?- and othtT vsm- 
tkftM. txamiDBtiuii fat ibc lubcrHa liadllu« audp witli » l^ltlu pmctlok 

thai Ihr tilbiTrli* lHiH>lit>i, iffmiHnortM. nnil ollivr ImicU-dA citn \if m^ni 
«ith drj objveüve« ol Iho poMtm tntctionvdj vo v>>ulij atr^oglf Adrt» 
Ajrm3ii«( Uic uie «J fuch by the Dovbe OCccpt wbcn Uiiavokt&tilE^^ 

Vor all lha«c lo whura uf^ir It not h inr^ulnv tT:in"iitfmlinn. U t» 
ilmntfl)^ ajtvi«lJe to t*hMH« ■ lipll^ omni, i^apf^inlly a goM iianil with 
«n^rv ad}Lj4inH.-nt for moving the tiibr. (AIaij 4 ii:iulilv or triplr no««' 
fiitft {wc njf- J, B: »ihI Kitf». 10 «ud ll> for Ivouh« uf Urn. mnlium, «uJ 
hl|{ti iiiiigniri<-4lion-«- — Ki^vika-) Th^ piir«hd44 «if turll^r Itnw^ pnrtirv^ 
Uilj «A ImiDcraloii ]auv can tubtojiimlFj he mtbJc Uncircli^ niU^nr^ 
•rap« «ra tnanafuluruil hy <?- X*1h, af Jen», «iiil K. T^JU, nl Wrtjclnr 
L«l*o by HiiiHdi ft LariIk of Kor>hMt«T <■•* FIff. !!>: S|#n<vr l^ni Com- 
pear, oi lUffAtoi Atitl ijur+n 4 Ox. of rhiWf I phi» ] . The UJuttfatcJ 


•copc, mtv pbogluitlf hrvcamrj. Fur Uip nmauicmtuit of otijwlt tbc 

"mWometcT tHjulat" tut be roeajncieaJcd [Fl^^ IKJ. Willi thli ftttach* 
inont tltc vjret«n« «n ba •oduralc-lj' «djuHted to >inj »yo. For counlinj^ 

1 »1 .1 ■' 


Ol« "nti üikiroLiM<tpr." mliiiHi i» pliucfrl vfttlim ttkc tube nnd rfriU Upon 
Ibr dfnphm^t it nFiKt vl hnhi» For UriL^viiig. Hit- j^LiMif-ra lin-Uln i>f 
OlicihUuKT and Abb^^ or Ibv l!n(1Atl^f prii^m ulfv vhu'lly viiiphivi'd [V\f^ 


t^J. Th« diiilicT prufm th* AbbA dntAtng ft|i]iiiratLi^ vMHt It sa AT- 
mii|f«4l tliAl tlir piiviii ATi<I Riirrnr fnriiif: Inck from Uki ryrfiifo«, per- 
miLtiziu Ihv* unv of Ihi; uik-ruFo^fv f->r vnllnury wutk otiti the d|Ai}||in|E 
Al pyvfiiFf» «ithoat «iiiiurbmg the «am^r« lucida [nag Kj^ |4J. Jly tbi« 
amu the dfffprcnt llnlJa at Ihc niltro4uo|ic van I« unilonnli tuiiafned. 
8(i(no iTMi-tut-, hnwcvrr, U Ti'i|iii[vJ \i\ t>u\t^ ti> malts utiiifi.('(nry iiMt 
«r lb« ajiipArDliik Kot infmpivultf too grtut illuniii»Llii>ii it a dialuii- 
Jng demi-Dt. and U not oYcii-omu b/ lU« >jiiuk?d fjlAs^ca nlikEt i^<:'>w- 
|ttfijr thtf HiifkhnlLJH. lit Miii-h [ri«tuijivM prii1itiiiiiLi<iiii^rLr. in^y liv fltoUliv] 
Vj rvgiiltttjrig thtt lliflit \*y adjtihtfarf&l of the nürtur In ihipt :vny #Uarp 
«utlinc uD Ifc oblnincd upon Ihe 4r»«1aK fturhu^ vhuib La AbtaluUljr 
«jirntui f&r clrnwlng. 

Iß tbtf op'<<^torn<tth obttv\Uv* tbo ckfcHiialu' nj*d iij>hm'i* abomLli<>ii 
«oDDet^lcJ ititU Ih« oldot uLtjccüri*« h«ji ttrii iilmi->t nbuktjr vljmiiwtQii 
by UM of new kimlit of ie^ih) uid crtvtlj lm]iroi«(l rm^lhodi of corr«- 
lioTiH Thu picture* Appear wholly It«* ol color, *nd by flight change of 

3n£< l-L— Ctmvr» LucLIl 

til« adjuetUnr«! a nniftimi iharpli^B» of ihn im«go U nbfainfd tl tlw 
ttntcf «nil [ivii|ilii-jy of Ibc GrU. 

III. In tlic- u»r 0/ lAr tnlcroMCtpe th* following nil» ihould br 
obavrvcil; Hk/ iiialniiiuml alioufj \m kc|it frvv <if i|ii:*l. and wh^n frc- 
«IHflOtly UK1I il is «dvlwtblc hi tW iijUTtjÜB to c»vrr it fUh a brll j«r or 
tA plac« It In Ihr mw. 

in rr^ry rjiiniJFt<ilivii If 4«, cj a ntl«, btuf fo bfp^ ieJf% foiti mtte 
irijfmtoih Only flftvr H KeariHl tcuumiinliim Iioa Ihvu umilr hlumli 
hiffhrr pi>«nv b» miphiyt^ (Iv*! vitli rtToli-in/ mi^rpJi-LV [*i>f Vi^;. %. If. 
Aod Flfii> 10 And 11))' In Ui<ing «Implo mipTHtii^ctpr^ ut>f^rovkli>il with 
coofM (Ml/uif«wnt [ttv Pfg. 3, Kl fvL-u^ini; niuil br dune hy cairlut 
dowDWArd nvAlvin^ mr-^vnmrnU of thf dm^fiub», in niiii<r let AiriM 
la^nry ic» th« frcmt Unn fmni (txi Mrnng adiaiw o( the'c. If 
Iha movtiumt of the tube In 0bftmcii>1 »t \m^]m, the luEh; »lifuld tm 
«^nwd wilb n lilt?« iloohni or iHglitly oiML 

btmmuitJi prokuidt with so (nJIcJ amU ami plaJon |i«nBit fTAjy 



and safe approach of tUc obJc^-lLvc to tlie propiLTiition, In using immer- 
sion IcnseA a aiiiall drop of oil ia plaoed upon the center of the caver-glaas 
[or elidej and the leni üürcfully liiwered [by means of the ooarae adjunl- 
raent] until it touc-hea the oil, |Thpn by gentle nmnipulation of the fine 
adjustment the object can bo brought into view.] After the use of the 
oil-immereiün lens it should be freed of the exceae of oil by gentle pres- 
sure with fiUer-pnper and then wiped dean with a soft eloth ^or absorb- 
ent cotton] moUtcned with pure benzin [or xylol]. Care should be 
observed not to use too much benzin [or xylol|, as ther^e, when in 
excoHSf Hoften the cement holding Üie lens in poäition. The fint adfttst- 
«tent [see Fig. 3, L] is under the control of the niillimeter-HE'rew, which, 
in modern iiislrunifUtH, \a attached to the up^ier end of the supporting 
pout. The light hnnd is u»ied tu work the fine adjurilment, while the 

Fig- 15,— TJnnach Sl Ixunb Mechanical Microscope Stn^je, 

left is employed to move the preparation in any direction upon the atnge. 
[The fine adjustment is employed for dvtiiil work, and when in u^^ 
should be kept in Ojfistant nirAioH. Size, form, and depth are made out 
by its aid. 

A mechanical ata^e (see Figa, 15, IG, and 17) h a valuable and 
labor-saving atlacbmeiit. It ia c^i^ecinTly adviintEigcous in the often 
tedious esaminalions for plasmodia of malaria, particularly of the 
eativo-antntuna] formni in rfltio and enufueration counts of the blood- 
coTpu*<cles; for gyiiococci in gonorrheal alireds; and for tnbercle bacilli 
in the uriue, fcccfl, sputum, etc- — BnoOKS.] 

In the use of low powrra Hpht may be supplied with either tlie 
plane or concave mirror; with high powers the concave niJiTor, which 
conrentrotes more lipbt, is usually employed [except with AbbJ^ con- 
denser, with vliich the plane mirror should always he used — Ukook^I. 

Iltoyli^flit ift |p;>ii»*n]1y \n Ikt |jn'lriTuiil. .^ilinrüil li|:liE, in Wm mxilifii-il hy 
a l-flu^-jtliiu jA^Vr ur Kbo«iridJcvr'ii ^lotii-. (Wlii^n tili^iifrur UjeM ii UHBd 
^ith ■ conJcn»r, a fr-tr<tfi v^v^t di^k FilmiilJ b? rliii.viJ in l^f liric-hifUlrT 

|>hTv^Bi- MhTiy c(>(ii|j-iiHrr*, tvh4ii Wvvl vtit-li tbn ^^■JT** *^<' nul loan* 
«itittrial lüfbt ('■^^''j'- '^^üi i>rrvt atn br o«tivi?^lt in tlic folloninK 
iitDnncr! F«ai Itit Irnt upon Hie olij^v» rruioi« Ihr oini^nr. Icok Inb» 
Ibfl tuU\ fln^l » adJEi«! (ho lulrror that tb* tnntg« of llio »ourca of tlglil 
rva bv Kr*'ri in ih*! 1'iiJ> nl Uii^ butlmn nt tljc IiiIt, if tbr luitilcLi^i^r I« 
noLv (:>-nlly liiM*n^l !>/ mPiiiiM nf Itii' 4iiliht/ii:r w-rvw. tJiA iiiifiKi» Mill Jb< 
iLj»pMr und the Im« bt?4Hi>mff briÜimitly ilhiiiiiijii1«il 1tirim)|hoiit- When 
lb» ikuinl vt \itiK\ili^t illuminatioa ib tcAcUpi), iTpUtc tUc oiittlai. Tlie 
minrüAfu^ UdM V^U Row tv fmmil lo |>* antplt hllmniiia|«if.— ltiii>uK».j 

fflg- lll'-Lcftjs UuUbU firtfrcil McTh4iu^itfl ^Ik-rdMupc Ho^. 

With hiifh inftgniAn^lionM, tihloh »liouJil. a« > niF*. bo *vpur»fl vith «tron^ 
objvHJtT^ anA M't \ciih fft^fjr ornJir«, & mtiulL ilifeirlkri^^ni opening la to 
be dOpIbjitoU- Tbt' hifii»P|,>i'n>'iiii» liijiiii']>i]»n \>*\\*-v» wLll »tanJ v<-ry viUaJijc 
onüan, lb* Abb« ntii^Iurmt-r tiw^l nor \m mmoii«! iliiriiijE obti-rvjit^^ibfii 
tl^rflf«, bcoauM «bfn « «mnlJ rfiaiiArYJfr'ri nf>rrr«n' h u<^ alrucluial 
4HaIU ftfc prnfttod. <)n the other tiin<}. If »inknH dMnIt» aia u> bit 
«lUDlnfil. all übAlrUfU<>a to ilium iDUliun «bauld bu iiimj^'cd or Uw 
iri> ^iopKrnifm ofvnnl »id«, in ordirr to «pcur« iht fullf«t vlTrct q' 
llghU In tbii *3y lU? hixlntii|r1c oullim^— ^(rut-tiirr — )« alviioit wLolly 
BltWf*d, whkl« oifl<imf parim nr* nion ttktincTly brou^lil la vivw- 

tn namiiMiii£ «iih hinh ^icrr ifry Jnuu it i> jiilxihubl? t^ nuplny 
rtiwr^l*««-» o| a UiKknr» lulN^lnl Ir» \\\f Wi\^ |r i|ii> Wiirr mike« 
«I SCci*« IpTifv« Ibo mvl4l cuMEijr i« niimbvTnl tci jh<lir'jitc \\\t «<jvrr£UH* 
Uiii-Lw-u Ivi uk^tV tbff kCB U uiciBt perfectly cuiTrttrU, Currr-ie^ovMii 


UlCltOecoi^- AKD cnEMlSTRT. 

of niftdlnm thiflrnm« mvauir« from 0-lfi m D-! ifklll]niPlf<P ('/iw to V« 
imiil ui^mrl. With Ui« tioiDO£«Dt«uj oiMmnivraoa Ininr« tin- lltlcl 
III ihc covL-rglruf In dot; of *nch gjwvX lirijuruiiu. [In imlng tb« ml 
■copo it U frdvWitiU 4orl7 to »c^iilto th« babU ol Ktaptng boft 

Tin? Irnttlli of tbp mlrrcifcwjpit tulH< [fro Fljf, J, D] U thio a »mlUr 
tor coniili^ntlon, livcDnH ihc objCk^llvw trc adjimlrd for t c<rtua tub^ 
Tfu^U- 71« tatiuUEcd nttd uccaiiipiu^yLug Dtciy |;ood mlcTOiuope iadi- 
^fiTHt tUr liiljrJtvj^lhk, wirh whirh tliv d[lT«rviit autgiitElnUnnn tli«r* 
^voa an) oLilainnJ- 

ll U not mn for tlw dfU oi Iht mirrotcopo to be olMcurv4 hj 
bright ivlii>ulatcil or 1)muc1ilii)f hne% uiirl ibirk anil Ifjfhl potQls. Thom 

Fig. K.—RnuflP?! ft I-flrrb MwhaniirnI Stage Ü1 Poiillan 
on Mitirwicoptt, 

kfii rjiifi to cntopti« plieuomonn. witlch now ami tliän or^iir cvan vllh 
oiiJtiiarT vi'ifm, auJ >iriE kiKmu at "wuet^r I'trUintilfS." liiitij of tJie 
ilfrlc pninld vtliirti Ih-ih jiiuI T.1ii»rH i1i»lLirb 1lii> ripw Jir«* lU^t- in itoirin^ 
«J UiD optic iDi^dia- Wbon kucU «re lotntcd upon the aculnr they cftT> 
iciidJI; be (ivUictcü by ut'Ji^l.*^ liiiiiEii|[ Llm lutUir in ihi; itiW- »nil iiutirij£ 
uhi>lhi'r tbfy mvvv tvllh tr. Tli» «jtuii' ivTunik U x\m> ippliiuhU to Iho 
«IjjwlJtc. Thi^ Icnnc* un4 tyoriccn ahniiU nUvnri tp cWrnnl by gcntlo 
concentric mlUrij wUU a toil dollu iijcji»U!ir*'4 w'tih ftU-ohol or U-rij^in. 
Not *nfttiqiii>n(]y mEnTiU frngiTiJ-ntt of rho f?lolIi vilb wblcli Ibft fir^M 
or «liÜFA iirr wi|it'il nra trft upvn the Kimmi. Wilb ihr nov'uc t)iC'*r nmy 
kwl Id nriir» at iiilripiuUtiuu. ^Ar'T/i/Jt' lAc bct'^^iatr i^ iffftmi;j|r 

nmtoDucrottY nmiAiiKa. 


wlitwd to familifirlzc himtolf itltit IS« micFeatojii« rAontrfrr« <rf mit^n^ 
KWft't ufxl silk' fihrrn. ia vifkr f» atitld fttiiuc <uibQff^*4tit<nt /forn lAra« 

(elfter i/dlmnni.) 

AntanpffUkil^urort»«»; /«ufUuw J ir.vrffoot r rattan. a^BtaRli- 
■raulah a,r«ft. «J^IViuIa JT, lf;«>ll«, oj U>f«*d^ «f '■>(]4t*, Jtfr, Ukn- 


IV, The follawing rfni/cnt» uhould be ftt hand: — 

1. Phyhiiilogic sfl^t solution (D.7 per cent- of »odium chloric!) aa an 
indifferent Huiii, which, likf the TCinaining reagents, is b«st added to the 
Bp^cimeti hy allowing Jt to flow beneath the edge of the covcr-glasa, 

2. Aoids: — 

Afxtic add, usually in 0^- to 2-per-cent, solution. It ciears up the 
albuminoufl substance of the oelM>odics and the connective- tiunue fibera» 
and renders them transparent. The cell-nudcf of the elaatic filieTB, ttnd 
fat, as well as ni icro- organ i am h, are unaffected by It, and are therefore 
made »hatjdy ptoniinent by contract with the remaining cleared sub- 
etanecs. Mucin is prccipitatf'd, and la not diHsoKcd even on addition 
of an rxcenn of the ai'id, whilv fihrin ia usually very rapidly cleared up 
and diaaipated. 

Hydrochloric and sutpkuric acid^ are employed in 0-5-per-cent. aolu- 
tiou for decalcifying. In the use of the former CO, ie liberated» with 
the other, lime crystals are formed. In 1 to 1000 solution they act like 
acetic acid. Ab an addition to alcrjhol (about 3 per cent.) hydrochloric 
acid especially is employed as a dtculoring a^nt. This hydrochloric 
acid-alcohol i» pennanent. 

Oflniic ocifl, in 0.5- to I percent, sclution, is employed for the detec- 
tion of fat, which i^ colored black by it, and also as a prcbcrvative in the 
ciaminjitiijn of fret^h blood, etc. 

3. I'dtasAium and «odium hj/drate fcaiirttic] are used in 1- to 3- 
or at moat 5-per-cent. solutions. They gradually clear up ur dissolve 
albumin, connective tia^uc, and ce[l-nuclci; on the other hand, lime, 
pigment, fat, and eiantic tissue, as well ae mioro-organiame, are unaf- 
fected by them. 

4. Oit/reiin etiould be used in the pure state- By virtue of its great 
refractive index it pcrvea as an excellent clearing reagent. At the same 
time it may be employed as a preservative, Iwcau^e it Is not subject to 
evaporation, and it doc^ not form ilicmic combinations except in the 
caae of fat, which is rendered invisible by it. 

5. AU-iiiiol is often employed as a hai'dening (blood) and decoloring 
agent. Ethft and cklorirforni are u^ed oa reagtnts upon fat. Alcohol 
and cthtr combined [njual puctsl serve aa hardening reagents. Alcohol 
combined with 10-per-ceut. acetic acid or 3-per-cent. nitric or hydro- 
chloric acid is a strony decoloring aolution. For ordinary uae 1 per cent, 
of hydrochloric add in 70-per-cenL alcohol ia of scrvice. 

G. l-'oniwl [f'irwa/in, formatdehyd, formalose], which contains as 
active conatilucnt 40 per cent, of formaldchyd in a mixture of methyl 
alcohol and walcr, is unexcelled for rapid hardening of dry blood prep- 
arations (see page löO), In 10- per- tent, watery aolution it can be 
hii^hly recommended for hardrning freah tissues, as it preserves the form, 
color, tranhparcncy, and ataining properties. 

7. Staining riaoüntsj the anilin decs are extensively u^d as stain- 
ing reagents. In bacteriologjc examinations the baaie dyes chiefly arc 


employed' In the cxaminatioa of tiftiue-cellB, ia addition to the ba^Lc 
dyes, the neutrml and »cid dyes alfto are made ua« of. The methods for 
tbeir eraploymeot will be given in the aectiona devoted to the examina- 
tioa of bacteria and of the blood. 

In addition to the anilin dyes, ioditt and hewaUufflln are not infre- 
quently employed. Watery Holutione of iodin stain flic albuminates and 
connective -tiasue Hlibstancea a pale-yellow color, and render the nudei 
prominent. The red blood-corpu^cles asaume a brownish tinge, and the 
Bo-calted corpora amylacea a wine-red or dark-brown color. It Is bcHt 
employed in varying dilutions of Lugol'e solution {iodin, 1; potasainm 
iodid, 2; dltitjlled water, 100). Preparations treated with it are not 
permanent^ because the iodin ia readily discharged- A saturated solu- 
tion of gum may be recommended as au imbedding a;;ent. 

Bfftnatoxfflia is on excellent nnclcnr stain. Di^^yolv^ed in alcohol 
it has a brownish color, which is changed to n blue on addition of alum. 
The blue solution ia used for staining purposes. By combination with 
ewin, which is chiefly a protopTa-^mic stain, beautiful double atainin^ 
on be secured. Detailed description of the compo^^ition and method of 
employing (hese solution? will be given in the scctiiin on the examina- 
tion of the blood. 

8. A few drops of an alcoholic solution of tfuflun III imparts to 
intracellular fat a bright-red color. 

9. Conada balsant, dissolved in either pure xylol or chloroform, 
is employed for imbedding preparations, ßalsam tyipaiba and cedar-oil 
are also adapted for the same purpose. The iron^imrcncy of the prep- 
arations ia enhanced by the u^e of these bahanm. 

V, Neecaaary or desirable accessory tJi'pitr'ilua are as follows: 1 or 
S anatomic finccps, with deJicate branclicp; 1 C'tttvt fnn-rpn, whiih is 
adapted especially for staining dry cover-gla^s preparations; 1 small 
sciJi$0t8; 1 amal! 9calpet ; 3 preparation needles; I platinum-wire inocu- 
lator; slides and cover- gl assea ^ 1 alcohoMamp [or Bunsen burner]; 
several small glass rodn^ pijivUc»» assorted hi^pfl; test-tubes; several 
watchglaa* di'.hea; 2 ^^a^t funnels; several eonic sediment glasaesj J 
or 2 porcelain dishes; filter-paper, and labels. 



The present known exciters of the infectious (lisoaeoH belong 
to the lower fungi^ Ab their eyetematic division haa h«cn 
subject to mucli change, it appears to na advisahle to adopt the 
classification of Flügge- Frosch ^ which Ib as follows: 1. Fission 
fungi, schizO' (schisto-) mycctes, or bacteria. 2. StreptothrixiiB. 
3. Budding fungi, hlasiomycctes, or yeasts. ^. Thread fungi, 
hyphomycetes, or molds. 

Oeneral Pretlmlnary Remarks. 

Since the fundamental invest igntions of Ferdinand Cohn 
and others, the bncteria iu general have been placed in the 
vegetable kingdom, as their elementary forms grow and divide 
like vegetable cells. According to Naegeli and others, they are 
also designated as fission fungi (schisto- or schizo- mycetee), be- 
cause, like the fungi, they are devoid of chlorophyl. 

The single cells of the bacteria consist of a protoplasmic 
substance, without a nucleus, inclosed within a cellulose or al- 
buminous envelope. The latter plaja an important part in the 
division of the cell as well as in the formation of cell-conglom- 
erations (aoogScea) ; it may swell by taking up water and change 
into a gelatinous state- 
In the absence of niore accurate differential characteristics 
the bacteria arc clap?ificil aeconling to their morphologic ap- 
pearances as: (a) pphcric bacteria, or micrococci; (h) rod- 
shaped cells» or harilli; and (c) corkscrew-shaped organisms, or 
spirilla. With but few exceptions the first never exhibit true 
independent motion, while with a great number of bacilli and 
all spirilla more or less independent motility is observed. 

Independent motility is always produced by very delicate 
fiagclhlc threads, which are usually attached to the polos of the 




5 a 





— ¥ 






organism; at times but one polar flagellum is present; at others, 
a whole bunch of thorn may be seen. Finally, many bacteria 
appear Kurroundcd by erect flagcila. [See Fig. 19.] 

Accordirig to Fiaclier, tbie diversity in th« distribution oF the 
11agpll4L miglit acrvG as a meaoa of claaäiti cation. Among tbe bacilLi he 

Sucina ^ Packd^occi ) 








CiliMed cell ^ ^ 

Spider cell 


Centra I ty silunled 
Clostridia forms ^^ ^Jl. *^ 
Knobbfd baclpria «ilh ^^^t^ 
irniiinal spoT-rs ~*^ 


Slender bacilli 
Short bacilli 
Bacilli in chninl 
Vibrios (spirina) 

Cnmma baditi 

Fig. 19- — Forma of Bacteria. (From Srhnik,) 

diiitinguiöhes: 1. Snch without flagcila: bafiflt. 2. With one polar 
flagellum: bavtrinia. A. With a bunch or tuft of flagelEa: bactrilH. 
4. DifTuaelj covered with flagella: bactridia. 

The detection of the üagolla is not ahv-aye easy. The meth- 
ods employed for staining the flagella will be spoken of when dis- 
cuaeing the typhoid bacillus {see page 61). 


The bacteria arc propagated either by finsian or spore-forma- 
Hon. In the first process the cell ie divided into two — almost 
equal — parts by a transverae fissure starting from its envelope; 
or division takes place not only in one, but in two or all three 
directions of space. Accordingly we meet with bacteria dividing 
into pairs (diplococci), or those which lie in fours (tctracocci), 
or the sarcina (packet-cocci) formation. If the diplococci re- 
main united in long rows they are spoken of as streptococci 
(chain-eoeci) ; if they appear more in the form of bunches they 
are designated aa staphylococci (clumped cocei). 

Sporc-foimation occurs {perhaps) ia two dilTerent vays: in the 
one, the ao-ealled endoffc»üU3 Hpiire-forraalion, — whith has been positively 
proved and ürst studied with precision npon the anthrax baojlh, — a 
Btronger refractive £one forms within the motlicrnwll, developing more 
or leaa rapidly into a round, uauaLly more ovoid, »pore, which appeara to 
be Hun-ounded bj the renmiiiing light portion of the mother-cell. With 


I ^. tfi 

hi \ 

si S % 

[Fig. 20. — Foniis of BaciUi sli-jwing Sjiores. (Froni Ocrtel, 
caurtcsy of P. Blakbton, Son & Co^] 

complete ripening ol the spore the outer mcmbrajiea give way and the 
»pore beeomes free. Under favorable oonditiana it then begins to ger- 
minate, appears lees refraetive, becomes more and more elongated, and 
finally reflembtes the mothercoll in ail particulars. 

According to some invcstipitora, uporp-formation begios only after 
exhaustion of the nutrient medium: fr,, when the preservation of thfe 
«peciea ia endangered. However, it lias positively been determined that 
a supply of üj-j/1/tn it abmiutflif H^irssiiry fur thdr dcvehinnvnt, and that 
certain limits of temjKratvrc must not be CJCTfdcd. ITie second fonn of 
■porulation ia that di'nignated aa arttiro, or joint spore- for ma tivn. In 
this form of aporulation certain portionH of the celle — which are by 
no means moq^boTogically well characterised — separate by constriction 
and form a resting or "lasting" [Daaer] spore. Further researchea have 
much to contribute to the solution of this problem. 

The spores present true permanent forms. They are dit*- 
tinguishod from the mother-cells by Ihcir pronounecd powers 
of rc^is^taneo. In contract to the motlior-edls, they are also 



distinguishet! by the fact that they take up stoining reagents 
only under certain conditions later to be described in detail. In 
ordinary staining they appear in the tlDged protoplasm of the 
mother-eelL as bright^ nucclorcd gaps. 

Owing to this ciTcumstance» the rode possessing such eolor- 
leae zones were formerly called "epo re-containing'^ bacilli {&.g., 
in the tul>crcle bacillus). Therefore it may here be emphasized 
that such light-zones may appoar as a sign of degeneration as 
well as a result of "preparation plusmotysis.'*^ In certain in- 
stances a decision in this regard is not easy. Strictly epeakingj 
observation of germination is tlie only proof of endogenous sporu- 

, The plasmolytie processes occurring during treatment of the 
bacteria with staining reagents, whieh have been studied par- 
ticularly by botanists, notably A. FJ^clier, deserve our closest 

Temperatures under 5" and over 50"* C. [41° to 12^" F.] 
may be regarded aa the limit for the life and growth of the 
bacteria. The eo-callod pathogenic bacicria, which are recog- 
nized aa the cxt-iters of the infectious dij^eascR, thrive best at the 
temperature of the hod'j, wliile the nonpiithn;;euic grow best at a 
much lower temperature — about 20"^ C. [08° F.]. Fermentation 
and putrefaction, as well aa the formation of pigments and acids, 
are to be considered among some of the effects of this group. 

According as a suppig of oxygen is necessary, detrimental, 
or indifferent for the growth of the bacteria we distinguish 
obligate acrohic, anaerobic, and facidtaiive anaerobic bacteria, 
respectively. To the latter group belong almost all pathogenic 

Those bacteria which are capable of developing only within 
the living animal body are designated as strictly (obligate) para- 
sitic bacteria, and those wliich are capable of living and multi- 

^Bf ndiliiLin of ^per-crnr. HiUjHilutlEius, «hieb are ftltDwed lo tct frnm the mirglii 
of the covflr.gloM, brigfiLly )flL?4iäiilng boiJLi'9 mny bs prodijc«il wlLhin orlglnul]; homogc- 
nr^oiifl fuDgouB Ibreada, Gu vuhlng vilb vulcr Ibcso bodlei dleappeiir. To aU tppear- 
inceB itity arc orijiioaEpd b^' Bepiirali4>ii at Ibe proHtplB^m from Ibe celL^membrane and 111 
Mil traction tiiEo clumps ^ aflcr vuhingouttb« Dull aDlutlDn lb? protoplaara eipinds to Eb 
foruer dlmeaBlDne. V^rySng wLih LIji- Itngth at the bacteria, w^ HunPtinteB obMrr« Due» 
«uniQiinm two, or even a number ur bright Eon« whJisb tbo InpTperiertoed objterver maj 
ra-iil; mE?ilahQ fur sporcn. Their occurrence on addition of BaltHoluttDD md Uwlr dlaap- 
ptfuritn« after nubiug madtEjr convince ons that thej are art«fact& 


plying only upon dead organic material are terraod saprophytic 
bacteria. Facultative parasites and facultative saprophytes are 
terms uped to designate euch bacteria which, altlioiigli primarily 
depending upon one or other of the soilfl just mentioned, preserve 
the power of development upon both. 

The metabolic products of the bacteria eet a limit to their 
multiplication and activity. Unfavorable soil gives rise to bad 
growth and degeneration forms. 

A ppecics of bacteria may be regarded ns spccifivaUrj patho- 
genic only when it can be microscopically demonstrjited in all 
caseB of a certain dieeasc, and in it exdasively. and wlicn iuocu- 
lation of "pure cultures*' of the species into other bodies always 
produces the same disease (Koch). 

Not all of the bacteria to which we arc inclined to attribute 
a specifically pathogenic r61e Iiave wholly fullillcd the ^Cl^ui^f- 
nients of tho above-mentioned poi^tiihite. This is ihie to the 
fact that the methods originated and brought to eneh a degree of 
perfection, especially by Koch and his pupils, are jis yet incom- 
plete ; furthermore, witli many i^pceies of buctiria animal c\peri- 
nientation gives negative results, because tlie:^!' bacleriii find only 
within the hunian body their true soil and the conditions essen- 
tial for growth and the development of their specific p;ithogeuic 


Demonriration of BacterU by Cultivation Methods. 

It would lend ns beyond (ho limits of llie jiri.'jri'nt treatise to 
disi'Ufls the culture methods of It. Korh nnd liis siliool at siirh 
length as to emihlc tho bo^liiner to work aflcr the directions 
that would be given. For thi^ purpose reTon'Ore may he made 
to the excellent text-book^ on bacteriidii^'V by Flii;:;n.'. 0. rriinkt'l. 
Günther [MeFarland, Kovy, Park, Muir and Hilchio, Eyrr]. 
anil others. The pr^'edures for cultivation nun', however, he so 
sketched that the beginner can at least piin some idea of tlir 
fundamental priiiciides, etc. To tho im[>L'ri7^h;ilde rci^'archcs of 
R. Koch we owe our knowledge of the isolnteii cultivation of li;je- 
teria upon 60lid and Iranspan'ut nutrient media — (he "pure 

to MirmostXlPV AXD rHKMlKTßV. 

In cx0ii]iniD|- iD&tnIa] coaUirkinfl bjiri«rit wo nruit nM. fnr ohviom 
rcMoQ«. lou iil|Fht nf lh#» fftfi, ihm, \u HJhhlitm t^ }h» iniv piil lii>jp>niiT 
bacterial a grvalPT or luuvtr nuifit-vr of «tlicr hpvviv* in Litm^lly priiui#nl-' 
Firvt ot IÜ1, ihfii» our vIToitU tbonld be 4JiT«cU>l tovaid lecuilitjt ^ep^- 
Hifcit i/ivu-fk* vi the tlllTfmil bnrr^rla. Tlili nn Ik* a??nmpTliliof| by 
itiitiUHff the mn(«rial Id bo oiAialiml rh much lu poMihli*; Llihlnhiilinjf 
it in a lii^tiiJ, ccmtTij Ul^i« nulmnt tat'dJum. nud npniLdiiij; Ihc lultr^i upon 
ti "pint«" in »utb n tiuiiiriFr thut \hr rnl^^Tiict r^inrnv] hy thf <\i\Tfr^-ni 
bind« of j*M-nin may <U\i-\fip widrlj hqiumt-M ff«m i'»fU Mbcr in b fjipd 
]hWLJEiii, lij Llivi iiii'iltiid wtm In hi.' r'inixiilf^i<-i] tmiro \a d?uL s douding 
nf Ulli "iilaTn" [hi-irrr in n Vrtri «ttulij run iitiiitlljr bo nolir'^ niTh tb* 
nnktd eyp ftflcr twenty four houm, Dfteo Monet. 

Willi lliv nEil uf hjiml|fln*h «r wruL iibJifTiv« Ikl» HitiuDrifr-H I« 
rAwvjfDiujd u till* tfi ]iu>lHtiiil «ticmitf«- h'mra Ih« apppumri'-v of ttf 
00l«af<9. from the firi^itiict or ahnfiic« of "li^Ui^factioii of Uic TiMiritoi 
mnilluiTi/' I'tr-. wp hitVd ili-llnil*' jniitit* a( dixUnrtion wbiiOi InviT* f" 
raonr aiVMtraU himly i^f thn aprrinn in rjuf-Nttcjii. To thin «rd n jTiMicirtly 
Iflolnlod cfilrjiiy for a lutiliüij of it] im tiikrn ("A»Ttrd"l iip wkli n htat^iJ 
(and *ii|i*oi^Mf^nl.!y fnukih iilftlliiiim nrrdlr." thf hand hh>lng f*fpfiilly 
Ifiiidi^il lij Ji IciiK ciT Diir'rif»i'f]|n', »ml triin>'f<^rT<<J 1» u iuvl lulm (lOTifiiinin^ 
;;Hilin or olWr miliHrnl mt'diiirii. ?TiivJdvcl mi trrJTninil rnnr hn- Urn 
miiJi-. but on^ kinil of Itac-tptln mint develop li^r^^ iTho "flithln^" ro- 
r|iiin«ii rauirh pmrtiirl) 

Wv diHiLiit>iM:?li «ffffit nniJ ffv«^d HHtih-Ht inatia, a^id, uuilvr Ulv 
fomcr, nguirip »n^h k-« ri^iiitl thv ii>»i|HirHlriTi> of llii* im<Liliiitj>r,' rniil mirh 
M nswin lufid frt low tt-injiorntii rr, but lI<|Uof;f at a «oin<'Wbat bif-her 
mm, lnmi-|t Lbii ifruwüi nf l!if Liirtrfm U. in ([rfnt MU'iL»Uir. drpi'iidciit 
(■[■on Ihfi di'ir^T' |if t(>iiiprrn(Mr(>, it i^ of thi* uMnniiit Uriporluncd timt w* 
>bi>ikM U^vf. al OUT dKpoBnl Ibo rihrJou? Itüid>i of ini>Jiij,. Mvft^cvfTr, At 
tliw ft>iiri of lilt! ctjlonlr* ii[tüt\ tndi pnrUculm nioilLuii Ltt nioic or k» 
dtuxmiftfiintiiip W4I un^ liM« to utillivutü thir uanio LpveLoi of bnotnk'la on 
ftpvpi/il wfiitK ftt lb'' 'nn>p timr niiti Ifj mnkp ij^ of ttift ililTemil oppönr 
«niv4 nf ^'ontha rk a Tiipana of rtrn^'nklltiTi. 

Of tb<i vu^/d »ulririit mvittt »itiirkftU' ('»r cu^liiro at 'Qtr tcinportlvn 
(bolow is' C. |7fl" K|) «I'ti'ifVif ^ihitln ii th« im-al IdipoiliLiiti iL N 
HftM for "p/nrr"* flMri dlnlij »rd "flraft rw/ff/rff.*' Ti i» jin'i'iii'cil frrMn nn 
tnfuFion nf mr^itt, to whipb common Mli. pt*pton. j^Hitlin, and pun ladA 

* pur eaiTi»1nMii tv*; ftMir»i»K HFth«?«, »bnlviA, L|l|.h(]kvr(A, «lis 

'|It 1i ail*-j»1>lA.»liUt *Ahi>il1ha1iii'i>r bulfitrthfftlMiroil vh1d]aho1dalHä|klAtln«iiii 
rir4idU —FboTiKI ] 

'Ihp draiAM) «lAine of umtKiniun [■ otitalaed In Ua «o^iliM "Hiwuitnffrtfvn'i 
flhtirmrPiUt Af tt]i<iilubtr), «i1iiiihLc-i*,0](>4l «iiipnr rhnmbrrrovuKnl uimn Hin nuljlila wkih 

E>« nliiii'il fij r» Ihlclt ||liM* cl<ior BLid « cci|jf>or*a:lt Jofir. [k^iwicn tho ««ll* <if llm cliLii»]»ri 
■■ w*fiii iifif (, Ihr iiiccnrfti^T* iT wL^<h ran It r<vk*1 *tn'frHMn vlili»>iLt t\y mrsinB uTa Llii'r* 
moAtclci. J bo 'kftMOf }ifiLl 1« nK<jl»f<*J liy «n rflifr^Ullj n7nftLrucir4 apjiarftLii {1liaririi> 



ftn iiddffJ. 'ib« Tnvl.lioil caF pirpentiJin U >« folli>v4T SOO grama (I 
poun^l of flady Bmuiid hrtt |fce Pie, tt], fr« <>f tixU m* t^ifully 
Airrod up wUh 1 lUrf II qUAiil ot dJtilltcd VAtcT. Atlcr sUindln^ tor 

Iwmij four U9m% In ■ cmI pUcw iiv toruiLon U iiiiiLiifll uid gv^ntl; 
tf)UH««d ttitovfih fl el<ttli; 40 Itui fi» tU «l^oal 1 liur 1 1 «^'UrtJ of aivat- 
juio4 ixtblAinrOi tif til« Ml Ainomit I« nut 0'1jtaiEi(ii.i>4(li<'kiit viM'-i tn^y 
Im- iJJ^] to mi>r LI U l(HV) }>TUin« i1 IltJ-M.—BftOüK«] To (tiUnn- H'Mfd 

yig. « - UmiI grinder. 

10 itram« (1% dnniil of pcpton (slomn}, B Kramc fl V« dran»! of 
«omnaa ult, mil lOO ^nmi [3 '/. oijii«^tJ of asmmcrTU] g^Inlln. ThU 
•O-0ftU«4 "nuttlcct boullioa"' Ia now iülov*d 1o «^«11 and iubtcqucsUj 



to rliifLoU'« tn n «nffr-hAlh. HtU I« 1<tlln«cA hy KdcLltloa of piim Mil« 
[«odium byilialo or bituTli^imtc] ia MtUTfl1<d niiter^ tolution until 
a iiJ>tJLK-t ulkiiliiii' i^vtiun [wirb IUiLiu>t-im[i(ii 1 ii juit vimMv. 

My ttcnitrig far tvtt hoiirt in b «I^Arn «t^rilinr [ifr V^a* ^ aiifl i*\ 
the ooa^ilablc atlniirin ii imn^ipitaUd. On bircful Aitratian ot tbe hat 
lii|Uiil lUlTDUfili pnpfT or al>BCitir!nt eoltonl n SKt-frctfi/ dear ahiI imrut 
parent ffiWir U obfnliiixl, whloh mu*l •1111 glr« t iU*ti(iH. nJlnlinn* riiofr 
liviTi. [Filtrulioii tiiAy Ew larilllAtt'd by Ihn uh at i^tv hot-wntcr funnel * 
(wo fig. 24) or lij pIfiL-iiif lltc flunk miil funup] lu ilie Bleuni dLrrtllur^ 
(Up. SII)."Hiwi"«* I Thi» rri*!ir illInKü ran unw bo jmiifril, jn ataauntAi 
ol 10 ciiUc ccfilliiieleT» [31 V| clrniDi] mih, lalo tr«t tulw*!^ pfrrJotial; 
»tt-rilbnl [in »n uvrti.FSg- 35T, »lidi vIk^lIü Ih^ dow^ü with lii-ltiry AtUi 
«cttoQ p^ugv tM*l«TV Jtiirl iraiUfllAltly ftflur flTTinji (up* I-^gs, äT and 34]. 

t'tK- 23-— Am-ilil ftl.uH* SUtillxpr, 

FbaTly Itie AUrd tc«! tubm aiw plarcü in the ■Icum BtcrillEcr, wher« 
Ihc^ OJtt lii'uli'il Ht Uui iMiiUnif'jhithil fur Iwcnljr mEiiii].r>4. ThJH LfjuiTsa 
Ift VtpMtff'l oni'p JL «3uy i>n Thr^t« or lifiir liii'i'i<<iiilvij lUiy-a in or<lvr In kill 

»U gomiB at fli-l i>rc»c-nt^ ■« well ut to d^Ati^y Buob bac>Uria u mny 

I'lie KiffrirtiF i;^/uffpi tliiin pri>p&rcd In fltvt imipioycd for "p/al* 
ealturP.'' By cut'lully )iciitjri^ llin Josver ^crliun of « K^^ikLin tube tha 
frcmtpnU nre Elqiu-llvil,' A mtmilv jjirrtUiii nt Hid irrut«rinl cunliLlnlnjf the 
bnoidfla id nov («kPti up ^y mmini of a plntinnm loop {p»vxuui>W 
ImtoJ iv Tnliu'H, iLtid luliPCtjuciitlj cooli'd} and tmrnr^rrffd to ilie lic)iijd 



lAAtvria U TDi^utr^d lo BOdUT« ft pur« culLurp, it l>, in (ho nmjorivj o| 
InatAliRf. n^ctMou; to furthi-r atUnuvtc Ihfl mixture ot orgtuiUm* und 
grlntln- Tüll tn»r b« (Lovutuplbibrül liy trHfitfi^rrEnff two fir Uiii'« 

pUUnuiD loüpfiil« from tha finl Inociilil«! tuh« of rlqurilf^ (fplulln to 
llu Kcond, «m1 iwo «r Ihr»« loapfui« trom tb* »nn4 inoculated tub« 
lo • tbJiil tulir ol liiftibnivl ie^'^hUei- Duiiny üiii> prucnlure v*nr miitt b« 
Olivnhl tfi4l iTitf Hin*« tiiW« Ar« n|wrikKl Iiut Ji>r lUi Imunl, and thsit 



Ih« plttiaun ItMp im bcBt*d to radnc« uid «gitin cooled hüton ond »tUr 
cub [bocuUtlop from iubc tv tube I*co funt tKilc 4Ti |iajc4 °0l. fltpuiiul 

|H?ndii lliif tLin^'CM of the pLir* ijuHuro. üßty thai portLoD cf Iht pluf 
wliith it outildc of ibe int>i' aho\ild L* toucliL'ii wltli the fiijt:tf» UnJ 
no [lorllnn nf It, cicrpt Ihul touchnil b^ Thr flrtfcn idould ooui* in rin- 
tucb AiEh anjr »Ljcu^t ItRooXflJ, WJiun umkinu Uw iiiL^tnilation, it ii 
bwb to liolil tliL' pLug in Hut IrfL h«.n4 — tti« b«iiii dflitoli a1«q IioIiU the 

Tlie inocuUU»! lubra at\t now rvnAy to Le *'poiirrd «poo the [«trt^ 
!t1^] pUtB^" Tlifl ftu i^lliftJ Ffitii Oogblv «IUWb wt\c m pUtc«. T.lifi 
upiKt uii«i of wli»*fi iTT<*» [i4 a (ininpMi^ j^ovcr l<nr Hie lowi^f. Bqtjr« 

i^ Sti^-Hol-Alr Stc^Hliwr 

"pouring th« platM" tt h ftdv»Mibl* caroJuUf to boat th* mouth o| ft 
tul« over a flume, uftcr iW t'i>LI-iii phjK im» Ik-^'h iftuiuwd, lit oidvt to 
kill ;ifi> t;«mi» wlilHi iiijl^ Ih« prc^'iit vvirUin U, Thi<ri f.lih cii\n uf Lliv 
iVIri |fiul(! U <|ilütkl/ rniiv.t. ih<- nu^rlium pmlriHl inti UiQ lgw*r dlHli, 
nm) Uw cor« nt oft«i tr[>|jifcc]. IScö ri& E/^n,] 

Jhc ptflf<* arc now wl Hililn n nnllriiiry room icmpmlHrf il'" lo 
JB" L\ lO-i' |<] 04' K-IJ lur Umty foux l^oiirfl^ oflor wlikh Uimt Oüvtl- 
upnu'Ht iif llio colomi«« cbil fTrqiifiiU)' 1«* (»lni'inJ {*k-i- Fi^- 21IJ, From 
the "puiu CKlturw" whlrh Hpvpliip lic^rr« (IfH* ixohilt-il pniJtinn of Th»> 
«□loay mult bo «oiillTni(?d b)* a huml-ICFii« or ■ lovr-poti^cr olijvetiTc^ ono 
of Uiti vvlonUi U Ijckra a;» wliU IIjf jjIüUuuqi loop h'l futihei- raUwo 
In tuTten. Tlip viihi\ gdnlin ponlnliicd In llio fiibc* li lnociilnii"<l '\>y 



«titUritijf wUb the plaUniiiu win wlilcU cAnIn a bit ot Uio pniY cvltur« 
1"«Ul> culture** (Fig. acj). Tli« tuta to b« inociiUfod U hoM bA'# 
up«»H- tlic cotton pluff rjuickly witluimwn. lU *Ub tnn4c, and tlic 

71^. 2C.— Ucl-WftLffi Vumcl for 

FJlLcrlnjif A)nkr iiml («diithi. 

Of talid f'Wi« adApfi^d ior culUvatitin in fhri inculoior, nutfif^l 
fipar-ttpur, ftlniid-^r^iuat. maH tttitato nioy Ix- mt'uliiimnl. 

WMrVnl Q^r-ttifor it prrpuml hv it<l<lmg {imlond oi gclntm) 111 to 
ED ^Biuit {0^ per cvn(,f of uguT^gar to "milrjont WuJIlün" which hiu 
|jfe«tauii1>- Xtfvu bi^iiliO lur «boul oiii^ hmir lu the vtcum ilrKlUcr and 
fnt^ Irom kttnimin hy nirmlMD (w« aWvrl, ThU miKtur« t« iH^llBd 


Fig. £»,— Wii» fidaket tor 

urttl tb« «^rBgar U «omplaVcly diuulvMli wlien «ocliLun liydnt« bt 
liK&jb^DiU i* fliJilnl up Ifi Ihr [luunl nf fniTilly ftlkAlinc rtncUon fas 
•hoitfii bf bhi^ oOi1nr«tian of ml ll(lllEM'pAp^^— RnoiiKa}, AfT^r boiling 
a^Mkhi for BrrcrBl boun th« Mluticm u »rcfutlj flli« rvd [vbiFc bot^ bf Aid 


of hot-water funnel, through a fllter-papcr or absorbent eotlon, nioiBl*ned 
with boiling wattT — Brooks], The procesa of flllration it very tedious. 
The liquid nutrient agar-agar ia poured into teat'tub«a ^aad steriUzed 
KB directed for "gejatiu" — UpookhJ, In order to obtain a large aurfHce 
upon which the e^ntiB may develop, the agar in the tubes is allowed 
lo solidifj' JD a alantiug portion [Fig. 31J. During salidifloatiou of the 
flgar, so-called "condonaation water" is presiwd out and collects at the 
bottom of the tube. 

Blood-serum is obtained either from the human placenta or from 
the freahl/ opened btood-veasel of an antmal. Some of tlie firat blood to 
flow is allowed to escape, in order to waöh off ftnj germs whith might 
be adhering to the «kin and hairs. After the serum has separated (in a 
cool pTace] it ia drawn olT and poured into sterile test-tubes, where it is 
allowed to coagulate at 08° C [154.4*^ F.] in a stanLing position (art in 
agar-agar). To test its atenlitj the tubes are kept for three or four 
days at incubation temiKrralurc— obout 3G° to 37* C. [07° to 98.6* F,]' 
If they^ remain absolutely free from germs thry can be iir^td with safvty- 
[Hydrocele or ascitic fluid may be employed in the same wnj. — Brooks.] 

PüfatoCK arc used dthtr in the form of simple halves nr sliced. In 
either case (he potato is thoroughly scrubbed under the water-faucet to 
free it from all dirt, and the ej'es and any dfeayed purls are carefully 
cut out with a knife. If both hnlvcä arc der^ired for cnlturi- purposes, 
the ȟiind skin ia left intact as far as po-L'^Jblc, and the potato placed 
for one hour in a 1 to ItHMJ solution of mereury hiohlorid. The potato 
is then cooked for from one-half to three-foudh^ of au hour in the steam 
etcrilizer, after which Jt is cut into hjJvcs with a heated fand Bubac- 
quently cooled) knife, the hand holding Ihe putato having previously 
been tliorou^bly cleansed with subliumte solution. If possible, the 
potato ia inoculated at some diütanee from its edge (one centimeter 
[about one-half inch]); it is then placed in the "moist chamber,'^ con- 
sisting of two glags di'ihea, one fitting over the other, the bottom of 
which ia covered with a layer of moistened filter-paper. 

The method of Esttiarrh ia much simpler. The well-cleansed potato 
ia pe^lKl and sliced into disks about one centimeter [one-half inch] thick. 
One of these disks is placed in each of a number of sterile double {Petri) 
dishes and steamed for from one-half to three-fourths of an hour in the 
steam sterilizer. By this procedure the disks are cooked and the platea 
sufficiently sterilized at the same time. 

[Dolton's method is still more simple. In this method a numbi^r 
of cylindric pieces of potato* about one-half inch thick and one and one- 
half inches long, are first prepared and then cut diagonally so as to 
give a large surface. One piece is placed in each teat-tube along with a 
few drops of water, and the luhe is plugged with cotton and then 
sterilized aa in ordinary potato mediur — BrookSt] 

To prepare the culture, the material conlainrng the bacteria is 
Uffhtly smeared over or rubbed into the disks of potato or upon the 
gelatin or serum medium. 

TnBaKTAnr.i; par^vitbs, 


Tbü fem, color, «nil di^mity of (hv fruvt-lhi vyva poUIn Diiltar«* 
me iifLrn «*ij rhanif'I«ii«l|r.-: tijum rlii^ «riii^t iikhIU »Im> Ulf? j^iipfsnuK« 
of ttic i7ulUiif iH ont JTifrrqiif'nLljr of dfvirtJip (4atLTiLr-1-*r. 

rurc millivAtion of tho «m'rvjbk bu^tcria «uodted« only «^hm 
uvygr» i« rtvlifilnil. In |>lAtc ruhuT« oiygcn can 1v exclodcJ by Uyiug 
a «mall fct*rtli>ft| Tfllm pUto upon tho medium. |p vu»U llm orygcn) 
muU b« dUplacd«] hy Uia iutru<lEictLüii ut (luro lisiiioffüii, aiicl Miv oprnisg 

UU41, :4onft Co.iJ 

piifvrd Fi^mi trur« doc Ukl E>"iv hjvt(iK:li1uiif.' «riJ rvi|niitM (u b« frmt 
of VK||d]iiM>*<l einil Afwmiiintr'l h}i1r"^i-n nnil fnr^ of o^yj^vn Fur 
tJkt* purjKiv (be hj^drogrn grntrat*^ U pAHcd tbroiigh thTcc wub 
botUoa wbirh couUlu AEk^Uao \rttd wlutlon» ■tUcr iiilinl« MulutiifUj aiiO 
aJkalin* p^ra^^Allouft iDtiitjon. nipctllvtly, 

Tbft USciiMQa^io Examination of BfloUria i« nlwaj« noM»- 
«ary» nnä will, fiirn^fnn% In* fully mTi*]ilrrt*d, It i« cnrrM ont 
wiUi »fdtijii'i anil uftäfdr/icj preparations. 


Mi(nios(:nn' avp themiktry. 

1. The UuBt&incd Ftcpimtioiii nn: exiimiiK^I ciUirr b}' pUo 
ing upon II gin» »licic it «utoll portion or drop of the titaUrial, 
potly prxjtcing upon it a ccTcr-glaw» anij TicwJng Iho whole 
liropurAtion ^rilh n low- aini a high- power I^np, or the obecrvotion 
ift ino^l*> in tl)r "hanging df^p." 

Till* first mdiicid will verj rarolj niffia% bivaiüw* too mniiv 
ilifTicuUii» fttlfOktl ita umt. Di(Tf^^n.'Eitial:oii »f Du; hdrtono \f 
ilLdJBitinct ; obacrvatioa ie inttrfL^r^l wiOi tj Ihc in:livc phcnom- 
oimof motility, ti'hioh aroduu pjirdj lo rndt^poKT^nt motion or — 


Fiir- ^0— Stab Cultur*. l?rom 

iJort^l, rourtctf ot K BlnklHlun, 

Fi«, 31.— Sinc»r Culture. (From 
OprUI, coiiTtr«^ of I'. IflaklKton, 

Sun k Co-lJ 

aa Ift fllvraya tlie cuse with eoiTi — 1u /Jrcift-^i^n iui>krLil;ir motion 
umI fluid nirn^rlK. An oil -im me re ion Iltis aiul jm Abbe illium* 
iiAtiii^' apparalijfl (rondenseE) are best rt<3ftpt<?<I Ut'^ pinmitintion, 
but (ID irio dinphrngin must be inarrt'?il,siiif<?,ulh*'rwi&c, llicstrut.'- 
ItiTol di^t^ils flro «entirely obficurcil hy the inlcnfio illnniiimtion> 

2. ExAininatioii of tlie ^'Hfto^^ Drop*^ ü of utmoet impor- 
tautt. It i\*A (julj *'iiligli1<.^ris ii* a>. to tiie fnnri, but also ü io 
tl»; nmnifraUtioiiB ol li/n (motility) of tbe badcrla [Fig. 813]. 

VWiCTAin.L: I'AKAtlTtS. 


iMrcCtloiiK. — MoihImti ji (K>ni[ui]<ii>4lj cWihipjI »■ovi.'f-nliu« «Ith n 
4rop of tbo ftuid to ba mimiocd and pWa üTVr thit ■ hollov gn>uni4 
iU*H »tidt— Uic tdpc» «f »to« wftlial dcpiiwiuu 1» »Hicui&t w^tti 

of Uiü ■JijL'i if A pUfc of |t>»iio nr * inilfiiro ii- to bf fXAriiinfd> a tunc 
of the maEtiii] ia adii«!! to a Jiup of Innh watrr ur 9l«rl)c fso c&lIciJI 
f>h]ndolngle HJt «olilili^n (O.C (o 0.7& per cciit.| nml 1hi<n rATTfitTty rik1)bAd 
u|»n Ihe d<fv«r-|flau until '^mtitvi ilki*1rltiulii>a U Hs-mTtl. The prfipara- 
Liuii it liivn iii^vrt«! nnd ciuiiiiikmI lu the usuul way — tmt ilciiic ir^lb ati 
otl'UnnienKjn Iciua fln^J 4&t>b& t^onflcntor, Lul uitU ■ Dearly doMxl ihn 
4iii|fTiTajfin, tlncp ibe ctiji'ct* tu be rxaiinneJ nra iinntAivird, 11 if bf«t 
flrrt tt) rinmini* lliv nmrii'i^>*1 purlinnf, 1wt'M»H^ Cli<< niiir|ihr»kivl<! ami 
bkologic chnriLctert of the tiDcteria are mofc fnvJI}* «tudi«d in at Ihtn 
l«j<n u poMiblr. For the »ikc <tf «IrnplLitj ii luw powt ■■ hu% ja ii.i4il 
Ont; Ihr hvKrr r*i rvplmvil |i^ iht- (iL[-miiiii>ixii]u Irnh ufU^r VhQ niHr^Lnul 
cone ha« Iwcn bronf-lii iiilo Lbo fl(<M «if i iNion, 

"Hii« luctboil i» aliini*t «xdu-ivtiy *in7h3üypd In the cxaiitLnnlidn *»f 
|nin* i-ullijr»a. T!i* i*li^4nlJiRct of lliia iiirlljtji] or^r f!i^>* Tr^-t, riirn- 
i,iniml ifu thnt wjlb it Ihe voJarvt form and iaoprtiii-»it t,f thr Anc-fTi« 
COB («■ «rn, üHiJ fhü* «ftj»<*i'/^'m rfui hn (^uHUnucä ftf hoUf» af a i^nio. 

l-' "^^V- 


By Ihi« nii*»fi* afonp. however. Iho piraent «taU fi !.-i. in ;iiiiiP 
kaavhlöf^ could not hart been ottAlavd- The ■aoiDpUifainciit of tLia 
end miuiml th» d^virlupiiki^iil f>f Ihr mcJAMf« o/ vJirJnfng now olriiott 
iiniTer«A]ly idt^tKl. Hr», ft1kA, H- Kooh d^MTVOtt tin* 4lit.tinHirin of 
liiiiinff coneciied and r^nployed tbo fuodancaUl mctbod^ Next t« 
lilni. Khrlioh. ^VdgE<.rt, lim^mi^rtcii, uiü the numcrouft piipiU of Kodi 
«n>l sjllion liA\# i^ntr)but<il HT'ftllf tu tha iiiiidttlt-atlon »nd p#rfpclir>n 
itf «tftinms l«ebn^irf. Of d^cidfJ itiipurtaiLre in the «lemmt« of hu^'^»^ 
wv»: Tho Intnvhirr ion o( llir »-iiMm(iier«inti lent in roiijiiiK'tion wlllt llw 
AbNJ illunmmlMi^ »pfiifftlut, tkt eötjpiiini of an öjipfoprtufff ptvmJvrc 
for tfjTirio^ ^cvm-tf/d« üry p'Tjwt'BfrfWW/' Ornl Ilk rfffjffr'tifiMii "f Mt 

Method ol J'rcparing CovcnglAU SpccEmcn». 

yCHh th» n&d 4f a prvvimiHly «trriliKPd «tA^I nmll« or platinum 
toop b ^cy iBuU portion or drop of tbe miitrTial to bv «xaiiiin«! In 
plaml upon a cnirfult) lU^antid co^k^U«» auA t,o ri>vi/tHl nilh & 
•Hond rrtti>r|i1jirva tbnt ihi> nlgv «»t Ihr on* pmJvctH «li^litly b«juiid Iho 
irÜtwj. If the «lii-lit prtf-^jtr ■■'frlfd by (ho cowr j-Ut- dfcfi not **nnj 
ÜI ■prnd iTie chject hilo n thin film, t ifpull« toiir)i nlth a iior«tle Hill 
MdHoK Tbt oot-or flauoi nn thou qalokSy, but gfvtl^. slid (not Uftnll) 


MiClEOSrorY AK] 


KpBjl by UlB «Id trt two forivpu. Afltr iwma pnctict Iho f[la*i«H muf 

Ui iiKjiHtr^J lf> M<iibii: the trwo |iiujifoti[iie edirm vihh the flnir^r« und 
ilipn HtiiJing Ibcm njiBTt. All kindling ol Uu> co^r-glMi »utfac« muni 
be ftvoid«^ 

An faiivituiiriKl ^^riik^r cod gpi alitn^ wiEh liiiL ovt^ ctivtr-ilip (ur 
ftlid»] li]' HgMly ifm'jrLii|^ a tthfell ^itnTiUfy of Ih» tnat4?ntj t« b« «xani< 
ioicd over the eurfA'^c of tlic gitA* iiy utf-Aat of a |>ULjdiiii:i lo^p, (U 
loit, nr »tjvl niTilli^. WltJi niiiila If. Ih mlvi'ikblti to pliu^e u Hmftll ilrop 
iwar DTio "^H" of tha co^'ur-oli]; nm] hirn^Hd it cjiii'^kly, but Rimtly, »v<>r 
tho friirfac« pf the latt«r HiLh Ibc edge ol a polLibcd objiwi-EtaH. tar^vr 
tfOtrr-fflnH, or other nlili^irl. 

1. tf m yoiin^ cuETiiro li ie hv oicBininc-il, tbi> novVT'iflMBi in gviiUy 
prc»Kd upoD a pulony oa Lbt IViri dJfL elihI nl '>ui.-t IJIIcd away, ll is 
thtti rrritfcl ai dlrvcicd bdow uuilcr Not. ^ ind 3 {"thU U i-ft11{?d <Ln 
inipnuwion prt-inntiua'*). 'fbc fonu or Uto bju-tci-ia ft« well 4« (hair pttt- 
liod in the colouy okJi tltus bo mtiujEiitepd- 

i£. 'i'ho pnpntniionfl «ra »t uidp, imear^d «Ida up, HnriJ ihor* 
lüffhlf/ drlfä fttf the air. Tht pro«** of dtjinn can be l(ft»lcoed by put 
iri|£ lilt? im^^iixruiiuu lmi.'k «ud Toitli ul suitiv diHUui^e I'kbuul nuHiulf 
mottr (.nin^küdi inchi'iijj «bovt Ui> fUinp. or lirnply tbrori^b Thr nir. 

3^ II in now iirLTMaiy to tfaȊfotyif llr al'i'ntrinoiis vufntimwvi af 
thu ji>rintfurif.n iittn an iriMiJnUW /Hnir. T\i\<* ih di»m* by huttino. Tim 
■iriiprtil plnn ia Ibnt iT"^^mn>Tnd''d ly lindi. w)iii:h «^niiniiU in ii/iJi9t"ff 
(he lkif\r,jiffhlß diUa tutpamtiifn teiutarrd itidc npf fftifC tlm^ thtvvj/lt 
IIU! flmnK- In Lliia vxy a |irrrrtii-ricriLly "flit'd " [ir<-|iitT)i1^m la oMninal 
vbich tva 1>o trutod fi^r bcurt or day^ with etoining solutiona without 
iiijuiy, I» tlir ubbLüJL'i: uf »kuIi Ui'uliEirdL. Uis plriji:lurt« nnr ^i-iiüfhlty 
hliiimd, iiH H pb4uU uf ai»ltiliii(t iukI ewFllLng of iTio slbiiitiinonB «nd 
niucoiin sub^tomcA, 

ßi'^-luiK-iit rr4iju<<nt]y iirnXs lliu niikliike of fixing ovt-r l>ie HAiric 
bf fen) tb<* npr'i-jtnvn le c<i>mp1fil<ily driud-, an oba^iiro pi''ttJiv ■■ the 
LvauU, and iijipaticDi?r is pTininbcd by toriä of iimt. Furtbcimorc the 
pn-pHtHfion nnisl not ho lii^ntini too Mrorigly. Thnn^fon* Ü^f buUl of 
poniin^ (.Ki> «ppiiicotin Ibrw Liimu tbroiiffb tli« Humu mu^t bo adr|iiir?d 
cBfly^ Only Iho flxntlun of dHeil lilatHl-rit^eduiciii ic^iulrva a greater 
nmnhfr of traniitt r.bfvugb thg llnm« — nt IpkeI Avo to itn tlmro — i>f 
bfiLtiiiff abovo a Itnnii« for «ric» or twa ruinuU'ii. A miHhr>d hLIU mor« 
la bt icGommcndvd h the l^x^ijan uf «uih [M^<|mi-ntluiiB in uVobol i>r 
foniiikUEi. TJiff Ihotouphly nirdnod pfi^pntnlion u plontyt rnr iTOm fif- 
teen t-n tbirt^ noiLut» in jtb:44>li]tn ftktjbiO; vr ^ii ix nuxlurc of nb>ciliit« 
»leabol &nd anbydrouo etbti, tijutkl pajLm; «jr lii ii huIuIjuii u£ Joruiftlia 
iH« -blood"), 

Aflide from flvntitin of tit** alhiuninotiB bodle«^ which h1«o 
re^b tTEüilineut wJib »taming f^^lutioJitt fur huurr. v^^ <ibfaiu 1>y 
tbii procedure complete guieac<mce of Uie b-tctcria, which groatJy 


facilitates a thorough etudy of the morphologic characters. [The 
slide method is much more convcoicnt and practical. See page 
3S.— Brooks.] 

Staining of Dry Cover-f^lBBS Preparations. 

To demonstrate the bacteria in the dry cover-glass [or slide] 
specimens prepared in the manner described, the smeared sur^ 
faces are treated with solutions of the anilin dyes — substances 
obtained from coal-tar during the manufacture of illuminating 
gas and distinguished for their great afhnity for the bacteria. 

We distinguish (with Ehrlich) basic and acid anilin dyes. 
While the former are chiefly to be considered as nuclear and bac- 
terial stains, the latter possess the property of staining eell- 
protoplasm, and especially the bodies of the red blood -corpuscles. 
This subject will be referred to in the section M\)on the blood. 
In the present instance we have to de-il solely with the basic — 
nuclear — staining substances. These are used in watery and 
alcoholic solutions- Those most frequently cniploj-ed are gentian- 
violetj fuehsin, methylene blue, and Rismarck brown (vesuvin). 
While the former two stain very intensely and readily over' 
stain, the latter stain more weakly and do not overstain. It is 
desirable to keep in stock a concontnited alcoholic solution of 
the first two dyes mentioned, wliile of the last two menlioned a 
concentrated u-atenj solution may be kept on hand or a fresh solu- 
tion made as needed, 

Staining. — About 5 or drops of n concent rn ted alcoholic Holulioti 
of gentian- viol et or fuclisin are Jii3i]i-d lo » wat(-liH;la*^-4fii1 of water. 1'\w 
dry preparation ia allowed to lloat, Biiirarc*! iside down« upon thi^ mix- 
ture, which may be nccoiriplii^hed by r^oiziiig the eover-gltiEs at it'^ 
opposite edges with a pair of forceps und letting it fall Hut upon the 
surface of the fluid from a hciglit of about one or two cenliinclcrs [one- 
half to three-fourths inch]. 

AftPr a certain time [see btlow] the cover plafls ia remowd from 
the watch-glass with forceps, (he excess of hiAin poured olT, and the 
cover-glaoa then rinsed in water- During tliis procedure the cavcr-flla^s 
nhould be graspi'd b3' tlie opposite edge» with the fori^p^. The Hpei.'jnicn 
ia now allowed to dry in the air— which can be hastened by blotting with 
Alter- paper^and imbedded in xylol-Cannda or pure copniha boläumr 

A simpler method is to grasp the preparation with a Cnrnct forrep'i 
and pour upon the prepared aide of the gU^^L a few drupFi of th? ^Ijiin, 
which maj be allowed to act as long aa desired- To avoid depo»titJon 


of diÄtUTbing prwipiUtea of the dye, tbe stftining aolutiqn may he 
filtered through paper^ 

Firiallf, the staining may be done upon the obiect-fflaaa. The 
material to be examined ia ao distributed between two aüdea tliat at 
least one-fourth of the length and one-third of the width of the §1idti 
remain uncovered. The air-dried preparation ia passed about ten or 
twelve times through the flame. ["Fixing" ia sufficient when the under 
aurface of the glaaa alightly bums the Anger on contact. — Rbooks.] Tbe 
prepared surface is covered with a piece of filter-paper, and this is moii- 
tened with the ataining solution^ added drop by drop- Staining may be 
done with or without the aid of heat (S^wiatecki). This method oiTers 
many advantages. With it we are able to examine a much larger area 
which nowhere showa a metallic precipitate (as ie often the case with the 
vover-glasB method}, since the etalning aolution is flltcTed. Furthermore 
(he watch-glasH ia Huperfiuous. 

The time of staining depends upon the species of bacteria 
and the strength of the staining solution. This point will be dis- 
cussed when describing the individual hacteria. Here, however, 
it may be stated that, the Btrong<T tlic stainiag solution, the 
shorter the time of staining should be, and that it is generally 
(idvisahle not to employ too strongly concentrated solutions 
hecaiLse of the liability to overstain. This defect can bo remedied 
by decoloring agcate, but many bacteria and nuclei arc almost 

Staining of spores requires especial precautions. As a rule, 
spores take up the dyes only when treated for a long time with 
intensely staining and heated solutions (see "Anthrax"). 

[Ffxjn^ FUma of Sliohanr^a, eto^ — \. Plare the slide or cover-glaea, 
film aide down, while still wet, upon a aaturated iolution of biohlorid 
of mercury in DJ5-}X!r-ccnt. sodium chlorid for five minutes; transfer to 
0,T5'per-cent. solution of sodium chlorid for hatf an hour, oeeaAiozially 
ahaking g*-nt\y to remove the mercury. Then paas through eucMH^asivc- 
atrengths of methyl aleohol, remaining a few minutes in eaeh. Slain 
and treat tike specimens of tissue sections. Nuclear structure, mitotic 
figures, ete-, are well preserved therebj. 

2. Place films while atiU wet in the following solution for five 
minute» or longer: — 

Abaolute ahtihol ..,,,,.., - . . - , 25 c. cms. 

Ether (C, 1V| 2ö c. cms. 

Mercury bichlorid (alcoholic solution, 2 
grams to 10 cubic centimeters) 5 minims. 

Wash veil in water, then stain. The alcohol may be saturated with 
eosin and this will act aa a countcratain, — BnooKS.] 


Um SUiplns Power of Solatlons Is Qreatly IncreAMd:— 

1. By heating, the cover-glaas being allowed to float upon 
a hot solution contatocd m a watch-glase. The Solution may 
be heated in a test-tube and then poured into the watch-crystal, 
or the latter may be filled with the solution and held over a flame 
until steam ascends or small bubbles begin to form at the 

2. By the addition of alkalies, as in the following formuUe 
of Koch and Lufller : — 

Koch'B (obsolete) alkaline methylene blue Bolution:— 

Concentrated alcoholjc solulion of methylene 

blue -..-... l.O part. 

Distilled water , 200,0 parta. 

10-per-eenL cauatit puiüab Oil p»rt. 

Lanier's atkaline metbylene blue solution: — 

Concentrated alcoholic solution of methylene 

blue - - 30 parti, 

1 to LO.GUU i:uuDlii: puUi?b sulutiuu , . . 100 parts. 

3. By combitiation with fresJily prepared anilin-uater (Ehr- 
liches gentian- violet- [or fuchsin] anilin-water solution). 

Directions, — Tit a It-^t lube nt-arlj ülied with diatilled water add 
a lAjer of anilin-oil about L to 1-5 ccnrimclcrs [one-fourth to one-half 
ineb} high and ^hake vig'rroiisl}/ for one or tvo minutes. The mixture is 
theo filtered- The perfectTy clenr filtrale must not ebow any trace of 
free oil upon the surfnce, PoLir eome of the filtrate into a watch-f^laas 
and add 2 to 4 drupe of a concentrated aloohalit: »olulion of fuehain or 
gentian-Tiolet. Tf the alcoholic amlin-Hiilcr-^^cntian- violet solution is 
frequently employed it ts advisable to prepare it aa follows: — 

5 cubic centimeters of pure anilin-oil are vigorouely shakm 

65 cubic centimeters of distilled water and then filtered through 
a moistened ültet-paper. To the clear filtrate, upon the 
surface of uhich there muPt be no visible oil-drops, add 

H cubic centiineters of concentrated alcoholic solution of ;*en' 
tian-violet or fucb^in. The well-mixed Btaimng solution 
is again filUTPd thr.mgh a moistened flUer, and to the 
flllrate are Lulded 

10 cubic centimeters of abi'üliile alcohol (u a preservative), 



ThiB HD il in- w»l«r'geDti«.n- violet or fucham eolution retains its 
Ht&iaing properties for about tioo or three tctxk», &nd may be uaed in a 
cold or hot state for ataining almost all pathogenic bacteria. It also 
reaiats decoloring agenta more than th« majority^ of other aolutiona. 

4- By addition of 5-per-ccnt. solution of carbolic acid 

Tormnla, — 

' Fucham or gen tiati- violet - .-. , 1-0 

Atcohol 10,0 

Acidi carbolioi liquefaeti - 5,0 

Aqa» deatilUU ad lOO.O 

Aaide from Ita tuteHse atatntnff poifcr, this caihtil fuchain {or 
gentian-violet) solution will keep almost tndcfJnitelp, 
[A aimpler formula is: — 

CoDcentrated alcohoJic aoliition of fucLaiti^ 

(or genu an violet} 10 e. ema. 

B-per-eent. watery solution of carbulic acid 

(crjstala) ^ . , 90 c. cms, 

— Bhoorb.] 
Differential Stainins of Bacteria» 

Since, in a^^ition to the cells and bacteria, these staining 
solutions also color small element?, such as nuclear detritus and 
mastcell-granuleB (q, v.), "selective bacterial etaining" is not 
infrequently demaniled to avoid confusion. Of the methods so 
for recommended, that of Gram deserves the preference. 

Oram's Method. — The cover-glasses are stained for from otie-half 
to one minute in a freshly prepared (or only a few days old) aniUn- 
water-genti an- violet solution. After &baorhing the excess of the dye 
wiÜi blotting paper the glanses are placed in Lugol's solution. 

[The Lugo] Holution used In Gramma method consiBts of: — 

lodin 0Tya1fl.lB , - . - 1.0 

Fotasaium iodid 2-0 

Distilled water 300.0 

— Brooks-] 

They remain in thia aolutioa for one minute, whereupon they turn 
quite black- The glaases are now rinaed In absolute alcohol until wholly 

■[lüiuKklnfftlilfliDlütlüD CA» sbonld be takm mt to ve wid/inhttfif which dooswif 
«lata Ul« tubenle ba(dIlui.-BBogEi.1 


decolored [i.e., until no more color comes away]. After complete evap- 
oration of the aEcohoI, or, what ia prercrable, after oarefiil waehin^ in 
water and Hubsequent drylngi the preparation — which atill ha» a faintly 
gray color — is imbedded in xylol-Cnnada balsam. The bactcna only are 
Htajned, vhile all other elements are decolored. 

In order to render the bacteria more conspieimus it is advis- 
able to etaiii the cellular element with a contrast-clye, such as 
Bismarck browii. For this purpose a watery sohition of the lat- 
ter ia allowed to act for half a mlmite. 

More diatinet pictures are obtained when the nuclear stain- 
ing is done first. To this end, Günther recommends staininj:? 
with Friedländer's picrocarmin solution, which ia first albwctl 
to aet for from one to two minute?, and after thorough washing 
in water and alcohol is followed by Gram's method. 

The picrocarmJD eolution ia prepared by mixing 1 part each of 
«rmin and ammonia with 50 parts of wat^r and adclm}^ sulTitient 
eaturated watery solution of picric acid until the precipitatp can no 
longer be dissolved by ritirring- Addition ol a trace of ammonia quickly 
dlaaolvea the precipitate. 

Gram's method is not adapted for staining all kinds of bac- 
teria, since some, like the cells, arc decolored. 

Gram's stain is ial-en up by: the bacilli of tuberculosis, 
leprosy, anthrax, tetanus, and diphtherin, as well as the pnoumo- 
coceus of Fränkol, the streptococci and staphylococci, and the 
microeoccns tetragenus; on the other hand, the bacilli of glan- 
ders, cholera Asiatica, typhoid, and influenza, as well as the 
spirillum of recurrent fever, Fncdliindcre pneuuincoccui^, the 
ponococcus, and the plague bacillus are decnhind by it. It 
should be emphasized, however, that Oram^s stjiin docs not always 
give unmistakable results with the diphtheria bacilhis or the 
gonoooccus, and that especially the diplocoecus iiitracoHuhiris 
(Weichselbaum) manifests a decided variability. 

Specific Bacterial Staining. 

This procedure is by far more valuable and decisive than 
any other method of staining bacteria. Unfortiinatily, up to 
the present time but one puch is known, namely: that for the 
staining of the tubercle bacillus group- These b<tcilli alone mani- 


fest such & high degree of resiBtance toward the decoloring action 
of acidB as tenaciously to retain the stain after complete decolora- 
tion of the remaining parts is obtained (see below). 

All stained bacterial preparations should be examined^ if 
possible, with Abbe condenser and oil immersion, but without 
iris diaphragm, because the large volume of light supplied by the 
Abb6 condenser brings out the details of the stained structures.' 
It must, however, be emphatically stated that the examination 
for tubercle bacilli, as well as for gonococci, can also be carried 
out with no small degree of reliability by aid of simple dry 
objectives having a linear magnification of about 250 to 500, 
Of course, certain details will escape notice — e.g., the arrange- 
ment of the gonococci cannot be sharply defined; but the ques- 
tion 08 to whether either of these species of bacteria is present 
in tJie preparation can be determined with the dry lenses above 
mentioned. [As has already been stated, the use of any lees 
except an oil immersion (preferably a y^,) when examining for 
bacteria should be discouraged. When bacteria are present in 
large numbers the author's statement hoUU good ; but when they 
are few and isolated, as is frequently the case, they will more 
often be overlooked than found, even by the expert, if dry lenses 
of the powers mentioned are employed. — Bkooks.] 


In describing the pjilhogenic bacteria and their micropcopic 
eharactcristica I shali consider only those forms whose role as 
definite exciters of disease has been established or rendered 
probable. The large number of bacteria which occur in the 
mouth, stomach, urine, and stools will occasionally be referred 
to in subsequent pages. The micrococci, bacilli, and spirilla 
will be discussed in the order named. 



]< Id the Various SuppurAtlons. 

The fttaphylocDccuB pyogcneH (aureus and albus, Plate Vlf, 
Fig. 1) is tlie cxoitcr of circumscribed suppuration (furunclo» 
panaritium, tonsillar abscess, empyema, suppurative parotiditis) 
and generally appears in conglomerations. It was accurately 
described by O^ton, in 1880, and because of the peculiar 
grouping of the individual cocci was designated as stapliyloooc- 
cufl (ffra^jA^ i= bunch of grapes). Division takes place iu a 
manner similar to that of the gonococci, but the lino of fission i^ 
very delicate. Each of the two segments measures on an aver- 
age 2.1 fLy^ the individual groups between 3,5 and lO'/t. 

Stalniag' — It la readily and intensely stained by all basic anilin 
dycB, iLS well as by Gram's method. 

It can be cuHivated at ordinary room temperature» but grows more 
luxuriantly at about 37° C- On gdalln plate? tho colonies appear as 
delicatfl ttbile spots, in the neighborhood of which liqu*;faclion begin;*. 
A distinct orange color soon develops (hence staphylococcus aureus): 
the color* la much more beautifully ahown in colonics grown at room 
temperature upon agar (best in ^lant culture). 1il [gelatin] atab culture, 
also, in addition to active liquefaction, the foruiaiioo of a golden-yellow 
colored eediment in oJiflractcri^tic. A Bpccica of staphylococcus which 
liquefies the gelatin more alowly and presents a lemon-i/elloK color iri 
called siaphi/lat^icvs fj/off^nc^ citrtus^ 

The alAphytoeüceus poaaeaaea icry great powers of resistance. It 
has been demonstrated in the air, eii'\va<^e, and »oil, and, thi^rcfore, be- 
longs to the fuciillntive parasites. \Vhfn it i« reniembevcd that the 
staphyloeoceuH ia regularly and cxehisivcly found in a number of sup- 
purations^ especially in acute o/^tcon'jfclifi-f and the general aepxia aaao 
eiated therewith, from which soureea it lia^ lieen cultivuted in character- 
istie pure culture, and that subcutaneous injection — indeed, even rub- 
bing it into the heallhy akin — liaa provoke^l circumscribed abscesaes and 
furunculous suppurations (Garrf'), its specific nature cannot be ques- 

Jt baa frequently bi-en found in the htood. and in several forme of 
endocarditis and general sepsis it is the sole etiologic factor. 

By injection of the alaphyloeoijcua, even in the absence of pre- 
existing leaiona of the valves Tiibt>ert auccecdod in producing endocarditie 

■>i=rtii[;riiEn]1IEiit^lvr = ,A, tEiüliiJkcLrr [=11^011 Inchl, 
'piwiUiplirEococuuB mlbuB (vlille) produccn no color— ElflOOK«.] 


iaGnüecx>rv and cueuisiky. 

pTfxfiiiiM in »nlrnftlfk Sihli lounl »Uphylococo»« pj^oirtiiM citivuii in 
uncompliodleil utuU «rlkmlAr tljniiniiti»in. in pFiIf^^rdilic and plcurilie 
cKiii|«ir>», fn «■mlivanltür rlqinihil«. aiu\ in nikn«>ii|i|iurMiift arttirUk #fTii- 
«biw- Till" nhftflrtiilinn Ipckf ronflrn>*<ii3n, od do tUo iIipm oI Wjui*«- 
inoAD «nd LlttrD. »Uo fuund m iireuUni «Ij rplovoeciia lu Hit blooil «ni 
orgfltii Of buntftQ «ulij«c1« i!«ftd of ^btfl]nT*1i« ft) polf^rthrktU. 

Th^ itrvptococciii pyo|f«n» (Plftle Vll, Fig. 1) prnjncv« 

i-r,vf^i]ii?hh and Hil' iiioredt-^-u'iniiiBtf-;! ;iMi'gfiu)ni>ti4 »iup[tii rations, 
and for thia ri?a«[>D, probublj, jt glv^ ritw to j/enr^rai infection 
more frequently thaii lUe atapbylococcuB. By « roEwirjIik« ai- 
rangenumt ol Uic indivtOual »ei;incnte mort; or Lcs» lOD^ cftcitrt« 
are formed, vrbich appear to bo composed of pairN united in 
a row. The »hi? of Ibc* vac-d ofton vnrim. In n chh* of jiwu- 
mrmin with »t f^'plocucfi the nutUor fournl llial nicli j»nir ii( 
cocci mcnsarcil between hS And 1.75 /l, It ü ca»Iy eUincd in 
ft few minute« H'itb all basic anilio dye« aod alM by Grama 

Th« colcmUt t>t Iha «lrvptai?ac?u* dcvclap much mora iL^tvly ihnn 
tbvw of llic Mjjtliylucoctus. Thry du iint liiiiirfy llw jii^nlm. I'lHin 
prliitiQ plnti^« Ihc i?oTon1» ippojLr u tuiii)! Hhllp ilnlh. ■TtDtnin;; ttl nio>il 
Ihd uco of ft pin'h hrnil. In »tab culltire they gtfw aIoilk the needle 
Iruck >kB drIi»LD pvatU» atiaiijji-d iiL tuwti. bul »Tpumtnl Uinn vkv\i ull^tr. 
Upon ihfl cuiU» of Agiv tho chtltiirpm apfip4r in iht fdrm ol di<liml^ 
i™n«par™i dnjji*- On palatu no jjfrowth tiikct plocp, CulUvjition in 
niitH<*nt t>OL)lJloTL fit hlh;h1y Ui ba rvmnum-mlrd ^ hvta Uli' tjowüi UKUOilly 
(Lppasn ■■ ■ ploudy ivilinifnt and sttajni ■ liituiiaul d^vulnpm^l, Ui* 
i4n|wrna1)i.nt (luiiilloik rcmainlnf; cloar. Thin by do iDrnna oonvtani 
pp.'iili]irjry 1« «n imporunt, itmrk at dllTcjcntiaibn from the otbK'wtB« 
limilBr pro^vtb of Frjuki»!"* pomniococicüft 1(1. rj. 

TJitf ■lii'ijtiJcoctuB iiyofitn« In idmtiml wilh tliv fvytifrfa* fiopca*. 
ttliiHi vfat, 4lJNU-iiv4>rr>d l>y Ki-liJcUi^n and Kotli In 1881 und uliUbird Jn 
piEiv cuhur« and «uc«iMifu1ty inuoulaUi into man vmI aaini«]i by 


Tilt »tnfpt(iffK!CU» frequently giv«» ri«p to mirffii in/firfiön*. 
/( itf t^fiWmUy io be /«trtd in, primary and in s^rloHnfil diph- 
theria, where itfl profonro i»fU"u induce* fntal e<>i«iB. In many 
Cüiot of "a^tic diphtht^rU;" wliit^b caase di^alli wilhin a ffw day*, 
atroptococci eiplnaivrly are immefimefl fovmd; cast« of acnte 
chob-riforni »?rrtmti* inth fuf'il tmninittion have aleo been 
(Iranribpil, in ttbicb the dcjcdn containt'd birgc- numbc» of atrcp- 
tococci in ''pure culture." Finnlly^ in mjicy cmcü of puJmonor> 



2. tit Croupous PncumonfA. 

Kli*nk ftpil Holicrt Koth fouiiil in iiiiuuincniir Lungi iHsctiliar cotvl 
to wliich Uivy Attiibutrtl o mi^ntiiv Trlnliun to tlio pntli'jt4>tfLT pr«»«^ 
Ftlrdl&ni1<r «nndiL^'TEnjf rijiminiittniiFi »pan nuinfrniii nidiiv<in, abAc^rvMk 
■ mar* rognjlAi oecurrrn« of muxi. 

«hJvA/ oral cvlU. Amtne«! In two«. Ut»eA. nr limn, iml ditfingiilth^d 
bf A c^tiit« lirwul r^riArrfr; wnlur «nd ililiiU «iilutjoiic «1 »iiatfc pola*Jj 
^bioW« tlib »paule- 

X IWU. lAltvt /YdflJtrl Mid rta^fr.}\ 

■UininC'— L llie n>r(r-;1nu prepimtloni lem&in far aboul 
tnFnlj^'foiir bourn in iho foMowln^ lühition;' — 

i:unr<phtFiiti>rl nlrahollo floltiUan of £pntian-riol»t M),Q 

DiflLillrd n«|^r ,.. lOfitl 

AocUc tcU tU.O 

TkeoSor In i-pm-müle »«Ik »dd taJ imsh \ti ntcoiiot. 

J. Tlip pr<*[»flr»lifin U nuiH^I f»r tu'<^ t^ t^Mw mlpulm In nnlUn^ 
«■tfT-Diotti/l'vi^lvt acilution. ihvn Jucultind for half ■ minutB Sn abioInU 
■IcvboL vid wa&Lvd ofT in HJit'r. 

HiB coael Appmr dstk btit(>: tbr »pnitp* light grayblu«. Kr«> 
qivmllj HVTiml piürK ol «ocel arc *con Id one i>nrc1opc. The dlp1oMK«u* 
Ü dnvlori^ by firiuu'* iiwlbi^d. 


Although Friedliiuder and otbera regarded this coccua ae the «pa- 
cific exciter of flbrinoua pneumonia, this property certainly docs ooti aa 
m rule, belong to it, for it is neither regularly nor exclusively found in 
pneumonia, and the inoculation experiments made ^'Lth It are by bo 
meana unasaailable, because; (1) croupous inflammatioQ never occura; 
(2) the inoculation experiments are too severe procedures. The rare 
cascH of pjicumonia in which Friendländcr*» diplocoeoua has been iound 
vere distinguished hy an especially severe course. Furthermore, it has 
also been found upon the mucous membrane of the mouth, in tiie saliva 
and expectorations of other patients, and in the naB&l secretions of 
perfectly healthy individuals, as well as in abei-c»s of the lungSf peri- 
carditis, otitis media, etc. 

A microbe very closely resembling this diplococcua la looked upon 
by Löwenberg, Abel, and others as the cause of ozena (fiaciUun mucoaus 
OsCCntFj, [As this micro-organism also occurs in simple atrophic rhinitis 
without odor, its etiologic significance in ozena is questionable.-*- 

DIpfococcus Pneumonls (Franke I »Weich lelbaumV 

Tnenmococoiu. — In contrast to that of FriedllLnder, this coccua is 
found almost constantly and usually unmixed in fibrinons pneumonia^ 
In the pneumonic lung it occurs most abundantly in the freshest parts 
of the exudation; furthermore, it ia almost constantly present in the 
diaeaaes complicating pneumonia, euch as pleuritia, pcricarditia, endo- 
carditis, peritonitis^ meningitis, and sepsis. 

It is almost invariably found in pneumonic »pututn. In order to 
demonstrnto it« prenence hers it is advisable to wash tha expectorated 
masses seveial liuies iu ^ttiile \v-ater and then to make smear prepara- 
tions or cuUureft- 

According to the author^a experience, the pneumococcns is found 
in the living bttnid oftener than has hitherto been stated. In a continu- 
ous series of 130 caries of pneumonia he found it in the blood 27 times— 
i.e., in 20.7 per cent. These oasca, however, were alwaya of the aevereat 
type and generally ended fatally. 

The poeumococcuB, like Friod lander's coccus, pofiscsaea a 
Tery dietißct mucoid capsule wliicii almost alwnjs indosea two 
ovoid cocci, which arc eomewhat ppindlc-shnpcd at their free ends 
and united into pairs by their broad bases [Fig. 31]. The 
author found the diplococcus to be 1.5 to 1,75 a broad, end 2 to 
S.6 fu long. In emcar preparations the diplococci arc usually 
ieolated, thou^^h now and then a chain of two, six, eight, or ten 
segraente is seen. Under such circumstances it is not always 

iBwriHtf Vit, vi^i 



«uj to dictinjnii«b tb«m from rtroptococd, becati«« tho cnpnil« 
%nd tb«i lATicmUtn form of (he cocri nre not nlinay« «Tiiirpljr 
tl^jtiiej- la' tiiicJi oiifA ciJtlvaUon mii^t be resorted to. Aside 
from Ih* ntacnwcf'piü differtutx*. Uie tuUon» obOTT importADt 
inicrvBco;nc p^iiLiunlif«, uuiiidy; id pr«paratioiu m&de from 
bouillon oTiitur« tJn> Htv-pfocöccufl ia Bt^eo in tlic {«rni of loop, 

UirMib of i-ight or tun »i^^miinb^ 

|F^. 34, — Di|ilor4tcoii PnirliinnniA: in t]iv Jlr^ri'« Uinvi vi m 

Tb« cvffnro* floarinh tw«t in oiitHcnt bniillon. whlcb bccaiQ« dU- 
foKlf «lotykd hy Ibe grovTthk A itlJ^tit ptrriphiLtc cnllecU nt llic ^Ltom 
04 ItW mllutV'tub«. Upon a^r and bto<i4<wniia llio ««loniM bppMr ■■ 

WliUe Ih« utter ar« dtlTLcult to dlstto^'uidli from »trqito* 
tfocdo coIuoicH j;rü\m upon the fttimc oiödia, thü jcrowth in 
bouiUon, -whith UHunlly te n^f doudtd by the «trcptAi^occa», pre- 
pmtft A nurkH macroicoplc dlfF^r«BCC. DiffcT^niijitioD is «uily 

43 MK;R0SC0PY and CHEinSTRY. 

accompli shod, however, when the cocci in doubt ore grown in 
Petri diehcs upon agar niixod with blood. Upon this mediuui 
the diplococcus produces a greenish coloring matter, while tlie 
streptococcus absorbs the color and as a result the colonies appear 
to be Burroundod by a light halo. Jn "hanging drop'* the pneu- 
moeocci nianifost no motility. 

Stainlagf. — 1. A cover-glaas preparation made from n smal] portion 
of the " rusty '^ sputum la floated for five or aix miDut^H upon an anilin- 
water solution ol gentian violet, placed for a few secondH in aLsolut« 
alcohol, and then washed in water to remove exi-ess of Etain. T?ie eooci 
appear blue-black» the capaulea colorLess and shftrply defined against the 
faintly blue background. 

2. If it ia desired to make the eapsule prominent by a contrast- 
Htnin, Wolfs doubte stain is, nccordmg to my experience, the beat. 

The eover-glaaa in placed for four or five mmutes in fui^'liam anilin- 
Vater, then for from one to two minuter in a watery, slül transparent, 
solution of methylene blue, and rinsed in water. The dark-blue cocci, 
suTTounded by a roae-colored capAuIe, contrAfit very distmetly with the 
blue-red background. 

[The following combination gives a elear image of the capsules ol 
the pneumococcua: — 

Dahlia ..,,.....,,,,.,,.. 0.5 gram. 

Methyl-green (00 crynt.) - . . , 1.5 grama. 

Fuchsin (saturated alcoholic atilution) . . . 10.0 c. cms. 

Distilled water 200,0 c. cms. 

Hub up the dahlia and methyl-green in a mortar with part of the 
water until diASolved. then add the fuehain, and finally the rest of the 
water. Prepare the specimen in the usual manner. Flood the prepara- 
tion (dlidej with the stain aird h^at until steaming. Then lay aside for 
about five minutes, wash in water, dry, and examine in oil with V^ oil- 
iinmemion lens. 

The specimen may be counterstftined with I-per-cent. watery boIu' 
tion of eoain. — Brooks.] 

The ataining of the eap^ulc is not as successful in ftll ca4ei aa ia 
stated here. Sometimes it rpmainn unstained even when no error has 
been made in preparing the apecimen. 

3. A hafity examination can be made by pouring a few drops of 
carbol fuch^iin upon the cover-glaas and warming it for from one to one 
and one-half minutes over the flame. Wa^ih in water. The coeci are 
bright red. surrounded by a light capsule, 

4. Gramms method does not decolor the eocci. 

Tb Fränkers diplococcus to be regarded as the specific etio- 
logic factor of croupous pneumonia? It hae already been stated 


that this coccus ie almoat constantly present in pnenmonk, and 
occurs most abundantly and almost pure in tlie most recent foci, 
from which a conclufiion as to its role can be drawn. On the 
other hand, it is also frequontly present in tlie saliva of pcrft'ctly 
healthy persons. It must, therefore, be assumed that under cer- 
tain unknown conditions an infection of the lunge may occur 
from this source. 

InoculAtion cxperimeiuta with pure cuKurea have not bem »iiilTi' 
ci«ntly poHitJTfl to reiaove all doubt aa to their r^poeihc pathogenic: 
nature. Efforts to induce infection bj inhalation have always resulted 
negatiTely. Subcutaneous injertions made into rabbits, mice, and other 
anim&la produce fatal septicemia vithovt the occurrence of paeumonitic 
process«. The latter change», which, to a certain extent, rewnibfe true 
croupous inflammation, can be induced on\j bj direct injectioD into the 
luag itself- Tlie failure experimentally to produce croupous pneumonia 
in aQimals cannot, however, be used a^ an argument against the speci- 
ficity of Frlinkcra cocci, becaufjc the auiiceptibUity of the human eubject 
to the pathogenic agents differs from that manifested bj eiperimented 

Be this BB it may, one fact of great sipiiticance remains, 
namely: Fninkel's diplococcus alone is present in nearly every 
case of croupous pneumonitis, while Friedlandcv's bacillus and 
the streptococeus are hut rarely mot nitli. 

3. In (Epidemic) Cerebrospinal MeningitU — Diplococcus Tntra> 
cellulariH [Meningitidis] (Weichselbaum). 

Weichselbaum, Jüger, and others have found in numerous 
cases of cerehrospiiifll meningitis a peculiar coccus which must 
now be accepted as the almost constant exciter of this disease. 
Its acceptance as the sole etiologic agent in opideniic ciTcbro- 
fipinal meningitis cannot he entertained for the reason that spo^ 
radic as well as crtdemic cases of primary nienin^;itip have been 
observed in which Friinkels pneumococcus was the only microbe 
found - 

The cocci lie with their flattened surfaces in apiiosition. A 
capsule cannot bo made out- To size they corri^jjond to the 
gonococeus (q. v.), tliongh in some instances great variation in 
eize oeeurs. 


Stafnlnff. — 'i'hey are b«st etAined with Ldfller'B meüiylene blue lolu- 
tion, Gram'A mcthoij does not ^ve uniform reBuke. 

As the cocci are not infrequently present in fimall numbers in 
unioar preparations (sec "Lumbar Puncture"), cultirntioH is often nec&*- 
PHry. They are beat cuitivated upon fftffcerin-agar in Petri diebcH or 
in culture-tubes upon a slanted medium. After twenty-four to forty 
eight houra, üpoording to the number of bacteria present in the n^alerial 
u»cü for inoculation, the growth appears as isolated or confluent, tran*!- 
parent colonieB resembling drops of water. The individual colonic^ 
attain the size of a piii'a head, but are only slightly elevated above tlie 
Hurface of the medium. When the inoculated mati^riul contains Qumeroua 
cocci, or the growth is transferred to new media, Uie surface is covered 
with a thiUi trauAlueent, homogeneous, grayish flim. 

ÄB the spinal fluid to be examined usually eonta.inB but few cocci. 
it ia adviäable to use from two to four cubic centimeters for a culture. 
The superficial colonies, viewed niicroaoopicaUyn arc clear and transparent 
at the periphery; toward the center there is an opaque nucleus. 

The cocci grow Iwst at incubator temperature, and not at all at 
ordinary room temperature. They dilTer decidedly from the staphylo- 
eoeci in this particular, and also by the fact that they develop poorly 
upon gelatin. Bouillon is not adapteJ an a culture medium. The cultures 
possess but Unfiti-d ritalili/; they may die in six or eight days. From 
the gonoi'occus whiHi they strongly resemble morphologically, they are 
distinguished by the fact that the gonococcus cannot lie cultivated upon 
ordinär}' agar. 

InoculatiuQ experiments with animals have thus far given no con- 
cloaive results. Multiplication of the microbe does not occur within the 
animal body^ llie toxic effects noted arc directly traceablo to the 
amount of culture introduced. 

4. In Gonorrheal 

The yonoconcna {diphcoccas goni/nfifrte), discovered by Neisaer in 
1879, is, through the exhaustive researches of Bumm, generally recog- 
nised as the epeciflc cause of gonorrhea. It is constantly and exclveivety 
fOHFid in gnn'Tihua and in identically similar proccafles, especially bten- 
norrhcn ni-oiiatunim. In the newborn, gonococci were unqueationably 
found (so far in but two coses) in superfleirtl purulent iuflltratinns of 
the dorsum of tlie ttfii'jHC and of the mucous membrane ol the cheeks 
and of the hnrd palate {Rosinflki-Dohm and C. Frünkel). Tbc fact that 
the gonocuccus has been proved to be the sole exciter of the following 
disease* octuninc in cfinncction Kith ffonorrhea is of the greatest dinical 
ttigtiificaucc: Acute serous and suppurative rheumarlhritis, pyosalpinx, 
reelitis, cutaneous abscesftes, pleuritis, and ulcerative endocarditis. In 
■gonorrheal rheumatism the author has repeatedly demonstrated the 
presence of gonococci in the fluid aspirated from the joints. 

la-elNule VET, Klg. t 


The gonococcufl was flrst obtained in pure culture bj Bunim, and 
it hu been aucceaefullj inoculated upon the mucous meiubmnc of tlic 
urethTa o( tvro healthy individualB. ConacquentI j, there can be no doubt 
as to its specific pathogenic action. 

Pure cultivation of the gonococcuB is now aluioat univerealTy con- 
ducted by the method introduced by Wertheim, in which Nood-SGrum npar 
is employed as a nutrient medium. '"Suvernl dropa of gonürrhenl pus 
are first mlTed with liquid human blood-scrum and thou two dilutjLins 
made from this mixture us directed on page 22. Immediately alter 
inoculation the tuboa are placed in a water-bath at 40° €., their content;* 
thoroughly mi:ced with an equal quantity of liquefied agar (agar, 2 per 
cenL; pepton, I per cent,; common salt, 0.5 per ci?nt-l cooled in the 
same water-bath to 43° C, and plates poured. The plates are put into a 
moist chamher and then transferred to the imnbjttor, where they arc 
kept at 37* C, After twenty-four houvri a dtlTu^e cloudiness can be seen 
upon the original plate, and upon PUte? I arid 11 isolated colonies are 
visible to the naked eye which are sunicienlly large upon Plate II for 
transfer inoculation.^^ 

Further cultivation in the incubator id Bucces=ful in tubes contain- 
ing blood-serum agar (best upon an obliquely eolidiri'd surfüce). A mix- 
ture of 1 part of liquid human serum and 2 to J parti of nieatjuice 
pepton agar was found to be the most favovahle niediiini. After twelve 
hoirn, abundant pure cultures will have developed in the tiil)e*. "Within 
a few hours there usually ben-in to develoji minute, f^vjiy-whito pointri 
which rapidly enlarge and eoulesee to form mi exti'N-.ive, <'nhei\'nt, pray- 
white, moist, yli^leuing deposit which, by furtlier gru^stli at the mar- 
gins, produCfA a delicate, colorless peripheral hiyiT, The 'c(*ndeii9ation 
water' is also covered with a cjhrrent film whirh, like the remaining 
cultures^ shows numerous gonococei in large sheclfl." 

According to Slr'in=chueiJir. an iiin,'ji-c of the pepton content to 
1.5 or 2 per cent, and oddilion of atuTile hum^m urine are conducive to 
luxuriant growth of the cullures. 

Proof tliat pure growths of Nei.^pera gonococeus wore present in 
\Vertheim*s cullnri'^ wo-* furnished by *<everat sucee'^--ful inoculation« 
conducted by Werlheim him^lf ivipon pnmlytici). 

In the autlior's clini<j Kii.'F(.'i'^ nutric-iit rncilium is prefprr*'<l. 
It consists of 1 purl of ascitic fliiiil sind 1 p.irt of a mixture 
composed of 3,5 j)er cfnt. of n-rar, 5 prr cent, of poptoii, 2 per 
cent, of glycerin, and 0.5 per cent, of Hidium clilorid. When pus 
containing gonococei is sprcail upon tliig mc^liuniH there will 
appear aftor tAvcnty-foiir hours nt 37° V.. smnll. Jiglit-vt^llow to 
roddish-brown colonies presenting a en;Lr>e]y pnmnlnr ci-nter, a 
finely grjiiiuljir peripliorni zone, nml a F'Trated mnrjjin. If 
articular or tubal exudate b to be examined, it is advisable if 

4^ MtrilOSt'Ol-Y AND niKMISTRY. 

poffiüilo (*) rinjiloy 5 lo 10 ciiWc ccntimet^TB Tor iiwxiilftitfin. 
Under Üieet? (.-ii-i^uninlaricu» ji Hptvml uutrifut iiieJiuiii is not 
DeoeeeAry, »i&cc it ^ulFiut) to mix Uic blüoil sr puriilent üuid witli 
on 0<]ual aiuouiit of orijjrmry ii^ir. 

A pecultanlj of Iho jp^riüotuci — n fcalure which do*** uat, 
flOl^■^v^^, brlon;! to thrm nloiiL* — is fhnt fh« nrnj/frUy of them 
f'titfr Ike hiitlicA of the j'vji'€i-lts, wlnTf tl»7 multijily in mnii a 
manner tliat they appear v^hollj to oil up tho cclI-bo«;lv and pJir* 
tidily or completely oUcurc iho nudcvia. Tho gonococci never 
pmotrat« the nuolcuB iUelf ; thoy but rarely ontor the fquamons 
cpjthdia, and more rarely iDvatlc the cylindrEc epithelial oclls^ 

Till? roi't'i ftliinxt Älw«yr* jj[>[ifHr in iTiiiLlIi.'r ur hirger gn>iiJiH, 
lie iodivMual» bcjnx ifSWtUif nniUd tn jtaivn f rrjivinhlimj a cufft^ 
hMn) which h€ mth their fhUaiicd surfaces in ajtposititm^ Now 
cLnd tlicc aro s^n fotir in cbso oDiilnrt, which arrnnffcniftDt ifl 
produced by fifgion in two dir^^Hjon» of npacc. The lino of divi- 
fion between '^jic^H pair of cocci i« qiitt4> broad and aWaya r^^eog- 

Gtaüilnff- — A klin;irfl »nil »loitl »iitiHrai:tary nicthud oi hUlnliut I" 
tliM, ^I'llli «■»nrcn^rnlnd wnl^ry sobirifin of ni«,liy]<Tn' blu^ wh^Hi U 
bllowrnl to aol upon tlifl prcpnialion fcr half a Trinuti?. Wanh in wiitnr, 
Lüfttcr** eohition nii)4E aot lor ona iriiiiutt", [A ihortri time wUI do,} 
Mrlli^l'ii« bliio tt pif-fc^rable ta Diininrck bri>u'n, hcj^ii^iai* It srains tliu 
<Krciii fniicib dffiiptr Ifiiin the nuclei- AIJ of Lha nrtiiuiniii^ buali: iidillii 
dyv> ciLu 1# ttj)[ik>ji'ilt 

Vpry bi'iiutirTil rr^ults *re obUia«d »Kh b /ir^n'v dtJHfPd iran4- 
liiocnt solulLHjn of onrhol liiobi^iD [1 pnrt of fnrhiin to S or 14) ptrt» of 
waterl. ir ihn prrjj^nutluii U AltDwi?il lo rciiiA^a ia Uit* KrTulLun for 
iLboiri twn miitiilo«, murh more dlslini^l picturw an t^ettniä thiLn vHlh 
moLhylm« bluC' 

Jn my courpos 1 ha^e fivquently obi^crved Ihnt bcpuno» 
mislock tlie email prol^ngntions of the pölymorfihons nucloi of 
the pua-ccTl? for tbp rnrri. Tt must^ tlieptffm?, he aitrongly empha- 
bjxed thai Uie lalti^ art-, vrt tin nvvrnge, otdij 1 to Jj?J ft. in «'«ey 
further, that they are cliicfly located io thu peripheral w>ne of 
the puanJcU, accenluatinff the pülo-blue or top<^oo|r>rad mar^innl 
outline of Ih© cell or even BUpploujoniiiig it 

Aooiimtß ohstrrnfion ia uiTordtd by douhte gfaining, in which 
th^ fM'lMiotly üt lingo) ^4ilh a protapln^uitc f-in'm and the cocci 
with a nuclear ^Uin. 


The cover-g1aB3€B are atflined for & few nunutes in a heatrd 0^-per- 
wni. wateiy solution of eoAin; the excfas of (.lie dye abi^orbod wilh blot- 
ting pAperi then, vHhovt washiitff in water, arc statnrd for one-fourth 
minute in concentrated alcoholic solution of methylene blue and wmhed 
in water. The gonocooci are stained intcn*+ply blup, and contTa*it sharply 
with tbe eoain-red i^tained bodip^ of the pua-celU, the nuclei of which an', 
as a rule, of a somewhat paler blue thnn the coc;ci- Litcrci's^, Ih: 
"eosinophile" (W/^, tchii-Ii are almost ctttmUiati]/ present in ij'jnori'hcü . 
are stained icith especial beauty [see "Itlood"). 

A simple and very di^tiniL double staining is socured with daMia- 
tHethffi-fft-een soiution (1-pcr-cent. viatery solution dahlia- violet, 10 gram»^ 
1-per-cent. watery solution methyl-grccn, 30 granisf, whith is allowed 
to act for one-fourth minute without heating. The cell bodies are tinged 
pale red and the cocci bright red; the nuclei I'eddiab green or more of 
bluish green. 

The gonococci are decolored hy Gram's method of staining. 

I. In Tuberculosis.* 

Ever since Villemln, in 1805, rendered it to a certain degree prob- 
ably that the products of tubercular diiiease are trnn^miasible to animals, 
and Cohnhcim, in 1S77, aueeesafuHy inocutnted tul>eTeu!uus material into 
the anterior tjhamher of the eye, the conviction that tuberculosis ii a 
genuine infectious diBease gained a firmer and firmer hold. This view 
was confirmed by Taumgarten, who demonfilrnled the identity of the 
inoculation nodules of the iria with genuine miliar}' tubercles. But the 
fundamental and iiidisputable (^idcni-e irn^i /irxt fumisJicd bf/ Robert 
Koch throvffh the disrorfry of the tiibrrvic btitillHS as the vole factor in 
tlie producti'jn of tuberculosis. Kven though it be admitted that, inde- 
pendently of Koch, Hamugartrn observed the regular occurrence of cer- 
tain bacilli in lubereular foei and inomlation tnbereles, (o Koeh is 
unqueaf ion ably due the credit of having fiirnii^lied the tnont absolute and 
convincing ]iroi>f of the sj^eifLc pathogenic nature of the bacillus which 
bears hia nninc [l?iS:2). 

Koch proved the constant nnd e-veUi'^ive oceurrcnce of the ba- 
cillus and siiceeHHfully conducted its cultivnlion and inoculntian- Uut 
what ia of greater importance to the pliyalL'iiin, he al.'^o oH^-inaled the 
"tperiflc^' method of stoitiitiff. later to be deseribeil in detail, which h 
diatiQguished by the fact that Itie bacitJi. Khen once sttiined, do not part 
totth the dye upon trcatntetit vith nitric acid and altvhol. 

The tubercle bacilli ore slomlcr, more frequently elightly 
bent than ^trai^ht, ro<]g 3 to 5 /4 in length (about one^fourth to 

iSttfU«? MI^ Fig:«. ■( indJt 


Micitosconr and cuKMjjmiv. 

f9tir-^i^ as lODg a« tb« «Hanieti^r of u ru^t bluud-corpinele) ; tlieir 
ODda oro often tligbt); roundel. They uniiiilly occur singly, sei* 
dorn iu poirSf thou^^h otraui^nnlly th^y nppmr in gronp^ at friiiii 
five to tvetvc and morv (in tha «putLim aibtr tnb^reulin injec- 
tion; Id \h& urine in iimg^oiiljil tutiorctilo&ift) . In etitinod 
prt'jmnitionjH tJtr roii* not. infrfi[u['nllv A|ipe«r lo he interrupted 
by brightly glifikuiuKf round or (iroid ejf^ru* (Platu VII, Fi^j- 5). 
the ei^ifjcanco of vhich is eiill a matter ot conjcctitn. At 
present thov ara ijiiitc f*0Di>raE]y inlerpratod OB Bijfiu of iJCfrcnonL- 
tiou. Fischer aud Olivers look tmx>ii Them iU pkamolytic dian^coiL 
Tlie nuUior ia bi^^line*! lo doiiljL wh»>tber tli« letter i>i tnio in nil 
cnac^T eincE* it 15 cvHaiu thnt audi fenlutvs ckccur man frequently 
in severe tiacA with hectic fcvn" than cthcrvisc^ 

TIlc view tbftt tboifi ^livtcnlag. round or arakd apact« ccoan-iii£ 

vltiim ihv iik])i utv apor«* hCiiji lo Iw iiL]]i|rgtM by tliu f^ct Ihkt » 
■puIUDi coDtainmj] hn<<il1i ahnKlnp nnrnormm {il»r trap* aj>p?nr« to muni- 
(i'»l ilficliJcdly pronounced powcm o| icALBlancc to gcTniUBJal tnltucnmh 
In rmiiH iimHH Lliu IiiutEIU uiir dtwtroyi-tl in 4 lioura at ^A' C-, In lA 
miuulrt At ftA" r,, in Ifi mimilh« at. 7fl* <"., and in I tnitint* %t US' C. 
Ttic> iraUt tlic atllon of <l*V htat far hours, »nd tliU iiku&ni bi^ tbrrefoiv. 
nnr, aJupt*-!! for thoir dp*tnietlun. Tho fnlt^r objprt i* I«*« aruiiittl liy 
tlu «•• 0^ S-pBr-Cffnl« carbolip mül or lO-jirrnitit, ly^i^l noluticii- 

Tubcrdc IagiIH can be urowo iipuii i'cniKi*l*^td j»liiTp Vbluod i*iuiu 
or irl^vii-rifi-aB'^r, on whlHi thry dMctop bcil »t 3T i:. Thait cultivftlitm 
U oll<MiJcd witU Bomo dJCHculty, A lutiitirJnl rich in (ubcrdc bddlli and 
fnir n« potedbic from vonlacainalion viüj oUic^r bacteria Iji acetaiiary. 
Thi« is rubbn4 tnio thtt ttirfiL(?a ol tlio pojLgulotod blood-ivniai- Acoorl- 
inj; to Ko^ti. ci^lturt» mn I1« obtained fnvin Inhtrvitloiin fpi;(uiQ in tbc 
rallonln^ inunijcr: After UiühjukIi olrunjiiu|£ of Uic moiilh jind phnryit' 
leii^E riixiE-y Ihi' patlvnt apilt dirtclly trit4> a »lorillu'd l^'ftn ilii^h. If ihct 
«puluiiJ i» IvLiiiil tn bd ridi in WJIIi ihy Hliuui-d |Jiv|>AJAtJtinl, iLc ftnki? 
U Wft»)iwl in repmttilly n-nfwrd di-lillrd wiilpr und a portion from tho 
cjpDtm oiTflfülly niiti-nd out upcm bl^tod 10™™ or glyoufio agur. Tlin iu 
iwulüLvd luU'i HtTi now pTLiiijci'ii rttUi ciMtiiii. And u^vr tliis is dr&^n & 
niEibor pnp. pMviodfcly »fi-filiy^Kl Aifh ■"Miriiiiti« *nh«ion, in ord<?r to pro. 
virot the k^ar ftuux diying durüig tlic fourtcvn dayi' cxpoeurt to tic 
tenrpcntuM? vf tbf iiK-tibiilitr. Xl^i« nilimurb ma ruuiid, Hriioutli, Aud pt|[^ 
VPhltO. Under ttus intlutno« of «iinliiEht llii<y rapidly di«, "Acfiording 
to Kodi, if IbL^y itt pUi^cd clc^c to a ^^'indow llicy nloo Lou tUcir vUttUy 
tindT Uli* fnliii'ih'i' of dlirujit^ duyhglil nUhLn Ih« (a voven dnya," fiiiitv 
thk nUMTiptm kt ctilMv^tfon atU'U fail. It ii^ nd^ixatile nltfaya to inrrnu- 
IaU- u uuuibrr of lul>cp nl the Bamo time. (A vrry favoriblo nuljkrit 
ini>djiiiii i* Kir'kliiig'fi neutral meat bouillon, whkb In a« IoIIowjit noft 


grams of bcef-mv&t lo 1 liter of bouillon, vith addition of 0.5 p«r t-ent. 
of common salt, 1 per csdU of peptone, and. 5 per cent, of glycerin.} 

iDtroductioa of the pure culture into nnimalB (Add-mice, rabbita, 
and especially guinea-pigs) by means of subcutaneous injection, inocula- 
tioa into the anterior chamber of the eje or abdominal cavity, etc., 
alwayi gives riae to tuberculosis. 

Staining. — The alkaSine methylene blue solution originally used by 
Koch is no longer employed. 

The following methods of staining are to be recom- 
mended : — 

1, The Eoch-Ehrlich method is very reliable, and should be 
used ia all cascB where doubt arises. 

Technique. — The dried cover-glass preparations made from the 
purulent secretion are allowed to float for from twelve to twenty-four 
hours upon freshly prepared or ant too old Ehrlich alcoholic gentian- 
violet' {or fuchsin) anilin-water solution. They are then placed — without 
previous washing — for a feic seconds in a solution of nitiic or hydrO' 
chloric acid, composed of 1 part of acid to 3 parts of dis^llrd water. In 
this solution the preparations assume a ^lecni^h-blue or greenish-red 
color, which is the indication for imniiilifitc «ashing in TO-per-ccnt. 
alcohol and water. If the completely dritd preparation is now mounted 
in balsam and examined under the microscope, the tubercle bacilli only 
will be seen stained blue or violet (with fudisin stain, ri'd) ; all remain- 
iriff eletnentA are dei^forcd by the treatment with the acid and alcohol. 

Examination of the prepamlion is ^eatly facilitated by the use 
of a so-called background, or contratit-Btain, whiih is applied after the 
staining and decoloration of the bacilli is completed. The dried prepara- 
tion is placed for one or two minutes in a watery solution of Bismarck 
brown for methylene blue), then wa^ihed in water or alcohol, di-ied 
thoroughly, and imbedded in xylol -Canada balsam. 

The blue- (or red) tinged rods now contrast sharply with the 
brown- (or btue-) stained background. 

Fy heating the above-mentioned staining solution the staining proc- 
ess can be considerably shortened. After from flft^cn to twenty minutes 
the preparation can be taken out and subjected to further treatment 
with acid, alcohol, and eontmst-Ntnin, Too stroni; heating, however, 
gives rise to disturbing preiipiutes of the dyes employed. 

2. The staining method of Ziehl-Neelsen is also very reliable. 
An advantage it pojsrsscs over the Knoh-Ehrlich method is that 
the principal staining fluid — the oarbol fuchsin — is ready for 
immediate use; furthermore, its staining properties are pre- 
served unaltered for mantf rrtotitlis (sec page 34). 



Th« preparntions remain in the cold solution for from flflern to 
tweotj-fouT houTB or in the heated solution abovt onc-hfilf minnte. De- 
coloration is Berured hy washing for a /rifl secntids in a 5-pcr-cent- watery 
solution of sulphuric acid. After immediate washing in alcohol and 
water the Mnirasl- staining ia made wiih a watery eolution of methylene 
blue. Dry thoroughly and mount in xylot-Cjtnada balnam. 

[The proceaa can be greatly ahurlened hy covering the pri^paralion 
with the farbol fuohain aolnÜLin and Ihen carcfallu i^^otinff directiy over 
the free flame until the Hnid cornea to a boil. Do not allow ttie fluid 
vjhoUif to ei:ap'>rate durinff Jicntiittj, hnt renew if necesaary. — Brooks.] 

3. Although the Zichl-Xe<'lsen metliod can ho carried out in 
a comparatively short t'pace of time and still be depended upon, 
Gabhei's modification of metliod No. 2 permits of still more 
rapid staiuing. The saving of time is pccurcd in the act of 
decoloration and conlrnst-stiiining at the same nLoraent. 

Gabbet employed the ZichI carbol fuchain solution aa the principal 
atain, allowing the cover-glns^ca to remain in Ihe heated solution for 
two minules- After washing in wnter the gln^srin ore placed for one 
minute in solntion II, eompoaed of from I to 2 ^rom*< of methylene 
blue in 100 cubic ccntimrtern of 2ü-pcr-rent. aulphuric acid. Wanh 
quickly and thorüughly in water, dry, and mount in xylol- Canada 

The author has employed this method for many years, not 
only in his Lcipj^ig cout^c:?, but ali^o for yonrs in hie polyclinic 
in Hamburg, and he ia convinced tUfit it is extremely convenient 
and possessed of a hij^h decree of reliability. Hottever, now and 
then bacilli wore found by tlie Koch-Ehrlich method after they 
had been missed with Gabbet^s stain, A certain amount of 
caution, therefore, appears to be advisable. Even without heat- 
ing the carbol fvich&in good staining is secureil; but the author 
prefers heating, becauae in control testa with two cover-glassea, 
made at the same time and from the same ppufum, decidedly 
more numerous and deeply stained bacilH were found in the glass 
stained with the heated solution than in the other. 

Tliiji is not the place to desuribe seriatim all the remaining 
methods which have been pmposi'c) for ptaining the tubercle 
bacilli. Wilh Ihe above methods success will ahroijs be attained, 
providefl the specimens which hare been prepared contain bacilli. 
The latter, however, is hy no means always the case even in 
epecimcns made from unquestionably tuberculous sputum. 


It is not rflre for an examination of five or eis proparations 
to show but an occasional bacillus; ind^fd, m not a few instances 
examination of a comparatively lorge number of tipecimens moy 
show no bacilli, even though the sputum has a distinctly purulent 
character and the objective symptoms on the part of the lungs 
leave scarcely a doubt as to the tuberculous nature of tiie afTcetion. 

In such cases Biedert'a method sometimes gives positive 

TtCHMquE, — Mix a tublp'ipoonfu] nf sputum with two tablespoon- 
fulfl of ta'ater conlnining S to 10 drop^ of caustic sodn. Boil the misture 
under constant stirringp nntil t-ompleteEy litjuofir'd. Then adit about 5 to 
10 table spoonful 3 of wBtcr, bring to a boil several timea, and after eight 
or ten luinutea pour into a i-onic gTas^, where it ia to remain for two or 
three days to form a acdiment. 

In examining for the bacilli, instead of drawing up the aediraent 
with a pipette it is preferable to pour off the aupernalant liquid down 
to the deposit and to make a preparation from the residue after it haa 
been thoroughly triluraled- [In this niclhod the sediment often losei 
much of the adbciivc ]m>ju'rty of the oii;"in]il sputum. Tt is, Ihorefoi«, 
advisable (o save some of the untreated sputum with whit^h to fasten 
the aedimcnt to the slide.— Huooks.J 

The metliDd of Dahmen is sometimes of value in demon- 
strating the presence of tubercle bacilli fthieh escape ileteution 
by the ordinary proeeflure?. Tt is to be looked upon as a modi- 
fication of Eiedcrl's method^ but Ihe aJilition of caustic soda is 
omitted and it can be carried out in a much shorter time. 

TpcHNr<iVE,— About half a te>t-tube of Fiputum \9, eooked ia boil- 
ing water or a steaTuor for fifteen mimitr^, Jiy thi^ procedure the 
proteid aubntancp? of thp cells eoagulale. and, on pooling, fall to the 
bottom, carniiiK *he bacilli with tlipfn. The Bupcmalant fluid, in which 
there are occa'iionolty a few mucoid cojigula extending from the surface 
downward, i^ thin and readily movable: tbj** in carefully poured off 
down to the more or le^s *b^ht nnd ^-runular prrHpiUte. The latter is 
triturated in a <Jish and cjin at once lie nscd for cover-glaM or *tlide 

The bacilli eontaiueil in this seilinient are often arranjred in 
large ma*se^; the iudiviihinl rods usually ap|iear somewhat less 
slender, hut are ntlivnvise fiuiltlesj^ly stained. 

Sedimentation can t>c ^rreatly hastened bv use of the rrntrif' 
vgal machine [s<.*e Fi^, 11^^ rii>, and 121]. Thi,^ inelbnd is 
especially to be recoaimemled in examining for bneilli in the 


uriiK', w)ioro Ihry arjj ofUoi found in Urg» cliirtipit, though nol 
rnn^lj- in stnnil tJiiml>**rH- 

In manjr metancca tlie Van KeUl methr^d aUo ile^erve» con* 
sidcration. Place in A t<:^t'nitie from 10 to ir< cahlc tentimatcn 
of aputuzrit Vi cubic coDtiiuetcrä of water, ii cubic c^ntimotcrs of 
deliqueseod ojirbolic aeicJ, amd fill «ith wiiIct to lüiJ oubio godU* 
mel^ra. Sbake vi^omunl)' for ono minufi^. Aftitr ilamUn^ for 
iw«-u1j-f(iiir hmr* UkfT iiji luinuL uf i]^r ^^iDitM-iit villi a jii^ir-lln 
and trcai in tl^c oritiuAry wnj. 

If ürirn; is to be cxnoiincd, 100 cubic ccntimolcrB of the lat- 
ter may be mixed with 6 cubic continidoTB of cones Dtra tod solu- 
tion of carlWic nciil, then shaken vigorounl^ and allowed lo 
"sediment" in a couiü ghmn [hoc Fig, 1S2), After U'l-iitj^four 
hour« Lhc £UjK-rtittliiiit liquid iit riirrfnlly p^iirrd nfT And Iho 
ffedimaiit examined in ilic iieuü) vray for tubcrrlr- Willi (^JolW)- 

It should not be forgc»tlon that ovrrj" cxp^'ricnerd phyeician, 
vbo ia thoroughly fnniiliur with both ela:ning tix^hnif^uo and 
the us* of the inJcroscopG, will mf^.it with caee« of chrooia tubPP- 
i:iiki&i8 of tlio liint''* in wliiHi the most froinient uiid eHrL^fullj 
€OüduolL>d exaiuiüfitiaus of tlie s|futiiin for tuljyn:lo li«[:llli will 
give negative result*. Within the loat few yvAn the author him* 
eclf obstTvod threo suuh caecti, and vxactJy tho Bumo cxpüricnco 
was n^portcHl yeius ago by ran licydon. It is cortiLJn, howovcr, 
that finch casts are of the ^tentmt rarity^ and it would nn(jiJ'>^ 
lionably bü urnng for lliis rr-jisoa to cfl*^t «von the slightest doubt 
upon tlio reliability of the diagnostic taIuo ot bacilkry exaiu- 

In one of »he »uthcT't *fl»o« the BiU^pty «bowed bot k 'NHobi'— 
pjrtfcU fixuK-J— t\ibcTvulo<iii oJ Lhc Iühä* i""! tubcccoJou* pcik'Uunihili» 
t\i tilt Iftryni. Tlii' |ihlI^nL fXi)!-«^!!)!»!!*!! n vm> modfihlu umLiLiiiL of 
cbielly miicoid cputiim. In thia iiiMftm-rt, it ii b^liffvdtl. n tlioKu^ll 
cuitiihi^ati'jik of ibc epuluiu would probably haw ltd to n poiiltivo 
[V4iilt- Tti a Ai'rniiil fflMp the ppiitiim vruB jkl^ci ohif Ay mcifulc], Ncvropty 
«hotPtd imall ca^iliuvilh inlenao «ihron^o dbroid infinmmAtLou- 

Thc dcnKiT-t iiiffspts (*f biimlli, rrol fniTf- culhtrvs of fuhrrrta 
lacillK i""c met with in ^Ticb prep^niHons na arc obtained from 
the *mootL, yellow, opaqnc sputum-plupe, "corpuscula crazoidca" 
(if, v.), or the yellow, choosy granitlc-ji of the urinn-^in visiea- 
ronal luberonlD^le. It if flilviaahle for the novice lo take a 


miDiite portioD of a cheesy mass, derived from cavities in the 
luDgs, for the purpose of staining. 

The PseudoluberculouB or SRie^nia BacHlua, 

Repentodlj ncgafiie results as to bacillary findings occasion- 
allj lead to diagnostic errorsi and the same is also true of posi' 
tive results- Contributions citing grave mistak*^ due to con- 
founding tubercle bacilli with firaegma (pseudotubercle) bacilli 
have been quite numerous in recent years. These bacilli, de- 
scribed by Alvarez and Pavot and Matterstock, when stained by 
the ordinary methods resemble in every way true tubercle bacilli. 
They do not give up the dye on short exposure to decoloring 
reagents, but they usually part with it more readily than do the 
tubercle bacilli when subjected to prolonged action of alcohol (one 
hour). As the result of examination of a large number of con- 
trol preparations we found that the smegma bacilli were gen- 
erally decolored by careful application of the Koch-Ehrlich 
method. It would seem^ however, that still more caution is 
neeessary, especially since decoloration of carbol fuchsin prep- 
arations for ten minutes in 3- to lO-per-ceut. hjdrochloric- 
acid-akohol, && recommended by Honsell, has been attended by 
erroneous results. According to Pappcnheira^a researches, 
Czaplewsly's method appears to be reliable: — 

Stain with carbol fudisiii and, iviikout v;ashing, place for 
half a minute in coucentrated alcoholic solution of yellow fluores- 
cin to which methylene blue in substance has boon added in ex- 
cess, and finally stain with concentrated alcoholic solution oi 
methylene blue. [The smegma bacillus is decolored by this 
method . — Bhoo k s. ] 

Runge and Trautenroth recommend removal of fat from 
the preparation by placing for three hours in absolute alcohol, 
fifteen minutes in 5-per-cent. chromic acid; then stain witli 
carbol fuchsin and decolor for three minutes in dilute sulphuric 
acid; finally, for countcrstain and further decoloration place 
for not less than pic minutes in concentrated alcoholic solution 
of methylene blue. [The smegma bacillus is not stained by 
this method. — BuonKs.] 

As regards absolute rcliabililif, we have as yet no method for 
vhich auch can be claimed. On the contrary, many conscien- 


tiouB authorities look upon animal experimentation only as con^ 

In fiputum examination great care is neteseary only in cases 
of fetid bronchitis and pulmonary gangrcue. Jn urine examin- 
ationSj on the other hand, caution should be observed in every 
r/ise, particularly since serious surgical procedures are often to 
be eoniaidered in this connection. [When such e.xaniinationa are 
in order, a specimen of urine obtaine<l by sterilized catheter, 
after the external grnitnlie have been tlioroughly cleansed, should 
always be employed if pojisible, — Brooks.] 

Kicrococcas Tctragenu«.— In double-stained preparations of 
liibcrculous sputum a greater or lesser number of ordinary cocci 
or small rods stained with the "background" or contrast-dye 
are generally seen. As a rule, these are insignificant bacterial 
admixtures wliieli have either jj^iined entrance to tlie sputum dur- 
ing its journey tlirough the air-paj^sages or have developed out- 
aiile the boily. 

Espeeinl inqmrtance is to be ntlached only to the streptocorci 
(q. V.) and the coccus above mentioneil. Tliis coccus usually 
occurs singly, rarely in large masses or clumps. It is composed 
of four rounded segments (about 1 ^ in diameter)» which are 
inclosed in a gelatinous capsule. W. Koch, who first found it 
in tlie contents of tuberculous cnvitic^, is inclined to attribute to 
it an importütxl röJe in ravitij-fornuition. On the other hand, 
it is occasionally found in the saliva of perfectly healthy indi- 

Tt develops upon gelntin pUtce in the form of fflistening, tvhit^. 
Blightly elevated apota* and in etab culture [getülin] along tlie wliole 
course of tlie needle track ullhoiit LiqueTying the medium. Guinea-pigA 
and wliJte mice die of ecpAi9 ^vithin a. few daja after subcutaneous in- 
je*:tii>n of culture». 

Stalnlnff'— Ai^ide from tlie nniUn dye», wliich are used in the ordi- 
nary way, the tetrageniTa ia aläo Htained by firanfa method. Double 
fitaining ean iioiiiet^inea be aecured by the method given for FrÜnkera 
pneumococcuH (pagt 42). 

2. In Leprosy. 

The baeilhiB wna diaeovered by IJanivn, Jn 1870, vho found it con- 
stantly prewnt in leprous nodules. It wua aiibaeqnently aceurately ptiid- 
ied by Xeii^ser. and ia now generally TQcognized as the npcciüc causative 
agent in U^jnosty. 


The leprosy bacilli are »lejider roda with rounded ende. Thvy are, 
perhaps, not quite ao long as the tubercle bacilluH, but, like the latter, 
are very reBiatant to the decoluriixg aelion of acids aud alcohol wli^n 
once tbey have taken up the anilin dyes. Tb^y aL«o preaent bright un- 
stained points in their interior, wliivh may possiWy be interpreted aa 
endogenous sporea (T)- These peculiarities entitle this bacillus to an ex- 
ceptional poHÜJoa, 

The bacitli are constaulli/ and e^tJuNitety found in all forms of 
leprosy, whether the disea'^e be located in the akm, mufoua membtane, 
peripherat nerves, or internal organs, espeeially the testes and large 
glandular organs of the abdomen. They are found m the blood only 
in weU-advanced caws; on the other hand, Koch and ätieker have em- 
phasized their fr^tjuHNt occurrence in the na^al 3ccr<'lion. 

Although altenipta to cullivjtte them haie tto far been unsiicceiKfuU 
there can be but little doubt as to their specific pathogenic nature, for, 
as has already been said, they arc of constant occurrence, and the in- 
fectious charaeter of the diAease has been proved by äucee^aful trans- 
ference of leprous tissue inio aninmU. Thof/ arr. to o vcrtuin extent, 
distinguished from the tabcrcte baviUi bff the tint that Ihep take up the 
anilin dues murh more reatUlj/ ond I'ort irith thr-m tuorf promi'ttp; they 
arf also ^uite easHy and atronfftif slniiird icith Kiitei-y aoiutioan, irAif« the 
iubercie haciUi bchare much more Bttibboi-nl^ in these respef^ts (Banni- 

Staining, — All basic anilin staining ^olntiims, even watery aolu- 
tiona, etain the lepra bacilU in a short time. The Kocb-Khrli<:h and 
Gram staining methmlä are to be recommended. 

3. In Anthrax.* 

Anthrax holonp? lo the diseatLS most tlioroiiglily investigated 
from a biicttTiüiu^ic standpniiit. It has not only been deter- 
mined with absolute certainty that the bacilli discovered in this 
disease are of constant and c\(.lusivc occurrence, and that even 
the one hundredtli generation of the bacilli liU'ays produces 
anthrax, but the germination and ^^rowth of endogenous spore;* 
have been fully proved n[)on iuiiuuieniMc occasions. The inves- 
tigation of these fflcts is kr^rely Jue to Koch, 

In isr>0 Pullender and Rrauell found slender rods in (he blood of 
animals alFectcd with anthrax. About ten years later Davaine and 
ßrauell proved the intiiiiiite rclnliim esisting b>-lweeT* thi' rods and 
anthrax. They |irovcd that only blood contiiining the rods ivaa vinilenl 
for animaU nnd thut blnnd free of them wan hnrmlp^^. KcK-h \\-i\^. how- 
ever, the fir^t to lietemiine their baeLeriul nature by means of stainin-j. 

'äee I'lale VM, i'l^. A. 



(]iilUvAti«Oj «ml inotrulatioTip Lnd be ietai »Uo tha ftrat to obi^rro th« 
ilevdi>pinc£]t 9I the cndosrtfauu» Hijurr* into fJip full i[r<»»n liÄfilli. 

Awtirillug lo Ktich, llii- ajiUi»»* Im-rilÜ liKSorj; Tii thff tms imprn- 
phyt«ii» and otlIjt c^fnuonally «rtlLr iIki hritntHl <ir fcuiniun bhiv %* 
"fACultAtlr« pftnüt«k" Thtir dcTtlopmcpt la a^t di^pcnd^ut upon tbc 
iLUnnn or ■nlmal or^nlnrri. I'hcy «Kaolc fhhfly thr^p and cattti?, mnl^r 
UiQ hOTSO knd BwInOp iiid nuvrr t-bü dojf. In i\w flt^t cimii'd nmnuifp 
tfifrclioci oii;«i> nlmufct rxclu^iivlj- tji i^iDJUnjf pUtt» 01 in fllnllti ulicti 
1>Tood and r^rnrtinTix ronlnltiini; «pnrm luivp b«rii dirftoaltcd upon the 
turfna«. The ^ntvritj ft^rm of Ihc dia«&«c li i^liaost alwa^i obiicrvtd in 

Man i« miirh Iajh IIaM^ In Infipolloii tliiin aniniil*, Thp pontont 
bH^i«!]^ atlork«d «r» («tUi-mT'ii, lanmrti, ftntl oUigl^ c<nT]iAf: in n^ntaei 
will; the hidi^i. tnir. or uJTal oi ulTtcK^ animals, Tlic lu^c'ciJttblUty. 
tiovovmr. In TinLoh ]tit* tlia.n in tli* niiiiruls in'-Tilion''d. Ji a rule, ttnthfos 
frtotffl JU fj/ii'cfj/YjHirr in nian Vfrn Ihc erterrml skSn (nt'ik, fixw, And 
liHndv) In lilt foiin uf "m^r^Jf/niiffC vu^ituJuJ' yrW\ih unnutly dvidupv 
fApiJIjr tfom a imnll rpd ncvlulo to nn «rt^naiva intllli-ation, upon 1h* 
nm'fai^ii of which jiiyi KCfu vf^iolim fiKiMl Millt u w.n>1i« vt l>l^^■)-■a^llf1llll■^uu■ 
Ityid. !ii JSr; K. WnKt»?r und 5«»ni[ij-i*r nlmuNt nMHidtMUCOJihly d^»rnW 
OJI ffit^llMnJ fnrm of »ntlirnK In buni«a lubjvoU vrho had iivd trith 
»jmptum* [n»'iiihliiiK typh^tid- In the ukciik1.vd InAItrativni ot tlic »mftll 
■nrl Tiri,')? Inli'^l^nft und in l.hi* nif^rnlfriv ^ImidA .ih whII aa in l.lin ''Hn-linil 
Jitimon'hfgTH^ h- Wivj-ncr li Mi'oviMvd I'lipilli ptfw-ntrTiiic tlio wiinr t^hnraij- 
Icii 4-> tliifit (oiiiril in Ujc anlmn] liaLr with nblch the dt>ccrL?Fj had 

CaiKtD nr pulmonary aatluMZt doHoribPd Aiipa4'iA[l]p hj Uagfinh ob< 
HLTVcra. aro o* mueii rarer gcfurifuof. Such tows rtie ntin |iriuripBl1j 
in rv^ii^kpm, wonhnrlrai (" n^oolMfArtfT^n ttt«iiajtf"j. nnd wtrkrr* In phprr* 
footori«?«. I'br potinibilitj nf infei^iinn vith nnthmx by nuplntlivn Ku 
boon ciperiiiJCDliLlly piovvd Lj Buohn^r^ 

That tho duB^ui TPaj a\no \>o tnDHniitt^ f« tnnn by tho bit« ol 
in*pcla IB duTncinalratcd hy l)%i- ('btflrv allein» uf Hubcr, who foiinJ vimlcnl 
anthntx boj^illl In Uil- lirtdies uf Hvu«, 

The bacUU Are fouod In tlie blood and in (lie hE^ninnbagic 
diacliflrgee (from Üje nioutli, nofto, bowel, aüd bladder) of dU- 
(?FW?od «niijujls, nnd in tbo vir^w^'o» 0/ mafr^nani pustule in man 
(not coxutunt), »nd nUo in tho blood of tho humaji cadnvt^r» C0pt>- 
cijiMy in fopi of intcrnnl liomorrhnge. Thoy art* bynlinc, non- 
motile rods nf chnrm'li'rijjUr rmii, mwisnnrig from nhmil 1 Ixi 
],&^ thick and from .1 U» >'' ^btig: ».«., nol quitriw loug a« tbc 
di&meUr of a red blood-corpuscle. As a ndr, s&vc-roJ baL-IlII arc 
Joined end tr> ^d. At the point of union of two eo<:iii<?nte a 
clear epoco oaq bo ewo- Thia pheaomerion ie dno to the peculiar 

VBOETABLli; PAlLAi^lTfift. 


foniiAtion of Ute onde of the bacilli« aud En tome instance« it can 
b« obdäTved i-\vn in u^Uiiutil pr^paratioo^. U is mudi mora 
diBÜiuily niarke>d» howc^iir« in atauud fipcciEni^iia. The extremi- 
txs of the liviu^ bnoiUi &ro somen'liiLt 4'U[ur;{od an«! luuaded; 
in MtAined propurutioDii thoy Are difiUncnj i.').tppM tt|mii tlicir 
circular ■HimUr »iirfutn*. s<> llmt tlw piirii|>ir[Mjn witli ilti.' «pprr 
«lid nf th'T Huil of tli<; mdiiiA iff not iniijit. 

StAinlaK-— Thi^7 can be »UiiJied wUh aU the ImkU: ftikiliri dym, liul 
too «tn>iij; Hj^ or «mK it« ri>Ai!t1y mi-rvlAlri should Eh' ruT^fiilty »mj>)oyp<S 
Vaterir totutivnt <if hi$martk &nnfn or mUhvUw ^lur at4iin Mf«r fj««t 

(Fig. 3S. — Colciiij uf Ai>tJii4\ BiLcilli. fl1i)Ehlly Mogniib^- 
lAftn- rjfi^pitj} 

[or ifMf 1 prr^Ejr'uHfmri fprrv rJiiirinifrjv fn fim mliteiff/. OpCAaionAtly th« 
inltmA^ pmt^plattui« jtcirtinti iiml tli« rHpKtiI« nrv plnintj tEi»k*(l, but» tA 
k rtilc, ocl^ Id badlb vauciincd dir^^tl^ fron the ahiid»! hody. 

la our ItlUktnitioD (riatc VJl. fig- ^1 ^« 4lki»*n p cudJUlud Lht oc- 
vurf*ii(<* cif vliich hnj< l>r«n tliff lubjpct af miicb oontravftTij, vIl: Uw 
ircquent incluAion of biuilli wiiMti IrtKocirtn, 

Tb* boctlH Biv iill|:hMj' <Iccüloml by (Jrnm't mcfhufJ, Tbc mllutn 
fnnr moM iLiioirSiintly on iiu-uliallon thui bl room lumiwr^taro; tii* 
«pUmuin ifl 37' C Orowtb vfiutv Wlov 10*^ C »pd •Iat« 4A* G 

T7j>on pf^lrs Uiom coIoiiIm which hai« reaohrd Ihe nrinn tit the 
ilJebllir liquolUd g«Ut)a «ro quLto Uipv jillafrwliile In «tfl^r» smnuTar 
ill "IftKlliir. And »Vow At Uii-ii ^viiplifry grtAt n)Anr< of twi)i|«4 uid 
intfEiiviDfTitj UrpjLith ^y^dii»« lit'Arl [Ff^ ^A)}- Tbi>i rvfli-iiUini U lormel 


bj Lh# luKurianl ^ott^h of tha anthinix iHkint^nt«, «hldi develop mora 
ni|)idly Ihbn tha «Jvarusj of KukUn IiHimruLtioTi «ml ilaii^fum djhI «till 
it^ikt4uiit' i*ljir-ii Ji^tiaU» tUeit ititmlfi. Tfcii> MtUVf fi^jiiuLtinu (3ji ba 

Til« nil irid oim tui-i^'i! tliivniU i-itn alhn 1<^ "wn In ^fffl'itin] *ifib 
CVltWr*- Willi iJi^iiiiT'iiii; lu^n^rm-tinn |»f thv (^clAltnJ Ihip ^{tiJWth ^nirl- 
Uftllf vmka b« a n'Litc. Hofculcnt iii*t« townrd Ihc bottom. L'pcn vj^T' 
dfmr Ibe toloiiW havr a pircirilarH hlitfUily ifUati^iiluy qiijimnuKV : on 
poiapj jt jftfiWA huuiUnlljT, frtiti)]fi|r n whidth, dry wuilirif;, 

fpOTC-formation Ukn pliw undtc oprlal^i «-«nditiont ^Ukh ■!« »a 
jfi ln*uf!^dpuii>' «»ipUliHul, Knw *rpv** of mjpm nnil trmprrtttHre* not 
IM'Iuiv 2i' Ut ^" C\ lira niH'fttfjiry »iiuircmunbi li^r thu ut^iitrtDc* of lliiA 
procnit, U can bv Tiny rnpkUy und BLijL|<]y «rcurvd by ciowinfi: Uie liAcTtU 
ILpon polnio ilkkt kept a1 n InnprrnTiirj« of 'M^ C. 

Thft nmti"« u^»pc*r u» ri-arvltk*' lifliiir« of -rtWinry vifiii^nU vhich, 
vttrii III iiU4t]|iiiKt tm^pHriLEumK. irt diunu'ftikrd liv Ihrir «.'Wur, biuMy 
rcfraotivi«, oiriirl form, 'Ibry pnw» all e'lTmrirdin^rj' degree of T«'rt^l- 
aniT. WUilo iioii«|funjTiAiinK Liicilli atv rnjkidly kJkd Ity jiuln'ftuTlJoii, 
I 'prr-ctf lit- I'HtljuUi' und. hiiiI uIxh lay llir guHlnV juici*. tli^ hjuirrfL tv"<i*<t 
Xht} Bdiob tti |iutr*fiUtioii for mnnLfi* «nd A-jvrortnl p«.rl>olitf luiid tad 
tiie Kimtrlr juk-c for J»y" wiihrput alTfmiion In thdr tlmlmw. 

BtAlnlnir.— Tkr iporo 01c but »tttlntd hy \mtufr*-'mfi tkr eor«f- 
gliiH ot atidc pivpartilinn in ft'^r i-nrWI Inrhim ^oTutinji for from twenty 
t^j fJKlj miimlüJi, in ^idt-i tu ii^^urc iiviirlmtlon uf tlir d jr into evvc tliQ 
mrti» m^i^tBint ftpun»» Th«» pn-iuimtum i*- Ih^n pliiimf for on* inlmitn 
in wrok lijdTadilorio aHil nlouk"! or S pm oi»iil. nilrUi [or »iilpfiuripj aoL^, 
h'lilidi ri'iiim'i'h Hk' >luin frum the Wdiu^ i^f Ihc niuthtr ■<:«!] lb, U iW 
|iri-|iur]4tiE>n i* now tTiiEm'tl Uir riTii>iit aai^ or tvo minutr-a tn i-onoänlnilM 
^'Otery loliition ol mplhyU-ap Idu« or I.^LdUir'* «»lulionH tfio cnll-boditiH 
iinly will appei-r blue, while Llic red spüir« cvniriLti Btrvii|:ly irJÜt llio 
hluci ratnuift» ol tli* mother polL 

Otnttier'A mcltiod 14 KiinplfTr. »harter, und Ibercfurc e^eftnlty 
Adapted for pijiuwork. TIlp iperliiicti H itjtjtir-d iu luth-iii ntLillii-wjLlpr 
»ciliitiuu 4:i»nLumiid lü ü TVfttdi<g1a«( wbtch U pa*ied Kji^k nnd fort^k 
■bo^e 11 ll»Tm «iilil Ibi? fliiiil ojtnm iii a bttil. ["VhU tn^y he Fiirlber 
«impliriM ly pr'c^pji ririf? iS'* »«[Ki-inif-n ti[hiJi h flkli'. Ibm i'r»i'i»nii];; Ibn IaiIit 
with itlaEii» unJ bcblin^^ Lturwh".} Tli? ditli J' Xhrn ti> I« «4<r a^iito for 
fiuin uiie lo Iwij inmnli-*. Tln-ii, icittiout viQjififii!;. thv |ih'|hii alien b 
lTnirpr»pd lor olio minnt'- in 3p<T ri^iil, fiydroj^hforli^ fliifl flli-nlinl (prepn- 
TDtion »ido upll' Tben follow trii>bin)z in wati^r ami nhiirl iLiimitij; wUli 
wutr/y hidiitiim vt iui»tbjknK Llmx Wa^b, dry, «nd mount [in xyloV 
C*nBda baf-üinj. flf uNdP i- iiaoil, moiintlrg U not npnetfJiry unlest tlift 
■jhctiinm Ib to be pcrmnnently pir-frvr^l.- Uroorh,] 

Fini'i-A rfi'oniTni'UÜA the lollowLnj: pn?cedurei About 20 cubic crntl- 
meter- of n lopur oi'nt, »olution of iniinnni« arr nd'lH to 1(1 nr 50 drops 
vf mi alcobolic cdut^<»D ol ßcnÜ&n violet^ fucbnin, ur methylcQi} blue. 



The mixture in heated to etcaniing and the prepiiration placed in it. 
After from thm to five minutes (with anthrax from Itn to flftoea 
minutes] the epores are slaint-J, The preparationi are then dipped for 
a few seconds in SO-ppr-ccnt. solution of sulphuric acid, quickly and thor- 
oughly washed in water, and finally alained with a contrast-djc. If the 
contrast-stain la ooinbinni with the add, as in Gabliet's method, it ia 
*dvisoble to use no more than 10 per cent- of ai-id. Under these cireum- 
Btancea the preparations should remain in the mijcture for from two to 
three minutea. 

Möller advises placing the dry preparations first in ehloroform for 
two minutes, and, after washing in wat*?r, for from one-half to two 
minutes in 5-pcr-cent. solution uf chromic acid^ then, after thorough 
washing in water, for one minute in carbo^ fuchain solution which has 
been brought to a btiil once. This in followed hy short decoloration in 
S-pcr-cent. sulphuric ai'iJ, and, after thoruiigh waaliing in water, stained 
with watery solution of mdhyltnf! blue, which »^taini^ the moOier-celift. 
This method ^ives very good result-^; it iä true thjit more solutionis are 
used than by the other melbodn mentioned, but less time U required. 

4. In Cilanders/ 

Glanders in the honie in nlwaya fir^t localized in the nasal cavitieSf 
where it induces catarrh, inllainniatory nodulo'«, and ulteratinn- It gives 
ri'e to more or if.-^^ intense swelling of the lymphatic {^^and^, lymphan- 
gilia, cutaneous nodules (farcuJ, and eeneroHy hUd to foi-i in the Ianffn 

The disease is transmitted to innn almost e\olUHively through the 
agency of the hor^e. This explains why Jiunian glanders is, with rare 
exceptions (transmission at necropi>y [ ?J, uli-.crvcd only in euaehmen, 
bostlera, etc, Slight abmsiuns oETcr a route of entry for the virus into 
the skin, where nodules and furUTiculuus imii phleH-nhmuus iiiQumination 
develop; or mure rarely the infcitiuus ninlcrial enters the internal 
organfi, of which the lungi and ti'MoM are ihielly alTccti-d, 

The bacilli recognised by LÜlller ami Stdiütz as the eause of 
glanders an- ur^unlly straight and somewhat shorter and thicker 
than the tubercle haeilli. Their ends are somewhat rounded. 
They arc generally found Jr^olaled, rari'Iy in pair? or in large 
groups. Tliey are frcqufnlly surroundeii by a delicate halo, 
which may he interpreted as a cjtpsule. The Uodii's of the haeilli 
not infrequently show clear simecs. the sipniriuiiiicc of which is 
uncertain. On the other hand, the retiTition of virulence for 
montha is strongly in favor of the esiritenee of "hsting forms" 

>ö«ruu.vii, tijj. u 



fDmmform), The bücilli arc sera free bchrccn tJic cclU, but 
aro oft^ found iiwloscd witbm the lotkr, 'Hjc pathogenicily 
of thö bacilli ha« Wti nbeolutdy c«tAl>lMli«^ by their ccmrtant 
CK^irrmco in nil foci ar^d produds of thp d]^M8i>, by pnro niltn^, 
am) by thi? t^Tii'CfHfiful transiiii^jNion of the specitir Bir>N:tinn bjr 
inocvilntioii of tljc! lAcilU inlo lionw.'«, JicM-miwj, luid gTimtwi-pigs. 
CnltivAtion i» vuccesaful upon nil niitnoiiL medio at kn^pirra- 
turc^ from SG* to 10° C. Ti\*i colcnioi pru«cnt a chamctcmtic 
app^rnnoa. ITpoQ blond-w^rum, which In oot liquoFlod b^ thoir 
gmwth, tlipy appesir n« bright. trJimpfliFrt, dmplike d^posiU; 
upon ngar-itgiLr ihoy produce ti glihl(-niu|)' tvhlU- km: upf>ti 
poUto, ft yelbwifili dtrpaBJt de^dopü wliirh i^dually nMUtiit^ 
a broA'nitth ixn^ No iDduperdcnt motility is obai-rvcd in 
hanjcm;; ilr^p oultkirts^. 

tUUnlnv^—A ipHriflc »tnln, a» In tlin rann of thn tftcUll of tiitfircU' 
loiiA tttid lo[>f&iy, hflH not 0j pfl liffm cllimmvi f'>r Ihi» baöÜlu» of 
liUuilr^rn- dSUbi>tf|:U Lbn «tmiii: bfLtic «iiiliu dyob ntid wprdaki; lJ>lS«r'f 
nllEiLlmo Knluiion of tnoMtylrno l}li]i> iinin Ih« HkHMI wriU the follo^rlng 
fepuviiil nifitbod rDCOinm«Di!cd by L^ltlar ia to bo jiraf^^rrvd! — 

Till? iirvpftraliom nic sUlnod fur five iniiiutn in a fcvaldy pnp«r«) 
«tBining TvixtDTC pi>tiipo««d of «quil part« »f tmlin'Vrater-gvntinrL'VloM 
(or rui'lifiiTi} nolutian *nil t to 10,000 lululion of cniijitic potAiih, they 
Mjv ilu'ii liTaU'i], tit m'jK^ »ae sfivfut ia \-\ivr-vvuL acelic udd to wlik'b 
miOklcat wotor/ tropo^olin ivi hm !>rcn added to givo it n Uriin* tt-ifid 
culor ilW till» nil4iÜon, itr.vujiijn^' Iv LAlllcr, t!ia dyu i% whollj r«moY<d 
from tho ^ll'bo<L]irs and nf-Arly k» Troir; Uio nudvl.] FLniiMy. wnih In 
wnUr, dry, nnd Imbed In'Conadn tmliatt). 

TXiv hn\'iU\ am dfrolufcil by Orixiu'i niclhod. 

\n dmibtfitl ruhfit inafVlitlSuit nf ffnttvit-piQn with tJi# nnflpAi-twS 
acdrc-llon apj>eaFa to bo the moit certain luenm of reaching a diA^aiit^ 
ir Jiudnlr*, uU-t<i4ljiflr. nnd liiuil lubiriL'TL'A m tbi; tr-*[(:» fulluW im>mibl< 
Uon into the pM-ibiiMiit mvjty« »nl i! tha htdilli «fu niv'k fmjud in M^i^t* 
altered foci, tho exintrnre of Kbndert i« proved. [An ^uinfn-pi^^B are not 
«fipfcbilty luu^aiUc^. at leatt tbrco aliould be UocuLntcJ from active 
J««ion«i l^t'c^nHu in ibooo th* b^LUI nro mora punicmi» and virulent.— 

9. In Typhna Abdominalis. 

SLntO tbo UiOToirph Invj'Mtpjiti'kTi^ ci UnHk^ tlif^ro U no dovtbt thit 
tbo bftrillu* b't<u(AlfiL> uLiirlit'tL by him UTid previuualy foufid bj Hbctili 
and KoL^h \n tho ^iJ'H'Ii ami inrtrnLvrir jjl.iiulä of l^T|iTiL>id eadfLvn* \t 
tho «tiuatlvc ngetit of abdominal typhus, The mdi tivMT]y 
Hnd rÄrlu»i*i-l/ in abdominal lyplius. Tlity liave been obneived in it« 
hloo^T (iTXt by XouhftU*. ami In the typhoUl «tool* by IC Krinke] and 




RirnEnoiid» and <^4pt^ii]ly hj SHti, ntsd OM«*lonBl1f Alut In tho iirivo. 
Nciunaau f^iun-l them Sr» the urin« eyco from Lwrely (o Iwmlj one Jny« 
■fUrr cuiivAlim-i-ii^-r. [Mtitl auULutUk« ntul« 0i4t tW lirpljoid Imdilu« 
di)*^ nut uitujillv n|ipr4r in thi* iirtn^ unlit i^iiir« hitf. In mnnj rwe« \t 
pctnitta for B Ioii£ tinio (»ix ^^efcralj »^tcr ^pvalcKcnnv in whici» 
AniiU(tr!L^A It uiH^ i-uiiH> i^yttUl». 'I'lit^ tj|>li»l(] fiftdlliiiN Hhh a1ai> bro» 
ffiiiiiil in tiii^ bilu TiiJiiy yi'nrv afrtr n>i'Uv«<Ty fnim lim urijiiEii«! fvbrilt 
■tlAck- — U]|i>OKi<.J KiirL^miintv, iltfy hn^v Wi^ii ]>ri>virtl Ui Iv i\f «qUt 
«ldl*ni of Diany of lIip iupptiniU\i* prorcsb^i cilivri^rvl In thn pcilofltuia 
■nd »FouB C4vxitv4 l4>u'iu(l thit tfnd of ixMi.>miii:tE ly^iUt^H (WmiiTruud|. 
nnallvi il IB ««jfthy of nnffl itnl l^ii-jr bar* frmnn^ntly 1>»rii dirrnuQjilnitfiil 
in tile /ff»ft niAfTifd ji|rrjfv miit In Ihc Ufi*j/ hlvurl («or Mow). 

The bftciEZi Ar^ ^uUe pfiimp, uaTci^ly n Uilrd «J lar^ pi üio c!lnm«Uir 
ol B nil Mvij^rci-ipuf^-t', mil nm-t iiiolcrAnl within cr]l>- lliry cue «liiLf^ 
jirlf-ri'nl hy arittf intlrjit-niU-itt tmjdJIiit, Vihlrh in iir»iliiJ.''d l>j numrroua 

SUdnia^,- 'I1^r v miv b«*t iiL«iiknl vith corbol furlitlu or l^Jlli^'n 

minuttt in the ilftming «oLution, nod ihcn be ^Mihcil «ircfnUy in vrui^t* 
Alcoliol «liould Out be unfd in va*]il»j;» tfcaiiK Ihe buSllL ore fftiJIy 
d«aotar*d bj Ii- Tlic^ in alia dmtorid Uj Crani'i invULUiI. 

If U 15 d««jrcd to stain ih« fltt^alia^ it is nec^HurjF tn observe 
the ^leetoil care in prepaxiji^ tlie specimen, and, &<i/«r« nfufmn^, 
to nuke use of a mtyrd^nt. 

A viinut« qiinntity of & «ix -hour-old cultur«^ u wbtoh Utv ««livo 
moUliij oi tlic bndlll hn« Uvu UoUnnlncd tu buigtng drop, U Api«d 
up«» a U!ni|mloLi«ly HMttii^d iM^wrfltau »ni! allowed to dr? In Iho «If, 
TIj^ pfcpnntjnn U rn^^ft pivi^wd oarr/u'fy thm UmH tliroiiirh tti« flAmf^r 
»ToliUn^ oTrrlK'nlin^. I'iw iri'^nifinf dvwribrd bp1o<v 1b n<]W ilrojiptMl u]ji>n 
It Uirough tiltor-pkpar ami flll«wfd to nmain lor from odo-UoJT t» ant 
miniiMi thia m qitJ^kly nmithctl olT irtlh «aUr» and Iho jirq>nralian 
driedn and fliuüly tulncd toi a kw mlnul« iitum tlirtv tu flwi with 
moduraldy hot gDuliun violet nmlm »alrr sglutiOB. 

thffer't mfinJnnl Jn prvpareil in» (otiowt: — 

By the aid nt ftvnt dJimolv« S jfrani^ ijf Uiinfn In H fuhlo ^mthnrlvn 
Ol vatcTE 10 thtd odd A cubU oontiTTiticn of »ntnnili^ irntrry tolutloJt 
of JJi^a chluEJil ami I cLjbic vcnttmcler uf »atoiaU^ ^Li'ubulic aululhin uT 
fih'hrtin l^if ■tirtrrliifil hhnuld }f Klmki-n V«-FoTv tiM* 

A* a fiff^nn nf difj^wrrrliat diaffatfi^. lAtr di#oaj <r|r of lAn b*ld/iJ lU« 
VAin ttfoaUv Uf^n iif InWffnOffQfif Irtifjorlawr, fur tJic itdson lluil micro- 
MTipM« i'\am:nAtii>M d*nft DOl Hiiffira, Lhi> lihi'iili ran hy no lu^ana b* con- 
MikDlly fom^d in ibc fc'^s «ikI rT^'^^r bt^a^Jw t-l^o typhoid bacilli ftrv 
ihll!] i!&lUcii|ly dliilnguubnl from llie ceUm toolTlL 

Both tlia typitoid and FoIc>n bacilli Kt^** "i^itw "^ ^*** iuxurianti/ 
opaA tha abovo-dflMTibfd mitnvnt moiia- C*af1l.j ddimrd that Iba 


typhoid baoilLi produce a chmractcristic growth upon potato; the whole 
Burface of the latter is covered at Uie end of forty-eiglit hours with a 
moiflt and wry delioatc ooating in which the bacJIlt are preeont in fount^ 
Tesfl numbera. The colon bacilU, on the other hand, pToduoe a thick, 
dirty-grayiflh layer Tliis diiTercnoe, however, is not to be relied upon and 
has heen justly que^ttioned by Siuiruonda and FrUnkel. DifTert-ntiation 
of theae frequently anj^oeiatod baeteria oannot be niade by potato culture 
alone. The following features only may be considered of importance In 
diatin^iahing typhoid eijKurea from thoae of the bacterium coli eom- 

(AFTETt EVttK.) 

I^Ktoee LitmoA Bouillon. 


BlCTLLüS Coli CoHSiUNisand itsalliefi. 

No Gaa. 
Gabtner and typhoid group». 

Ga» in gluooec gelatin. 

Acid and eoaf^latiOTi in milk. 

General turbidity and indol in iMinillon. 

Fenuentation m (ocoharoae media. 


GliK^iso gelatin. 

No GnB. 


LitmuB mitk. 


Litmaa milk. 


Aeid at first. General turbidity. 

Alkaline bter. No indol. 

Ko ooogulatiou^ Scruin-reaction. 

Acid, General turbidity. 

Xo coagulntion. No indol 


— UltOOKH.] 

mune; The typhoid hnfJlli grow in aterile uiilk without oaiming it to 
eurdle even after prolonged aHion; tho colon lia^-illi, on the other hand, 
curdle milk wilhin from twcnty-fonr to foiiy-fipht boiin*, l''urthemiore, 
the typhoid bni-illi do mit produce pan in either bnuiElon or 2-per-i-entr 
glucose grljitjn; the tolmi baHlM invarinhly dn no, Viruilly. the lultni-e* 
iif bacterium coli, in contrast to those of the typhoid buiilli, produce a 
repuli^ive odor ami bIj^o give the indnl rcjicTion, neither of whieh phe- 
nomena ia manifested by cullurcft of the ly^iboid b:ieilli, 

VanouB methodA have been recommended for deteotldE the baollll 


In tbe stoolft. The only one of ihew wliich appcare to be reliabte ia the 
culture medium of Dh^l^kj and Comudi,' 

Pi'eparp a nutrient medium of ordinary gelatin boiW with extract 
of potato {'A kilo^am nf potato to I liter of water). Before filtration 
and sterilization add to each 10 cubic centinietcre of gelatin 2.5 to 3 cubic 
centimeters of de<'inomial Holuiicin of podium hydrate. The decoction 
ahouFd still have a slightly acid reaction. When the niedhim in ilfsired 
for uae, 1 per ffnir of potar^sjum iodid i^ adiTi'd to the gelatin and then 
the Deceasflry platee< f>oured. 

While the TPinainin^ bactma develnp poorly upon thia medium, 
the typhoid and colon baciElL prow fvei'ly. The farmer Hppcar only after 
the expiration of foHy-ri^-ht hourA ii»^ »nijUI, bri-fhlly ghr^trning, finely 
granular colonics reseinhling minute dropn of water* while the colon 
bacilli are hiTfuriantly developed at the end of twenty-four hours. 

The Gruber-Widal Reaction. 

R. PfeilTer and his pupilr^ denionstrati'd that the «rrum of animals 
immunized ogainsi tyjihnid exerted a Rpeeific adion upon the typhoid 
boeilti. Typhoid haciili uhirh aie injecti'<i inln the abdominal cavity of 
& guinea-pifi are di^-olved and disappear if at the f-auie time thr ■-eniin 
of an inimuni7/'d animal is aNo iiLtrodiieed. It wn^ fuilhcr nhiiwn that 
Pfeiffer's reaction aNo nreur« in the lesttnhc Finiilly, flruber and 
PfeitTer {Rolle), indejiend^'Utly of each other, d* ti'imined that the t^rra 
of human BubjeelH who have pii'^-ied thrnuj;h nn uHark uf tyjthoid alao 
exert a specific aetion upuu the typhoid bof-illi. If twiim from a typhoid 
convalescent is added to a flujuillonj ci^lturc of typhoid hai'illi (he latter 
cease their motility, collect in mas^en (aj^sbi^i^i^itr'), and form a tloeculent 
precipitate at the bottom of the culture-tuhc, OriihiT llr,'it reeömmeuded 
thie phenonienon for dia^nn-^tie pur]iit^i':'. \Vi<lal, supported by personal 
observation, he^d that apj^liitinalion in of din^'no'^tic value not only after 
recovery from tht dij^ea^e, hut alr-o during' Ihr atlark^ 

After pcMTJil years' test nf tbc rr-uti'in in a Inr^jo series of 
febrile coses» und cirefnl vnnsjdrratioii iif tbe iiiimerrms piibli- 
cations upon the subjot-t, tlu' author eon^lders it nec<'s?iiry In 
urge cflutiim in tlie iiiterpretütion of ihe diaijnostic value of the 
Widal method. ThiTe ran be no doitlit that f^or.i of imlividuals 
not affected with typhoid and »ho liave never siilfereil from it 
may al^*^ produce a;rglutin;tlioii of the b:u'it]i in bouillon tul- 
tures. The sera of typhoid jiijliints, hnivever, ^ive a ]K>sitive 
reaction in dilutions uhii-h, as :i rule, do not j^uHieu with other 
kinds of serum. Aernrdin;: to numerous riMiirelus hv others, 
as well as h\ the author, il iu;iv he *^tnt<*d tlint llie Widal tmi:- 

1 Zellncltrin Tiir II jk^*''**^ unit In r^^lilittiiBt rank heilen, M. kitEi, }>a^ '^r<ä 



tton can be look«! u^a aa proof of the exUtcuce of Ijfphoid 
only Vfhen it 13 dittincfli/ positive in conccjitnitioD of 1 to 50 [see 

The reaotton miy he •Mored both macroicopicftlly «nd 

L About A f-ubl« wntimptf-n cl Moni ira drftvni fmm ft dtnt'^tiilpil 
v«ln of tha nmL b; iat«rit ol & LtarilUiMl liy^iAlrrtiii^ n^^UK und fUnfd 
in a «Inuk-il Int'tub« uitUi Uie vi'rvJiii ni'i'HtMU'o. Fur teaib:* ihv ruUim 
ol The ■crutTi upon ry;YhDTrt bu'ilti frr*h onlTiir«* tn^n tix to lir*lvo hmir* 
old ftre ftf<^pfipafy> Coiiwqiicntlj', ikn Jresliefit culture* AQii thoM In whi-h 
til« fü-rt^tltvmii#« InnaTil lyphüjd »cnira hmi Imii jncrinj to b« u grv&l 
U pon^ihlp mtitot }>D tmnfl^xtüy «l html ftsr uak. [White ««17 fonn^ viil' 
iuttt ftrE prvicnblv, ihoa« froni tAf^ly-four to tUrty dv hour« old tOAf 

I 11 

[Pig. 39.— Slafiv« ia Wid*l A^Acti«^. (ATUr It'ihin.]^ 

b0 UFMt without HTlr>iiit tro|UiTin«nt nf Ua vaIiia a! iho iRtl.— IticrKihs.] 
Tha kutltof in a^x-viitotiicd to vmploj inflj (miv uvpnil 1>üujI]e>ii cultiirex, 
UBijij" tubL^4 cDntuniujc cubic cciiLimelfni of buuillun. Tu euch of thtnt! 
an nddiNj riom Uvo to llvr drop» of tMiim from i. pi[irtlr>; 10 ttnt ttip 
iQAtip« iMLLctii WIÜ1 ■ Doni-'iiTiErulUu ol I l<j jUh I lo 4t), uU, TI;o Lu1k<3 tliu« 
timit'd ftie krpL at 37^ C. ur «I twum lr"iii"rii»liiri% Wliru tlio initcüoii 
m positive the boadlon bopouipi ^drnif^y oJpn'^r »(ti*r irnm flir«- to 
^cv<rl:l hour», vhilc tliA badlU ooLlcct in and farm U/ßr at tbo 
buLtiiiu uf llii^ U]1p(i (microjaoplü icaotlon). 

£. Tha mteroBCOpto reaction in nmr* itrlhln^ ami a?i?Eir> wilH 
j^«ter rnpidity^ After the motilJiy of the bnciUi hu« Wn *p<tfi] in s 
C4JdUu1 prc|>JLiaUoLi 1. l^. aiij 3 diopji ol oomut 11 dtop oquj^ti Vn cubb- 
Tvmtliiioiurj nr* idiliyl iui<ett«lvely tc ^ ciihtc of a fi'dwFi 
boniUon culLLire or bnctfrtal nutpcndion ami then l]ia['cmf;h[v Rii^trd b/ 
diliklnf- Aflvx imcb nildlliuu vi »ruui it plntijiiiiii Iljuj^CuI of the cultutv 



Auid U Ukm for «XKimnfttion. The Ihtt« i>iT^Hnli<Hiii D»n<Mtp&nd t/> a 
<3iluicun »f ] lo lOOi 1 la AD. uad I to ii''\. In thift uiiunfr il i.'»n 1jv 
not«td thHt tbo bacilli Iom tlicir m&tilitjr and «^liwt morv ar lev« mjiidlv 
or «vdk fautuiUy Into inA«*««^ If dumpinif <1«<d not o»ur, but tb« 
nioUtitj uf tbi^ lifLcilJi ruiiUnii«*, l^i» InA i" nr-Ofithfi. If thr bnutlli 
ititnil^b aalr a prAnounot^l «riijQgiihnp«« of moTpmint, whil^ elumjiing 
i> tbtcnt. tliD rea^rüi^Q U fiot to be depended upon, Uftdtr lUch drcum- 
itjuAcL!^ lUv U4t nioj be ri'pratrit- In llih ntclhod of vxjunluaUon Utt 
<I^»* of coEiuntrnlioa «ad tott«r L« controElwl. 

Only Ü poMiivi naction ohtnincti nfUr exact attL*QUf>ii to Ihe 
degm: Ktt dilation {[»it hi-lavi I In 50) is of ilingnnslit? value It 
nhould ii<}t he targMen that a iwHitivc reac:tioD may &1ki be 
obtained nitb the blood of iudividnals who Iiad tvflioid feTcr 
yftAK before. Od tbc oüier bond, a neyativti ri:>?LilE, caocot be 
Utk^n as eiriijenco of the nonMiatoBOO of typhoid» fyr id many 
u&queaüoiiable c^»«» of ty^ihoid the ruction mny bd nbieiit 
Uiroughout Üio wliolc coure« of (he diMsisi* ejvii liji In thr timq of 

IlTbcnavcr pomilhlc. leturi obiAliied «lllitrr from i'oa^iii&U'd 1>]och1. 
tM äintxM fthovi», Ar b; vui'^L&OTi eliouM tie •>»ph>yi-i] If it V fotinfl 
MQCMftrj to fonrard mcb mrttcriAl to « difltviKv fi>r cxflrninatton» <Mpll- 
Urj J^B lull», into whkh the htuiii iradilj «ilcn. ■» Uii^ moft c!Dlk* 
*<ciont find prfifilie*!- The» an #»tily nifido by Uftiling ufdm^iy glM« 
piped« tuhiniE Iv rT<^ii«M and quickly drawing it trni*tfiwi*it thlo ft 
■lender thn-Ad. Th« l«tt«r mn fJii*n bi> broken int4) fv^nvMii^r-nt Ipn^rth*. 
After tbo cajkillaiy tiibea aro fLlFcd with the Hnim, both end« i^ould 
Im *iL*a1rd in »n alcolwl or Bitcueri daiuc The lilocd atio may be Ukvn 
In thf** oapilUry luhf« Thr li-i-l vtitli t-U3H !■ rsiiTlitl »iit In Uii aam^ 
mbtntf a» nith «rtiiDp but Ihc (Ültition vlict^Id (lo nt^tn^vliat gmt^r. 
Vrbfu nlW of Vtfu- niclliodi cacncrt b« »nicd out, th« f^jlttirtinif 
prorAttirf» may l* rfpomnn'nJpd; — 

CanfuUy d^'inf'"'! ihc f\txt^T-\Xp or lobe cf tlu <<nr and wiltidtaw 
one nr two dro^ of bt^odi vhicb arr to 1*« melted uiwn a clean Kla« 
obJ*et4hd«v Allow to dry. rarv bring taL'^n Ihat the »peciTnen U not 
fiy^^fd to diivL ^Tkd hlood ciollecU'd in Ihin tnuiner <:An lie lrin*pnTt«d 
to a dt»tjinec for vxAnilnallnti.) Pj nii-«as of u 9t«tilif>-d ;>1a(lnfltii-Aiiv 
Joop, diliil« and thoroiicrbty miv th« hlnod wit>i "f 'f^iuf W t^nrU \iy 
roJiun« of »UrilijRd water. XhU can b« done by dipping the pEatiuuni' 
v\nt loop in »«Irr «nd traiiHft-niiij{ to tliv hlkla a •ulTiv'i>'nL udiiLbai of 
dMfjB to make appro vimately a dihitlon of I'SO to l-S/i, llio drtrp« nay 
b« placed io a ciuU uound tbc blood drop and irmdually mLied vith tho 
blood, a i1nip «t a tlinc, vinlll a uniform «tid tliuiotiffhly mUcil dLJulioa 
ia ma'lr TUi> dilution ia nr^w iiiooüUlnl and fAwou^A'i' nv'Md «ith ft 
mifttits portion of from tn-dvc t« Iwruty four hours' i^rowtlL ffoiu aa 

66 Micmwcopy asi> riiF,\nftTiiY. 

AjEmr-n^ «r cullura tif Uio lyphc^Ld buUlus. U U Uit«r to hftv« ft {'■^vtL 
conlaintn^ Ilia barllll amingoHl in lonff MirftuJi, «a thU fanti of rultur» 

mixturo of boHUi and d^utjan U «i>uiii1clTt] [ficiii viic-lmli to doe ulnate 
Li"i)a11j •iifllcp«) oovrf Ihc fluid with ■ rnvrr-gTAfU anil niamlnn iiainrdl- 
■ed^ vltti from A V. la m 'A ilry dbjtTlivn, If iha milium of hacilU anil 
ililuljcin Jian Wh »urtY^f^il, tlw bjn.illi trill be sctA cliltffly uaUlcd aiul 

A pcinltivf rififtjon (• man^iotlöl by a moTr> or lr«> Hridunl cf««- 
tii'ii ul iiiLiUJitj und iLi- i-tilU^i-UTJii of Uw burüli iuUi Iwrj^T ot ainallrr 
itAlaini n]itm]tH nr '*"iin«-rrrEi njuEhilinAlKiriv th« bii«.'illi in The iiiaiiAai 
flnall/ ibowiaa bat vory rli^hl or no uioiIoiL Tho tpiuu btlwt^'n Uio 
mftuv» or i-fiimp* may U- riiilMy (rru t^t barllli or nraTly tn. Tlw Mme 
n^iitml for Ih« ivn^^inTi to d^vtlop vanp« fi'orn trih ruiniil«« to ono and 
cnc'bati hoursp a> a rule, howevor, a positive n^sult i« obt&Sacil tn about 
fn>m flffi'i'i» to r.birly M»hn;(i^. If iiftvi<*tiry. tb*" oUwivullon may hi* 
OBviliiui-d fcir onp and »np-bntf lii>im. Jl JMnlati-d nnd imji.l| i^him]'« aro 
llttlcd At ottvc after placing iht ipctinjcn uiidrr ihc mJciosL-ogf?, tb^at? (»aj' 
bfl due in ^Eirfiin|>klf njuiiiiT, aj\(\. hfino^. »hould not b« n^gaidi-d *■ a 
rv^pmixn I<J on uf^tutinalin^ suUgUtiicu in i\ie blunJ. In «ui'H m>tancrs 
a fltid oiTijfk'd only by ifolatcd mid niulik bnuilLk Filiuuld Ix? [ii!JcH:lud 
and walohrd for the rracEion. Not ntrrty dilution« cf l<iU ta M3 may 
ahflv a]iEii>Ht at tinrc an ib>:^luUni>ti<m of tin: lioi^illi- Hi-r* bi^lmr dilu- 
tlana am hi otder. in uU luitvs in uJiü-U a pimititff iruif/"» in ci&frtJntJ— 
vMch sEgniHcs ulthcr Tlial Ihp ca«o u onr- of lypbc-id or iUnt Ihiu di-JcflsP 
}kH4 Ihkh jidw-d ibruiiKh wilbiii a mimlH-T of ttmuiUn—lho tcet ihonid bu 
trfiT-ntril u-Uh ir\i-ir'itlpn ttilvliitti". r-tj., I Ui !iO, I tv Ait, I In ^U, rir , unlril 
the roL-tlüa U no Loitgcr ninndctlcd, TIid d^'^rcc of reattion cHii IhUi 
liQ a|i[iioximat4>d; for avjiiiiplti» wQ nmy nay tht bluod >lii>%t'i:d iunciit>ij 
in rllhition of I lo 00, 1 tu UK», i-W-, at ihv i'imc iimy I*, df*|n>mliii^ upon 
Ibc düulioQ in wltii^li tho reaction no lon^iT ni'pcnTe. 7'^'^ hiffh<T the 
dilution in ichich tfvj phcaoincnon U mamiffi^trii. lAr t'lorc pofl»ttc the 
tnnilJr Am a nilL-, the IiMIjt Hil' jmli^'idnil Tli>ii-1A n iIim^v:^ fli« («DTliikr 
tbo agclutLDnting povfcr appnara a:id th« more i<ni<rgfllic it« aoUoD (P- 
Ciiuriii4>nl). The Widal ivairliuu Ifi very ofli^M a!»cnt \ii khoga uf ly^hciid 

Aecordinjx to Ro^cr. tbp ngglittinntinj; p]'oj>trii?o may b« at^arat«d> 
llcittlJiig IQ W C. [Ur rj nbollHhcB UiB i^prtuivldal power, but modirta* 
Ihe af!glulin*üni( p-jwor very little, if at nlL Tho two aubHlupp^a miiy 
aW ht} et|»ninl(^d hy dialy^iA. 'Uio ^L^riiLidüul «Lib*tanc4s pafts tbrougH 
cnllodion «at's; ihr B^%'1iiU[iHi.iri^ :4i)b-UrKi>4 do uot, — ]trtüi>K4,] 

Examination of the Kose Spots, — l^ifFL^rcnt icvesti^tor« 
liiLTO quite raopntly nbtnioed po«itivr> n^iilta in baotorjolo^c 
erftmirnlfon* r>f thi> fn^li murtilw*. Altliough Noubnue ond Tliie- 
luWU hail alreaJj called attojitian to tlie imfi>rtiiU(!V of iUIa 



H(?juT*i3t to dlagiiiMiitj via ATt ini^flit^d to X<-uf>'!d f^r iU practtc!«] 
JipplicnIioD. In fmirtf^'n tTphnid cn^f^g in whirh iht* spots wi-rn 
ci&]iU[]e<J bj Iiiiu he obUiiuwl ]Kvitn« re^ülU iu Ihirteeo. After 
thorough diaififcctioa of tb« flffcctol cutanoJus nrca^ tlie rose 
^poi Ü opuned and wnj« »crum Uikrn ^'Ith n pUtinum-^irc loop 
and af«d for boaUlon culture«. The »cram phoitld b« fi<^urod oi 
■oon jw piÄ*ibk' lieforr the ptoajw of ilnod, <Tiin;c?lnTint]ii hIh» 
HjUfiil» ht^liljk' tii Ü1Ü nii'tiind Ktid HuimK tn l;ATif wrurvd innrU^a 
pcwitirc n^ults frniu ti^cntjr tji"pboid paticat*. 

filood-cnltuic. — üoccni rvtoarvhe^ »yelomalicaUy conducted 
by my firet oeeiatajit. Dr, Schottuiüllcr, ahow tliat bluod-culluro 
ii of diagDOfitio h&portaiiiee. 

TwTnij cuUc cmtiinptcn ol tsrmk Uoad «JO mk«d Id fltc or iti 
babca «f liqurOfd agar ia< 4^' UJ uid pouf>^ into t*Mn cfi»h«i «nd kopt 
at a lenipvi-«turc of S7* U If t^pliW l«ri]li an pmirnl, colonio:« vill 
luiv« Urvvlufvd wiUim Jruiu fvH>-vi^lit tu p<?vi-n1>-LAU liourh Tli« 
ootoaica upon tbc «urtaoo of the nirtncnt iij«4iimii hut'f * prayi^h potor. 
wUId tbofet ja the drptih of UiD Eiic^itiui Ap^K-Ar a* liUi^kbli iHiiiilH. If 
cm Ri:cnJ>"cji»ji- fimitmuUcm iht litifllli In lhi^*i> (vjLuiiit« n.tis found to ttir 
SDOtila» the)- iTV, niMiout miir-h ilmibr^ ljphi>u] ItariHi. Tht^r ficDtfuMoa 
«till €otua Uiclciia b posdLble octj Ln a^t of ki-ma coudccI-^ nrlth 
dtiapAV nf thH lillEarf pauo^ii. In vhlch rcindlLlon <!a1on harSIII may 
enter tlio bloml. tor furthrr ounBniMtioa llm tutvilTi ru«/ b« trunhlfrivd 
tu »u)r*i ti>üUl<]p. So (■!-> ÜUO nnet haie been viaminr-l In tliid m&micr 
with poaittn fHiiIti In IFU^M pci cpttt- [Tho prvunco nf tyiihold 
bMiti in th« blood do«« not naoMurklj mout a *atk4U4 tnficLlon.— 

Quito rcoontlj try o«Ulatit, I>t. MioHnKllli-r, wn* t^*' flrtt In frvrwd 
«baerv^ljoim act^nnLni: to ^hloh iUerv cut no longer he any d^jultt that 
rhr ohiikc ayuil'Uiniü «jf tvjiliniij tim^^ t»^ |iiik]ijci>1 V iiifi-i-Eiini «t^ilii badtU 
vüi<b on dtvtiDgiiithcd Trorr tho ryphrmt tTruHllii« by ^ii«-r<>nTkiiti'>n «n»! 
4«tYlHVi""i^ ^'' alkaLiuu luicUon. lh«c cbhi, bi ^Ui^l r'i,. ürub«r 
Vid&l rt«<liii]i viUh t[ii> typhtrU liiidllJ U uxijilly alih:ki;, h\ii imnLllva 
trittk tbo tru* inf«<tionii aniriit*, an* Llb>tii|7iiatHEl Uy SohAttirilllvr n pntv 
lyyhuiX SliTicc Lb obacrvBliojis ^^i^i^ puUi^Lrd mnujr uUicr author* hare 
nptritHi BUf h rft4M. 

A. In Tcianu«. 

T1i# builli wrr* Touod by MntjUier m iRftI, in Ih« «w^vpiii^ of 
iilrrpu and indllnfi« dnJ \a many variclicn uf foEL. Itioy produca tTpk 
|«t«iiiiiB and i^UmuK vhpn inofitlatpd tnto iiiiln>a]<. |iafiK'u1nrly j|^iinv4i' 
pJIPh Hlvj vttttt al»u dt^uaA't'ivd by Kotcub^ch iii i.-4i>ih uf Utiman l«t«ntJa 
aad by TivlSvt dl ibv Tunuh vf lu IvUuiu« m-unaturaDi. KittiBtO 
ihbUlovd [oir« cuKuna of tbr banllb, vhldb an oUlfatt ^tatroble, hj 



iawulaiinff trUiiu« pu» upon Boliilifli-d blood-KTum «x;d ihwtl rxpotini 
tlir m^liiTP Inr c*in? hour at HU" C in n wntwhntL in ftrdiir tn flMlriif 
oU I'^^lAthti bactcrfL From Ibcu cultuiY«. ^'Iii'.^h Dov uronX^xiifA noth' 

beLcilli dtvclop «t ffötn 18* to 30* C» meiibf»« ko tfmprnititfc fAvur^ 
UH^Ir growlli, whkb cc«ao> below 14' C. 

Sin™ ilie a^xjrös of oilier IjAclcrm m^j ln5 pitwiit in tbi" 
crriginnl materia], it ia adviaabK* to make nrnmnl itvU in AfHit]r>D 
to plato cult^irtK- If Bomu of llio ettepictoue vouud «ccrction w 
Üilroducod baueatb the ekin of ^^iDca-pige ot mice, tcUnio pbo- 

uotimTia will apfH^r vilhin tho firnl, hvi-ntj-fcur hnunc^ pmvided 

trnuiiiuljc tcLiniiM if, actiialljt' itrcfcnt. 

The bnpJlli arc dcliralc rods, soruclinjos foriniiiK thnHiJ*^ lamcUmM 
iKiTurTiug in duni|m. but t^iubH^ afiigl«. Orily tin? uu]|-.poru]ii1rJ farm« 
mnnitctt ilighl JDdv|ii<Dd«nt motU^t^. Th« sporct a.n rouiiil and ^rioriLll7 
pc^lOT [I^K-3T]. 

liMJcoUlicm uf jruFc ciiltuns into niiiiiiAl" h inu»t «uttv^Aful in 
tiii4ip> ffiHnnpl^«, nnd horvK, A npvoiAi.^ ti^iiii it fnnriod whiHi cmm«« 
f}i« charovIcriBÜG phenomena cf U^lunna^ ^hilc the bncllli tlivrntelTcs 
dtwppcftr »ntlfT<]>. ruin niUuc» ^f ti-laiiuH liwil of the bm-llli wa In « 

■toiiö" baftfria. Thfi blurKl *»Tiim oi nrliiicialTy iiJiiimuinr^ JimmAl« 



SUlaiBp- Thv badZJJ aUiD with kll tMAic uilm djv«^ I^Qlcr'« 
tLc ^orm It I« c«»ur7 t« «oiploj^ Ui« inolhod givon for LIiom of 

UlthlBJI (MC (l«|fO ^J. 



7« In Cfaolvra AiUtlt«* 

Th? comma bacillDt, discovered b; Koch in ISft3 and foimd 
by laim to be |>rvtenL tiuluHiivly iii t-aaw (»f goruiiie fln'l<»r*, 1» 
now miiveiHalij' rtiifj^uiied uh tlii; Hpmfic^ tauHe of AkIuUc 

It 1$ found in tho iototine and fccca, but ntitr in tht? blood 
or ihn or^od (»f tbd body. A feattira of dio^o^tic itnportAnca 
k that it oft^ oca^ra in ^ormcne nnmbors in almoat pur« eiil- 
(irre ID Hie vell-kiiown "rJoe-wnf^r" or "BOüplilie"* atooK Thö 
niona fvrukut Oir* A^julti, Um lis» Dumeraue^ tb« baullu 'Fbe 
bacilli arc «liirMly bmt, coititnAlike rod». About half as large ae, 
biit ctiatincUf thicker than, tiiborcJc bjij:!]!!. SomeLmce thay 
an Tvry docidodly b^rnt, almost hc*n)nihoc-«hnpcd, or they rt««mbla 
ft larp^ Itoman letter 3, which Is formrd by tbHr pöoiilUr end- 
to-end union wHli each oiht-r. Othprwiw? tbf^y nviiftlly occur 
flinglj, tzireljr iu Knij;. uudulaling Üirtüdp- Tl»e latW are, aa 
A nik, inToIutioQ forms, aa muj bu inferred from the ApirUluro- 
Likc fomu obacrrcd m culturofi grown umicr unfav'>raMe eondi- 
tiona. Tlw Intti^r pUrnomcnon has led to tlanr cluiMiäimtion 

Tlie cbnlnrfl iuicilli btip furllipr dwtingiii«Lbri] by tJiHr yety 
ceiivti fiwtiiitj/. The occurreDce m tiiem of unJot'cnoua epor> 
fonaotioQ c^n o^iiainly bo dr^oiod. The arÜirogcnoaa sporula- 
tioc do»chb<^d by HupT«^ is improbahlo, bwauiw of thö roadily 
pfruliabk nature of the bacilli. Drying often Jo*lrüy< their 
TirnUncc wilbin a frw hwiw, and with ivrtiiinty aftfT from one 
to tuo i^yv, VitubncT^ i« jirvwrvMl for iitcml)m in a nioiivi ttntc. 
Of pnuriical inUreai la fAe f{i(?£ JA<iJ Ri>r7HaJ ^<ifiJJ gastric /üica 
^uicA^Jy i»7ts Wtfwi, and tliftt they nrc alao df^tmyod by putrcfno 
tioD and dTrinfooting aoLuli<^Dfi («ven VrP^"^^^'- carbolio acid). 

It:J«ction apparently oocnra tlirough tho ag^cy of food, 
wtileb eithiT cont^na the hHcilli ldrjnkinc-wdl>-r, milk, fniit, 
ale.) or \9 cs>]itAtaiuat^ by bacilli ffoui Boilnl houJa, etc, uaimlly 
vlille catinic^ 


M|i-RC>!^\)PV ANII «'Hr^riNTKV. 

An ohulpm AiilAlini n»vtr otviin in iinlinAl«, «upccMrul Imioula- 
tU>& oxpmrimnoU woiiM A|>jipAr to t# hnp«!««. N«Tartti«lv^ Kuoh «no 
evvdfd in fn^i^ducLDfi in jfulocaiiie« % sfvttc mt«lin«1 alTfiliQii b; 
iiFLilriLllzm^ Uip mi^UI of llir niojtitifli piul nrroAlng pcriiutfU hj opium. 
In man vliülvra Ims ntpaWdl/ bMn iniliiciod b^ «ncidunUE or iflt«nUooit] 
tvuii iVKvnlfcofrr ncicl Kmintriohl Umn«fvr<-i;oe of oultiin^ of tlif budlU 
FortunAlMy, hmvp*»r, thtv oov« of *'lftbprn(ory rbolrm" wprp, a« it 
nilo, not fu^nl. 7AiTf infrrlhH owHrrffljr 4ii (Ail ni*j/i)»rr mwy tnd jaialii,- 
after i-mt^uitig a rimfte pmn-atino f'^ tvfih pfcluiv of yüaultf pholtra 

by RcJn^^k?. In all I.Kp*c cat« viniknt «iirintD bdcilla «rcre füund in Ihr 
n>]üi|ea« ilcli-ijla uf lliP pjltii'llln. 

For it« ppHoniidncc lake a platinum virc loopful of llio surface jurowth 
of ail n^ur cuUurv. piU in nl'-rllc bauUlun, afkI Knjort hiUt llii> alhliinifin 
of It yihrkv)i-|ii(; of al^iit 1liti4 hundrAil Hmrim' u«t^lit. Th» auimAlH 
which is Ypfj flH'wptiU**, flinmllj diw in from twehr to fiflHii hours 
with t^at lull in ttmpcnturp. Acronltng to ft. TfiMfTcr, tJi* tcxtn I» 
InliniAUly iinit^ «ith Iha t-itjl boUtDH uf tli* hftoillL 

BtAlnlJif, — TThli biunlli Mütn wJlh lU bunii; anilin d^m» bfol will 
fn«h d{|]it4> cAFl^nl fui^hifn tnltilion. mndf« hy aclihn^ h fcv drop« of 
diCjrhlV ioLution (o vAtcr, The prcparatiuD ihüuld bo «ruincd witb UiU 
for Arc IaI niixit l4*ii) miiiulcx |T]|j< h^villi r-an ha yvty rapMly und 
iliKlLm^My Hrjiini-i1 vtth Ji /rjtf, rlffuCj^ afklutlun n1 rnrhnt furh^in, fioiiJa by 
adding I pait of ^ictü's toliitioD lo Q parte uf walf^r. — httooTiS.] 

Tbrhii'"Mli hct ih*i:"kifpd by ymin'w iin.'t)uHl, 

ta th^ iiivn'tJti' of a »fiff^/lr Htitn, ti piiHtttt'*' tiujQJtunIic drrtMiOP 
e9Hnot Ic triatfv from thr wtvriftcfipic Oirpi-tirancc of the btioilU itt pi-«pai-<i- 
tkiim tuitdf. fiwn thti it^iuU. Thtt ruwtiihhLrin» »f rhu dadlli to ruuiy citd* 
dL&d ■pirllln found in thv fvoi^H can r-mltly h*]ii] to miKidt^rprcrlatiaii. 
fap«uU]l> by tlin f/icrpfrir'K'Ftl etamlncr- 

Anrnnlin^ U* R, K<h'Ii, hovcvvr. From th» mntniAl #ihiriini>c1 in 
ths InitiliJt« !t>t Infcnti'Hi« niipiür«, a diA^o^io could be luado fram 
tbo Dikr(iw.-upS« ikppe«ranccfl lu abuut LUtre-faurth» uf LUtr iulu* vf 
grnuino obnl«»- Uf floura*. tho divgnaaj« Vfttm alufiyn ironflrmHl hjr 

Fur pure outtuie of Lhc burjiU II ahuuld 1j<t rfiui-iiihcinl tUut Ihv 
DUtri«n1 moilLum diu«! hi&va a. dtJitlrkt-tly AlUftliiie tvaiiEiun. Accüriliny 
to l^uliTtien, Ibin in Hc^urril by mddinii 1 tT%n\ of vudn to 100 cubic cciiU- 
lovlvm uf nciruratply iitutrukiEed bulttcl jcplutin. 

I'or cull uro« xipon tji-intiti ^iititn u^i-craL of tlio charActorUtlc? muooii« 
flutrulj [wliUh gUc 1o the slouli Ehii tiir wAUrlik« AptvitutirT] nrv 
<-Hn<fully hhAkrn bi ifi-liLtln |irrrv1uuh1y IbiiifnHtL jleiiI (V>oIM to 'M* (X 
P'cm thii tbo iiNtiftI ilibiriohh sri mulrt and pmirpd info Hvurftl I'vlri 
diabfi« »od kcTii at hiich nioiu l^rup^TiLturT (from 2^^ to 24* C.k Aft?r 
frnm tireDlj to tvreiilj-four huun dlitinctl/ grjinLiUT i^oloni«« rtn b« 

v^:^J^TABLK p^r^isiter 


«vn Qpod tho plAtTA WiEh «haut IW iHAgnLAralSan LHba« ipptar iLi 

fai'iJoH vf Uw cplfllm ^unvundiiiu th^^* ociluiil» prudutvu m. Kintllp fuimd' 
^»iBjW diijiT^K4inii, ni thp licittflin cil whicli Ihr moit of baMcini toI^p«» 
Tho colonioA ^tbtcD bi'j^litly wIk-ei lb« objective U purpvKly funci bttfM 
Üia pmpi-r furiit, and hfrtimn ilurk vb^n fotruHd too h!|[1i- Of th« 
niimrrvm* büfUria nriTtifrifijc ir> tJw ftrr« undor qoito«! ftnd jittholo^ic 
»ndUlonii, only a fcw lorm« ((tott \n uutrleiit fcrlntiu^ Ibry fttc Jit 
ttTL^itLihi-il fnnii th« coiiMDiL bHdIU bj U# fv:t thul Uittjr aiiuiilly «f-i nuf 
Uljtttfj/ the gt-Sotiit. 

Growth in ffi^lalin ^lnh cuUt'f^ it ibBractcrirrd by the appcArao«« 
of « funn«! ihi^pr^ ffidi'rjinif ot Uip iipprr portion of th* «nl>, am! a 
dulirutt« Bpirui (.Avi-liii(f of tUn Kiwirf^ tiumiw mitt «f tha nr«(Jld tntf k- 
Vpoaottar th?<xiE»nHH Bp^ii^iir rn iliv ForTii of & niuiiii» |:U»triiiri|£. gmyUb' 
nbilo laypf, frfrr^f^r^n \% ffn>nx\y dodtfpd by Ihdr |trnwlh. 

To hAlUB lb« dlAfnolU of OholCTA (*&(! ftiBfi for u» in nalcnAl 
Ibat» la odilitiuii to nninrruiH olbrn». CEiiiUltib coiopAr&tiv^lj tew eholeni 
bat^tZ^) IL Kwti hft« «ITcrni th« following En^Ihod^^— 

JVpton Oiftlufv.— A Koml] |iciti<iii of tlio atk«p^^tcd «tool i« piACvd 
in n t^4t-liif»rfiTl nf pr'pf^n M>liirion iinnilon^ 1 jut efu!,: WMlliim i>bloriil, 
0.0 pDrcout.). atid then incubntcd at ST" 0- I^hvubc of th«ir ^caI nccu- 
^tj fur oxj/ffr-ii, tKri nipjilly urrrjiipiii^ i:1ii]!rr4 Ijudlli tr-iy «luicklj' ru11«vt 
upon the «urfiiJNf, If a iIidji frani lb(* Kiiittitr of iTifi |>i-pL<in iotulioa \n 
tAkea Abaut from «u to IwoKe bour? nflcr ino^juktioni i«^ wtoB the 
Ik|uii] ju"l brjEin» It.* uluud and Ivloen Uic pcltlüc bAa fi^iriiivil« Üirrv wiü 
b* found On rhr>1*>rAj *tthir a piir# «iiltiirf nr ft iiiitliin« '^mitAinin|; * 
vttj Urg« nambcr of «holer» bacilli [I>iinham Htmbar Sdhottollufl 
imtbiid). In «virj ■^■■^ I'uri cultlvml^on ■lould be further coiiilucLed 
upon 2«]h1in or otb«*r nnfrlvnt m^IiA, 

ALttioujfb the opptAmncc of lh<? ooTom» upon affar ptnta i« L«u 
rbimi^lT^atic thfin Ln poIaiLn. dcntonntniibn U fnr more mpld by thU 
mvtbmj bivKuii* Hut plutii* iitij k-^pt at V C If a drop from 11« iudflco 
oi a prft'm rtillurt' i« >ptiui] witb ft pUliaum win l^op upon An aipir 
pldir ' dnveltipiuvEit of tbi- niluiijv« tAkvA plHcv ttitbiu Itvm eijclil tg tru 

H&AUy, tbr eholctn retotlOB U of vtatt -Laifnuttic jiiifiiillnnra. 
In ftlbumlnoiJ« niit-rU^iil hivhUa Hiob^rH hHciMl dfvitlctp (14 do m^ny 
otbrr*J Sndcl ud nitrite«. If piiro hydrijotiloria or 4iiJphUTic AcId tu 
niUlv<\ tv iHiH'h A cullurt, nitric Hfi-i bi libvralitl And a dijlmt't mw ur 
Hlirpipdr-r^l »olnr Jlfvr'lopt Tbt^ rnAr*tlon cam 1* unMiivd Willi a ptp- 
Bt* (vlfu*^ At the end of twenty four boiirA. Salkovnki demüii>4rAtr<t 
tfiAl ihU plJ«n^iiicuu(i \» ikpendenL uptm lUu w«lJ')cm>wD ftllroM-lndal 

'Uli k4*liatdr Arvl |a fr» th* ifar nf fhd BiKvtLtd •' rnnMamlttm vslv" hy rvmiw^ 
nil». Tii)»i3iLitvikmvbrBlJ(mii|ite|]<]ii*0v9 tft' lo »Hdlfy In PMri dlibs mil Um« 


alinn of the chnmctpristio fflalnr?« of f-h*» q^ltun*. WUrtii it le 
Doco^ftr/ to itleiiiifj ^ cliclera a vibrio cultivated from Ibe 
fcc>c«i Pfciffcr'ft rwictioEi is lie most certain aid. Tbie oorre- 
flpond^ io every way with th^ test deecriboJ in <ciiinu;tion with 
the diagDOfliA of typhoid (page 63). 

8. In Diphchcrla.^ 

Til»? liürilli ili»tijv*frei] in iTipli 111*" ratio mttmbrfliiea by hof^tr 
and secured bjr him in pum c^jlture have buen umjufationahiy 
proved to be the specific c:vciti:r» of dipbtln^na. TVicir diflg- 
uustie fiignificaiicn hjt« b<^n repontcdiy confirnied by other üüTW- 
tJgjLton. The liACTlli oet^ur priDoipfllly in and tipan the mem« 
brnnes: in trvfih frniu« r^ftiti in piim ruIturG, in nlilrr en«« mixtnl 
with otlirr bacteria. Net infrequently Ibey arc found in tlie 
phüryugi-ivlmueusof putieutft. Tbe '* nest« of 101:1111" öometimee 
5cen iu «tiiiiied proparuiiona made from the membrane often 
»iifllce for dia^Oi^iäi in otber inatanoea, wliere many other lao- 
li.'riii An.' al?(r) priSLTit« diii^iitii» nuisit bü «vlaMir-bi^d by L'ijkLin*>4. 

The liipbtlit^ria bacilli oct.jir in a ntiml) mid a lar^ fEirni. 
I'bc " pKadodiphtheria bacilli*^ iimy be niiitiikon f^^r tbi^rn, »ince 
they arc nrrnnjfod in a similar mannet and nW ;ih'>w a c<^rbiin 
degime of Hc^imlntion. They are usually imalicr and fAicJt^ 
than tbe true dipbtbei'ia bacilli, ai^d il*> iirit priTi(*nt thi» olubHV* 
HrtelHUj^'H jil llii^ir I'ndT*. Wb«*!! riiitivJit«^ fn nllialine bouillon 
true Oipblberiii barillj produce a dJ«ttDct nciJity^ «bieli jh mjI 
prceont in the ouUupcö of pseudftdiphthcria bacilli, In doubtful 
caaeu |ioditivo animal experimi^ts (a^e billow) aru of importanoir. 

P^r the demoMtration of tbe bacilli it ii* bout lo ftorwpo »mo 
of the membriiiK? utT wilb a Bterili^cd plutimim-wirp Wp and 
»uake a dry prtpa ration , ora piece of tbe looöeuetl ini-ififinme mat 
Ut quiL-kly i^pci;! ovpr the surface of a cover-plaa* [oral idt*]. For 
the preparaiion of cultnn^s a plutia urn- wire loop ii dravva once 
or twiwr over the shitiloJ äurfueo of coagulated blood-perum" or 
agar which is sprinkled with fr^b Iminnn b!ood (taken prefer- 

■S**l"in[n Vlir, lit 5- 

■ E/klH^r'B blwa-«niut ! Tikh« tirt«ufBlM»p'i und burtunim bihI 1 pirt of b»r 
IwglllDia DoolBlqtJiCl |HI (»uk t>rglML«*t ^ Hjdlau uLi^utliJ. a<^ (Ktofitt,, and 1 ppr mtV 9T 



Äblj from & T<*üi ot the iirm \nlh ft Pmva» B>TiTi^). Afl«f 
twtf Ito (ofti>ti nft«r ^ght) houra in the incubfttor th« ctiarAcl4>ri«- 
ti(? pnifjni« appear as stearin -whlt^, floe and coar^ dtnjin. At 
lint ihey tiiv. ifilalHl^ but Hulttmiiiciillv l-ujiIiac«.'. 

[The Jlphtheria baciUwt cjui aoinotiiiie-i bi- fuun-l iu jjrepara- 
Uone nud« from portion* of the (JiphtlicntK? meaibrane. Tho 
tiMcimcc is made in tho caitic mnitncr iw in fputum i^xaiuma» 

:: 1«., iprnd into & ttiin Uyer upon n *lu\^ and drk*d. Tlie 
^ _. _ prvp«nitiim am 1«- vljiirii*!) \ri(,h iiili l/ijlllrr rrn^l.hyUnf* blue 
'fltSBBcoi. (or from two to tivc iiiinuic«» thcD voslicd in natcr» 
drinJ, And c&amincd in ofdar-oJI with V„ oil-iniiDcraioD Icr*. 
WhoD powibk, culttrc« n)>on aa appropnato nutncDl tno-lmm 
(blood aeiu til) should be mado from the Lbr^l, and the reault- 
big growth owmlnGd after from twdve to eighu^e« hour«. The 
fol]uw:iix dirvrifcjns for niuking « dipblhi*rIiL ruhun? front tbe 
.throat are abridged from a circular ia^uod by the Bactcriolo|pca] 
Dcpariutent of the Nt-* York Cifv Buard of IlmUh;^ 

The patient »hould be io placed n« lo olltr a ;coöd viow of tbc 
throat. IX'jir«« i\w longut- mid with a «ttritu rotltin nwub rub 
Iprntiy, hut frrrltj^ ngniust any visibliTi^xuiliifr, rfvohh\Q the ^u'üh 
htiii'ttii the fitt'jen i^ aa to i>ri]ig all portii:>Qs of the »«Lib in coa- 
tdct with the mucous membrine or OAiidatc, Withdraw the cot- 
ton pluß frmn thr ciilturij-tnbo, holding it K> that ÜiC portion 
wiihdrawn irom the tube doo* not come in oonlaot with the 
Id^gtb or 8Dy other »huIjaUuc?. Cart-fully Im^rt the swab in the 
CulluTt'-tEtbe and nth it ^jenUt/, but tlwruttghty, buck Alid forth 
.*iCT Üie cnliro stirfuoc of Ihe lultnre luediatn for at leant halt n 
ml«, revolving the evab ao ob to briii^ uil porlionn of it in 
mtad .with the eurfaee of the outmrL« mvdiurn. Do not oilov 
ik0 stvitb U tourh ant/ifiin^ fxctpl ih* throat o/ f/i« patient arid 
the turfcr^ vf thti culttsrtt mrdium. l)o not push tlw swab into 
or broflk t(]v Aurfuce of tlie cuIltiTc Enedium in any way. Do not 
UAc tiiU« in whicli tbe culturv nie^lmm ia contain innlcdj liquefied, 
or driod np. Ifcplaoe the pluf^ in the tnocuLittvi tub?, mark for 
idctitif^cnliop, und pV^e in lh<r incubutor (£t9* F.). UD«alia* 
taeUiry ciiltun», allowing iiimjfluMrnt »imwlh or ri iti la mi nation, 
uaaallj rt^fcull from failorc to folio* carefully Ibi-wr dirvction«. 

In examining the culÜTai^ btidllj, a miaute portion of llw 
growlli a tnti»f«rrtHl to a chfan «lida by meane of a plalinnin 



KiTQ, tfioroQghly mixv^i! with a «nnll <]rop of wat^, iU^n «pi^AcI 
thinly ovf^ th? surface of the glass, and dried by aid of gentle 
heat Staio for Ivo or ilitt^e tniiiLiUv vitli «jM I/jfUer melhjlöne 
blas Aolution, or yi'tüi lif^ttcd ilikte cnrbol fudjain (ZicJil) m>Iu- 
iiou (I i>urt in f of wu1«r), vnsli in water, dry, and cxiunmt) id 
oedar-ftil wilh '/iv cil-"f"ut?r*iou l&ne. — BnooKs.] 

Tl](* baoUU are stained for on<^ nr tw» minutiv in hontffd 
iJlflliVs hJtnliiti' niE*tiiy]i-n<? bliii* mliitinnj or one or two minuü» 

••A' ^ 

in dahlia mcthyl'^rn^'n, or thruc niinntr^ in frcvli, cDiiOBBfaM 
alcoholic gentiaD^violct-anilLn-wnter eoLuttoD, The lattor etain 
is to be preferred, becaiiae Qraizi's method can aflerward be use<l 
if rL».;Mii'T-(l. In Ulis wJuiM-ilinii, mM'ordiui^ Li> PImuI, wHabiMg 
ttJÜi akohol ahould not be ooiiLiuuucI until complc-tc; decoiom- 
ti<ni. AniJin-oil is brtlcr than alrohf>l, (Thc^ bndlH ran hr 
botttitifnliy and ropidJy etaincd witli dilute hoat-^d rnrbol fuch- 
i^in (Ziehl) eolutl^in (I part of Ziehl to Ü parte of water). Wash 
in water, dry tborfmghly, and eTnmirp. — Hkookw.] 

VKntrr^MiLK pafajuikä 



TIio nonmttiih rods afa UKtinlty atiout cut lon^^ but twioo aa 
broad, u tubcicli> bncilü. Tho laaAt ofton uppt'Etr woIIod in 
flnblikiT form. In ^uinorl prr|iHrHUjinis^ «^«»«'ijilly IIhimp mtopi^d 
will» LOflltr* iiietli,^ Inno blui* bolutiim, the bacilli tictitmUy pre- 
Kiti TcTj distinct &c{;im-nUtioa, This Ircrjuontly gin» to tbrin 
sornowhal j:rmiu)nr ujipuurarico, whtclu ici ariJition to tbo 
^■^callod "<:lutih«U run»/' i^, lo a eerUta ^'xteat, cbar:ict«ri«ttc 
of 111« baollll. 

ViniEt-iil. burilll biivp mratiriTkiilk Iuiti fimiii! fii the nioulh« 
»f bcnltljy nniJ uli^hU; inclifl|inj4^il itiilividuHK What if ot 
n\fTc iTnpf>r|j»nc€ from a pnictkal point of vicrw, liovrirvftr, » tho 
ffict that ih*?y havo becai obecrv^ in tho nral cavitK« of con* 
Tali-^wEts for day« and «tpu vwk» afi<»r diii*pp*?a ranee of llie 
nupmbmne» ^Eec^e^ipll). According to TlJ^gg**, when ilt^popit^Ml 
upuu lojtt^ uli'jipiU^ üinl «rlidi* of dolliiiii', Ui«y reUiu Iheir 
»irulcrce for in>m four to »ii vecka. If protcctcO from com- 
plete -lt^iri'nti<m, slrf»ng liijhl. and ihn action of puln'fivt^liw bac- 
ivtiiv, llity nmj live for from n^ to oi^'ht mr>u1liK- Duinfi noilod 
clothing kept in n poorly lighte*!, coftl c^llnr in naid MiM^riwlfy ia 
favor priTciTViition of tlifir liLiüty, Infnrlion ™vii(v rbierty 
frciu nioulh to luuutb» by cipo^^toration, ujid tbroügb tLe agency 
of ooiataminalcil objects. In tlie form of dtiai the bacilli an- not 
iEfoi:Ur>ad. \\ livthfT they aic cüpfible of do^"<>l'>pini.''ht up^n meat, 
milk, and brotbi and tbus prüdu<<e infection u itill & mooted 

Th« olurrvalinn« (Ann<n]in|C llifi otTUironf^e of L&fflcr b«oiJU in 
i«md* «ad Disny f^m» of luiijiiiMitifi« irliUh ditiirally »if uu( II» Im' 
«citi*ld«rv<l pniijunpii^Hl Jüphllivrui n^uiro tiiorr ilioToiigh «tplnnalion 
«S*! iiiin»lii;nli4f[i. 

Tra&ifcrenoe at the btdlU td aalAiftla fniiP tt> twii looprtiln of a. 
imh cuJliiro «HWi^lnriemiilyK ff»|n'('«Ily Ut thv v^y ■iiwvptLblff jjoim»- 
\''nc. ilm>i iiul iiimliii'r lUfhthrrlk, but tn uniivtjalty ■ercre bil'knicatloa 
»I ixhi^h ilic nnitrmU iISi' in fmm *<tiv lo four ildyt. If Ihf^pchrlnd of lllneM 
1» iTkifrv jiTntrtiitpU. |iiital^ihu lO «virry wiiy ra-i-rnMiiiLr |i^i4E-li|iMlk(iflliv 
pikialyitia U ulrwfvril. I^^JTlcr'it AKiumptjon tbnl the iriiLUii'llrAlInii of 
ill« hwin«riA a.i tlii> pr^inf of inffvitan L« «^fon^pniilHl by fdt (|ifviii!opinf<nt 
t»( « U'lin wlii'b in prulfiibdly iujiiriau» 1« tlin body lin* Wn iiiitTr-rvaHy 
runArmol A fiirtUvi dn'iui'r frgm tbrBclivit*^ ft (hv ti*ri]rj i« iht cpilhr- 
lU] BfCFotji prndiiiwl h}- thpTii, nhb-li oppfi« ih« vmj for tb« «ntntlCB 
of olhrr buUri«, «pcrUlly itnptuca^L 



k iundthf^ by the HTliflci«] Immuitiailioii tt^sU oi Bthring, whi4h oonb-r 
Upon othmviftc BUh^tpi^Ue anEmAl« a prgnounocd tlcgrce of ~loiia in- 
ninnlty" b> th« invtraal fttumpr.« ftl Inftu^tton- 

9. In InflucniB; 

IL PfHfT^r hAa di>irTit>«Hl iIMumlv Idunlh i^ Ih* PAiiUltV* «fnlfl of 
la gflpp* or inJKidiJi»- Tho «saiimption elv to their Bpoaifia paUlOgt&Mtf 
bta 1»uii (.'oJißrmed Iry Uulr iroiphuluifEe ppcuhHTltku, their udutive 
«OCUmoco »Q influeniB. and l>y piim cultivation. Succuaiful Inoculnllou 
CffptlbntnU» howcrcr. likve lliui fir not inr.n oLLaiDeci; dul tlii» in not 
UlEprlllRjf whfN it iit rciiiviJilwiaHl UtuL uo nm^ltt hjhh'I«« iif juiiciia] In 
«ponUneoiiil/ nltferked by Ift jfrippo. On the other hand, tnonj aniitialc — 
CJF«! »bblta— «n BLiuFptlblc to Ibc toxEc ttTrctd: Ihoy dio witli dys]'»!-» 
and pAnJyiü*lik- |irffitiiiiü<TR. In ihtir ^^ultivaiiim Vhitfi'r «I flrjt nift 
witL gTMt dtflimitliflfli Ahioh wro (ivvrconio only when hd ffoiplofcd 
btedlo blood ipL-lnkltd upüQ tbc aui (a4]c of AlanU'd 6^a.i *nd tlicn rubbed 
Intft llils mprtliHii ihc grippal flxpectniiiiSim, Thifl vis\t followfl*! hj \xix- 
iiriiint in^wth of vüloiiit^, wJik'h irimld hn further millivnti'd at wilU 
ll«iji<jj;lüliLn jp iiidi-prtiqable fur Uit isronth of Ibt cdlonioL lAccurdlnjf 
1o K>'m owl loll, thr Koflli-Wefl» Itaolltui. fuund lit the miiPUA of aciil« 
«ünjuiic'UvltiH, and Uitt Indutnio LaciTlLUi Afu iJanticiU'- HuooiCj 

Fui Uw preparation of pure flollure» Pr<<ilTvt m(iiiiiiiriid& tlic ful' 
Imring tnvthod? A fmgnipnt of tpntirii) it nibbod up thoroughly in from 
one 1« two cubic ci-nlimoltr^ L>f bottlllou iu drdfir to diatributc the 
b&ciltl aa muoh u pu»hiblt, ^ml lu a^rur« tlie funrintmn ul bt|>juiilf:!d 
colonl«. The cuttnro ii then innilp aa ahovf dcat^ntwiJ. 

All lli^ ii^jlonica akuw a diddcdly ^laulilc.e imti^parcai^/. Tliej an 
nf^^b^, ^nm h^l At £r° to 42° C. &ud An d<^vdoEii>i1 afti^r lviTitj-fL>iir 
kuTiJi. In [foiiillon or upon hloodajfor Ihoy rnUin their rinilenw for 
Ijum f(H(it*"['u L" Iweütydfibl dayt, they alfo retflin thrir vitality in 
iTioiHt Hjiuiiiin Ut tbn AAint» lergth of lima (l^fdlfer), but ihAy Arc very 
iueccptiblo to the A«Mun of drybi|r. 

The tadlh oftm apptar in tbr «patnm in pure cultoi«.- tbey havo 
KlftQ bftan drmonntratrd by Pfi'lUvr In pxrHKiiymnloiiFi rismtm In inriii- 
cnra pncMimiuin» and by atbora in Inlluotu^ oni^cphAlili» And nicningitü^ 
lliialty. üho lu the blvud. 

In r^nler to demonetnite microaropU'hUy Lhi? biu^illi in hhi; 
bpuLuiu tbc Ifltter must be exanjmod ff*^i<li, Tlie nputiiju i^hould 
be ppreaJ out in n ak-rilt? glass dmh nnd n portion taken from 
the middle of the purely porulmt part. In fresh, uitcoitpli- 

■ Tbft ElSi^fntlBB fplBt« VIII, PIf. I) vu niJtfioiii an «riftair prapanllon fa»- 

Alth*4 itjg quiT.itr h^ R Wi<im>f 



cftttfd cflsc« the bacilli will c/ten be found, zta Pfeiflcx first iBemon- 
rtmted (and the (luthor coulJ confircn), in grejit aumbcn and 
often in pwi^ culiura. The baciHi niudlly bo in otumpi in tlio 
tnncnid basement subsfanoe of th^ jputain, fiartinlly aUc vitlxin 
the lioditt of tbe piis^oqinsL^lm. 'Vhvy nrt^ gi^iif^nillj from two 
io three tim<« £a long a& hroad. The ends are roumliHl ; «onie* 
tim» two rhori boidlli lie ^ close tt^gcthcr that thcj greatly 
fcMonblG dipUfMcct. Ilicy are norttn^fiV« und httTC no c^pfmlc. 

The bncilli are iJEiuUy ver^ niimeröna at the beginning of 
Ihe tliu-fi)u\ Willi prng^n-w anil mbsici^nce of the malady the 
numlKTr of free bacilli boconii» les», while the pu&KN)r]iuscle4 
If pear t^ be fihifTed full of theui. D^t'^'uerative forma fraqaeatly 
occur at thi^ eta^; tli^ bacilli appc^ir fnifrnicnW, stain badly, 

fUlainr of tiTFpBEmtlcina it Int done wUh rruhty prvi>Lr«l. dUuie 
mrbol fticbtin lotutinti. whlrh 11101)141 ba nlloviid 1o mrl from Ifin lo 
iwraXj miriiiLrA. Wiutla in Hitler, cLjj. ant! imliril rn CaiiaJa luiliiun. 
(If iili'lo \t up*d riiHikdH-hAl-BMi linlK'TiOln;' I« not niHw^ry imlir-« il U 
dr<irablo to prottrvc th? Bpeciintii j>tniiini>ntly^ On tho LMintrary, tbv 
iiuim'tiiiiin oiL can be pUudJ djrectlj upiiti llii? aaieAr «cii Itiit tLpi^citiiffa 
f'lAtitinj'il, Fiuinin; f*n tta grpAlly hmhl«<no(l by rii>Rt1iiie th» nirhxiii 
KlxilioSr — HnooKJcJ 111« <]ülic«l4 roiln, fr» and intnu-UnlAr^ hIkiw * 
paftly unilorm »UinJjkj;; &nd parllj a poUr etainLnf. vlilcb Dot Infiu 
^utntlj iMd tA Lhftlr tuning mbtakcn for diplococct They Am iU*cniart^d 

10. In Orlrnul Ruhonk PUt»e, 

Tlie bacilluA of bubonic plague vaa diacercrod by Yerem, 
and ila regular 0('cuTTcn<i.< in the «wollen Ijmph-fElauda and Ük 
pus from Ihc^s A£ wi>ll ofi ia the lungs, liver, apl^en, and bl^od, 
has l)(vn jM>»itii-i»ly prnvt^l. The gi-riuK mitiT L*hi<.'ny Ihnnigh tJie 
riiiii nnd I'^ngE, alUtiju^jh inf<!rtiQn mny ali^o occur thri>a)^h ihc 

Micc> rabbits, guinrn-pi^, and especially rata arc Euwcpti- 
bla; ind^, tho latter are mid lo pUy nn important rale mi the 
spread of the pTagiin, Tn thp Iflf^t «^jkidk^mic in Cwton the out* 
brt'flk in htiiua» t»ubjc<:tfl wa« precedt-d trwn tiro to thni' wn<ka 
by sftcAi mortality among raU, and this phenomf^ntin wnjv t« pijiW 
ia noch ncvrlj attacked portiMi of the city. 

The baciJI: a« short, thick, scarooly motile nid*, *rilh 
iDonded «idfi, wliich «tain intensely on treatiuent with ha«io am- 


Im iJyco (po!&r stainiDg]. Thay do not sUm mtk QmvCs 

CvltwaÜGn i« roadily wcured upon ordüiü.r_v niJlri<?flt mo'iia 
nt nwrni and hody terap^rature. In gelatin th(^y (jrov ait umall, 
nnindr f neJjr gr&DuUr oolonieA. ITjun flgiir t}if> form ■ grayuli- 
vMte indo»c«uit ÖUc. BauUhm i» n«! fhijiffd l>y tht»ir lerowth; 
fi-ooouli cf bacteria co]l(X-t ut IIk! Mtom of thc^ tiihc, in thij« 
reepcct offonu;; a cicrtatn nmilarity to pltrptrrfticci- 

Yt'riiin hnnA that tlioir growth occurred bft-t id S-por-cent. 
ppion H>liitimi tntLtitining 1 1o S pnr €cnl, of gelatin, GoA and 
indnl (^nrlopmrnl nr« absent. 

Sports have nof b^eii observed- Hence thälr tMghi tfegnK* 
of rwihlancc. Heating at Hli" C kilifl the baciJIi in from ten to 
twenty mmutea, cud at lüO* C. in a fow miuutoe; treatment 
vilh I'per-cent «irLnltc ndd kill» thom in oo* hour. 

Arci^nliiig U> IhiirkJin-, itijirlicm nf t\fnt\ ruM.tirea of huhonir 
plague bncilii sl[ppii('^ i iTrl.nin lit^gn^r nf pmicctioii. Infection 
with till* [\w\ bftdlli in iKinfatal dra»r» confers immunizing 
pro|>orti(^ upon thr blrtnil-ipruiiiH 

Bacterium Col* Commune and BacteHum Lactiv A«rogenc*. 

lo connection with Um püthogeuie huiilli vre will briefly 
diecime:^ — 

1, The bacterium coli commone (I'^scherich). ThiG bacillus 
hftfi in rocriit yonrvi attrcicitGd much rittenLion ns the causativo 
agent in punilent (perf^jrating) p&ritonitia, aa^ocholitiE, and 
many forms of cystitis. The aütJior haa n^ppHt^ly found thin 
Wttiium in pure culttiie m cyaljtiu urine; alKi hi the iuflaxu- 
nint'jry exmiule of the güü-bladjer and giill-diicta (at cpüfatiou 
and at necropsy) ; finally, a nuniW of timca also in tbc blood of 
patients eulTfring frum aevere — fatal — cholangitis, und in a few 
n»re cafieB of puerperal fever in uhich the baeiUi, c!c»mbin*>d witli 
fltreptococfi, appcBrr*! in thr hlncul iinrj mutuatulii? U'v.\- Schmidt 
nnd AachulT fuund the bacterium enii commune nine times in 
pure culture in f^jurtcen cabc? of pyHom^phritia, It i* constantly 
found in th< cek*n of children and adulte as well aa m all inteti' 
tinal di^ehurg^e. 

The bitdlli appear a£ ^elkflt? or plump, ghort Toda of an 
nveragi^ thii^k]jt.-F<a c}r OA fi, Thoy ^weaa sli^lit Inili-^n^jidtittt 




mtrtiUty, VfWich ie effected by meaos of one or mow polar flagcUa- 
Thcf bacilli often occur in pain. The/ gtaxn readily with tho 
ordinary m^Jioda ; thciy are dccotortd bv Graui'ii mothod. 

Tn piir^ mflurr N|iiin )r'*lHljiv [ilvUvi Ihr* Inrilli ][rc>w in ü fnmi 
»Hmhlit^B tjrphr>jd harilti, producing tiuull, whituh K[*oia m Ihu drptK, 
■nd upon the surface coluoio ^4 ;l1i »«nftled marx^Qs. They dr/ not UqurJn 
ihvt mnliurn. T\u:y rvu<\Kt hnulWuti i-t»uily. and jfrow iipoit akht in thn 
lorn of ■ umj-wbil«] film Hnl upmi jiii(iiti> at ■ ^Mf>v]Hh, moint (lv|hi>it 
(m« P<J[« S0). roinl? vf ililT'^rfiilinl clin^ioMic importuife «rr; the} 
Irrm^nt ^Inrotp HiZnlioriB virh priifau pntiliirtlun of gan iCXi^, 1li<^f 
r|iilokl\ cnnKiilaU nnrk (aI mculiflUon lp(n[H>rAlEJiii} ^^illi infj^iiH« forma 
Uc-n vt a^id. Hbd, DiiHlly, ^ItrJi c^tlliva-tpd in |H-p{A)ii n'ltrirat uinlia UiVf 
prodiioft thir nttrvbrnvA rttu-tiim. whiüh r&n U< miulp to ap[ipfir t.i ■ <ltik 
UiMi rva« eolontloo by addition cf 1 cubic ocntimclsr o( 0.02 pc^rci'at 
«ulutiijfi of p[>tB«»iuin aLtrit« and k few dn>p* of duMtiically purp «ul- 
phuno acid to IÜ r>tHi* ntatliiiM«ni of t-h» lioiiLlInn nultiirv {«^pp jlTic 

S, Th« liacterium Uctii ««roifene^ ahn finx described b; 
Gschemh, re0«;iib]eM jii rnan^v va)» tbe bucTi'rJiim (V>li corii<imii&. 
It occurs rrgularly in tbi; feona ot iufiuita and nc»t inftvi^ucnlljt 
iQ the atoob of adiilta. Lt oceiLiioniilly inanif^U pntho^nic 
properties. \i£ recent demonrtrntion by Hi?3"3e ne tlie ciclter 
of /^i^mufurid ie a mout int^rrnrting fat^t. In this inttanc© the 
inf^tlon of the blacVler wae probably Induced by catheter; the 
bacilli were fonotl in lite foam^ vaginal »eeretioij, Ea fJie f^cos, 
and tihio ([K>titn^tiHrji]) in Üxc cuntvitta oi Üit goIod. 

It nppcdre in the form of quite thick, tdiort rods, which arc 
Dot infroqutittLy united in pnlra, thu preAcntifi^ ihe oppcaraDoo 
ol B diplooocciis^. Tha rod*; aro nonm^Ui», do not form eponif 
■nd aro dßcoiorfd by Omm's niMhm), in whieli particulnfs th^ 
ffseiuhle the ba^^tcriuin coli. 

In pure oiilturv jfurt^ptililg difftrtnt^ between tliin biicillua »nd the 

In plat« c^ulturv* the harlvriinn larll« pmdiKvi a ^-rr; ilvnar, gliiil^ii- 
inf, vbitc lajflr. la *tab cuKuna a chain of pcftrllike vhii« col^ilfa 
■ppMrt, Mid vhru tht< iniH-'ulaUun u|ji'niiijr b at onOV clovnl ihi*y alHU 
Bfltm, ntlfir iwi^nly-foUT hoiira, lumii'rmik |f*ii'hiihlilB*, th* aisa of a lentil, 
which rapidly Ufitm« In aiM and widely iliitcod tho i;rlatin. Tht cul 
tUJM «fV odtirli-Mi- t'pou pclof'j a.ppi!ar Kiaj i^li while, rnubi» tf^l^trninjf 
d»pi>iiU •Pt'iTiLl iiiilUiiw<tiiri ihi^^k. contA&nnig miinvKitJt ifaalmlibl». 
wbich uv nut prr^nl in niirh cuUuru uf Loctcrium coll. Trrvlj a^rjr 
U vntlrtly «ovirntp alUir fouf huui% with ft tbivk* w^ tv lay«! auch Bei ii 

$4) MIC:Rüft>CO]'^^ ANI> aiKMl^TKY. 

obacrrei] wlUi Ui« LocUvIurn coli unl> iifl«r > iuL]f]i lonifpr Umc. After 
tw«ity'four boup* m*/* U ourdlod in fary* Tuinpi. which lAp&nt« 
ilii> eJinr rtbry. Od" ^irmiiticni ii much more (nrrjfptifl here tb»n b 
carc with liMcii^iim evtl. 

In Dywolery. 

Various nullLora — especially Sliiga, Floner, and Kruwc — 

lm\"c* rcconlly demons trnlcd the conMunt prw<>ncc ßf crrtain 
tcrin in tlie dnjocta find iji part al«o In tho orgnne af largn num-' 
bpiw (prpiijomir^) of ^,^wnt<!ric caw«- The n?»parrhrti of the*« 
invi!«ttgat^»re are of much ^Töib-r signifii^ant^ than tho^e of 
former jeare, bocause the culti^aW bacterium is flgjjlutiaalcd 
by tJiC blood of d^ntvric patiout« in Uic muiic mimner oa Ui«? 
fv]))^c»id biH'illui* iu the Wlfbil rc-uction. In thin iniimi"?r t!n> 
t'liologic rolo of the "bacilhts dt/sfnUria" in at Icatl u nunjtn:r 
of rpiilritiüv Ij& iifviiri'd. 

Tiiii* biM'iliijjv iV dwcribrd Uy Sbi^H ae fnTlows: Tlin»" bwrilll 
founr] in dysentery by the other autbore mentioned differ only 
in liuimportiiut dütaila: — 

It ifi a bacterium doeoly related to the typlioij bfjcillus and 
bacimum oU. It is morphologically idpiUiL^nI with thcw.^ It 
iV diM*oli>ri*d by GrFim's n^olliod of etninfng. It is inodtirntt-lv 
motile. It forme palc-jellow, finHy granular rolonios in geln- 
tin, and doM not liquefy thia mcdiurr. On ngnr it pnodiicoä a 
hhiieh> transparent film. There is no form^tioji of gtm In 
Biigar-apor. Upon potato it shows after Uventj-foiiT hour* a 
jicurt'cOy TUible, whitish lojcr; !uter it produoes a brownish, 
mot^^'Iike pHiide, Bouillon i« dilTiisely e]oud«l; llu iiidtil rwuo 
tior. There ia acid-formnlion in litmu&'milk, but milk id not 

|<Jnite Fwipnlly Duval rind llaesctt havo isclntfri this hfteilfuB 
from the dejwtft of forty cntng af »ummfr diarrhea in infants and 
alen from »crapingÄ of the iiitraÜnjü ninrnsa at nner^psy, and in 
Olli- crihi! fmiti tlii^ mr^euterli: glamlb aud liver. Iu tlii^ AlTui;tM>ll 
the bacillua wua SM isolated by Dairal, Baasett aabsttiututly uid- 
ini; tum in hin re&carehts. The invcHtigations of Duval havQ 
been eonfirmod by Spronok, of Holland. The organism is 
fljUglntinjilf'd by the st'rum of patients GiüTcring wttli the dia^ 




Splrochttt« Obermeicrl in Febrii Rccmreiu. 

In all eases of recurrent ferer, and in thie disease only^ there 
ifl regularly foun(3 in the blood a spirally twisted, uniformly deli- 
cate bacterium which was described in 1873 by Obermeier and 
spoken of with all positiveness as the oauaaHve agent of the dis- 
ease. The spirilla can readily be seen in the freeh^ unstained 
blood with a linear magnification of from 350 to 450. Their 
presence is usually manifested by active spiral progressive move' 

O ,0 

Fig. 3ft.— Spirocliftt« ObfTincieri, X :1S0. 

mentSj which are produced with great violence and often thrust 
aside whatever blood-corpuscles may be in the way. Although 
they are generitlly observed singly in the field of the microscope, 
it is not rare to see them united in larger or smaller groups. The 
microbes vary greatly in length; they measure from two to 
five times the diameter of a red blood -corpuscle. Their ends 
are usually somewhat more slender than the rest of the thread. 
They tire always found in the blood, but never in the secretions or 
ejcretiona. They appear shortly before or at the beginning of 
the febrile attack, increase greatly during the latter, and disap- 

89 MicmosmpY AXD CHKMIS1"äV. 

pear ciiitin?1y v^ltli ihn AuhMvttce of tbe fäver, to reaiipuar odJ 
repuut a Himilm' iijid« wiLli eau^h new ivUfHe. 

Th^y lia\^ itot nit yd bt^n cultiv^tvi]. ulÜiougU inoculattoiu 
with Ü10 blöo<I üüntfljninx the qurilln Imvc bL*«ii (mcc(»4riilly 
priictkcd upf>n mun dcri moukoys. Th« mod« of iufection is 
still toiblfiU, but Ihß dic^'itm h piTbnpK IriimtnnltiH^ by fiow, 

Dpiironslrntion *i( tJit? K|tiri]]4 Jn the blonil rexulcrs the di«g* 

StaiDing It onnrcfj- uiincL-p^iary, if, honvvpr, il ii drairwl, tli«' dried 
hlood ipcdmma iimjt acctitiliiitf to COnlbtr. ht niuiaUncd for Irn jii;con<U 
with «Vjier-wnt- iKrtici »c-iil <lo nrium* lht< |ii>nic>|flHUln from t.l»« rwl 
blöod-ccIU), tnd then ■taircHl fi>r Ion miniitr« wicli gttnlitEi'Vinkt-dTitCiii- 
vftUr Bolulion. They iilvo readily «nd quithl^ iuke up ül oUicr »titlki 
dytB in vaieTj scXitWoji, 


These octupy a pu&itioii mlUwaj Ltlween bacteria and thread 
fungi. I-iko Uio molds, tbcy form a mycvliuin whidi i^ pro- 
daceU by trui* Uivi^ou (didiok'nnou* bninchinj- of Ibo tudividual 
thread«), whilo, on the ctiher hiuid, the thread funnrd from Hit 
gtfrmiDal cell np[>i^(« lioutogeui^iua and dyliciLtti iii cutiiparignn 
with the double-contoured Uiread of the moVL 

I'erpetuation of the fungus occurs by wgrnentfltioo of the 
oir^byphffi (eeo below) and sut^c^uent diBBerajnation, 

In many of the fltreplotbruciae there are formed at the enda 
or in the middle of f.hp tbrejid buUxi^is ewpJhngH. whiVh an? ^ne 
to gelntiiioid Lliiokfiiiu^ of the inuuliraiie anä art prubablj de- 
pcmitTit upon rt-irnaiive altcrutiona- As a nik, Wieie awellinga 
arc found only Ju the maU-rinl taki'u from the aniinnl body. 
They are founcl in Lbö barJ^ i/ttthieish granuUs, while in tin- gniy 
and rcudily toitipreKsihle ^amilps only the nonlitilbnus (young) 
threadfl nru seen. The diief n-prpsi»ntati\e of Llii* groirp is: — 

Acltnomycc« (Ray-fungu«)> 

Il U ihn frci|ui;ut i^auac in ^feltlfl u( tiirnut* oi thr JAW» loriuuc. njid 
cml ciftvUy [wooden Eoiigiie, lumjiy Jaw]- It wa« flmt drirribcd bj Bol- 
liiif£vr in \^1%. In mjia il aluo Attft«k« by prorcrtano the urat cdrifii, 
vpD?Ul1y curloLia Inth. und IfAds to woody biud ijirillriillou in llic rc" 
yion of Iho nuglfl of th« Jow. It not lnfr<qupntlj entert ih« rtftpiroittry 



tiOKiatfrA, iDdiicmg frrUI lirondiRl*. ^rlbronc-hlti? und finriiinnn&f? iavi, 
M ^vU »n [>iirLiknt and wm^onnlly alio *ctou> pkiiriii», |rrtiplvuri<iik 
fluil UH.-dUhtüial IrMcriiH. J^'UiFtloic^ thv i»tlUi7]oi:vj iiiuw» in vtvi^ 

ft« (L purely looal AfTct-tion upon ibc f^xicmal »Hn or in Ihc alidcmin&l 
L-Jivliy; lu tlw \»\U*t (XM* U umy \vif\ to »livEhliiin. with luiitmit htiu 
(hv int^*1trH> «n'l 'liKnlmrup of 47rfittiinjf/{>irir pujf rn IHe tUiah. J. tarm«! 
(dho Ai'il acciArati>1y rntcrprclt^ IhJs n>}^caeii in mnnl. PonAk« Ilottrocni, 
and otlipfv hft*' jT"^aIlj rfintrUmirtt la Ihr knowli^dp^ of »Ji? my f iin^a 
diiM<AM- J. Unii»] lirvw nVt^ntitm tQ c^iiouti Iwtli i.« Uio pvrlHl of iintn', 
ind in a c&w of putinoDatj actinoinjcouA Le found Jn nn Ijifrvtcd Focus 
Iho fn^rmmt of n mriout 100th. ßoatroem. who acciiraroty ttndlnl 
Vm biolvgiv pvtjLjIiMrilLre of Uui funguB, bulinTc» Lhiit j^rfflfl, rtpf^i(ifl$ 

FIf, an.— Ai*tlnom7m Hnninla (t^ingr X IM. 

■pm icftfrA «Ac funßüs h /rrrjffcnffv prractif, fa the maUum »t 
Thl* ha,imctviijf% with (h* v#ry fwi^ni-nl Hpfwnrtn» ol lliti 
■ffvCtton dtiHnfi huT^vat month», f ArtjnomjtT^ hu b^r■] found upon 
jMhing diooU of thomj- Btiniba AUd the hark of vood n^U^rnl by mfk*^ 
tan. Bolllxksor Ixiu daUuUd U In milk» and Artant In o^gt.— ItbooM J 

Wb(!D Dig dift«iuc oti^ts, Ihorc viU tic foimd in Die pu«, dtft* 
cfaargvcl fpontmuHiimly nr hy innsio«, or tn i\iii [mn]l**n( ^sputum 
or Ui^ puralent ailrni^MLrrH of tlio foce«, ptilr or i/m/i yclhn-, 
ttwcJiif vinhU, up h pinhcad^ii^d granidu, usually of <ht^y 
cooeUtCDcc. On crufihins one of t>lce'^ ^mnulrs thfrrc vill cft«ö 
bfl Boaiif eren in unftaiaed proparatioiu, naoL^roiu throflds vtth 



more or low ^Hstening» pyriform or club-slinp**! eorls, nrranged 
m the ahflpc of tmall i&ns or roumW rodUte bnilic^ (Pig, 30). 
The diar^ßMA rtin n^juilly be mads with cfrt'tinttf ex^cn in 
ttfwteinfrf prfparations. Now n«d Khv-n objod» will bo met vith 
whJeU ^yitly ro*t*n^ble Iht«; bo<!Ji«, nnd wbich^ on compflrittin' 
villi p[v-prini( 10I15 of J,he true jioüntniij'iTji, can be dirtiiii^iished 
only by th« fact iliat th? clut>^hapcd iWi^Uinge arc not eo pro- 
nounced- Trtatnioit of euch pr^pnrationA vith alcohol or Hher 
«hovB Ihftt Ibo mi»;löadiog objects ^r« pixiuliar, ladiatdy orraogi 
fat crtjsfah. The Autbor htiA twico met fludi eryitaJsr onco ia 
GftrdnoiTiatoim pleiiritiri anrl once in pulinonary ahsG»s. The 
diagnoflis b made ahsvlutcly certain hp utaining. 

atBloiuir.—l, Stain thn dry prppomtlon fur frmm OiJrtjr Uk forty 
nüTtutcH III h(dit«d nrbol fiioh«tD. than Sut from ton ta Qflvfin minutw kn 
LufoV» eoltitJon, diMoIor with akoliijl, ftrjd irAtli Jn walrr- 

Z. StAtn for fnrm Ave to ten tnlnutis in &a.Lumli>d anlllD-ntfr- 
gonLlttH violet Ewlullon, va.*h *n pliyaiclogl« ealt tolulioo, <lry ultb ftllor 
|in|jerp plHfe Uii- ftirptrutjon lot twi> nt llitce mlmiCu tn kidi»'|MiUk*mmiL 
ioJid snbttion \\ or U to li)0), iJry ufaJn willi flH^ir-imin-r. d<i>f;l[»r In 
9iy]oI ujiiüa oil fl t^ 2), aud WAih ia xylot- Imticd in Canada baluhn 
rWoigTut). The iiijcclmiEi «ppcnrm alubit^il dark bta«^ If iL iw Ucjuri^ 
■Inn to :«Uln l.h# relluUr element«, ainin JlrAl for Lbr«<i nilmitrii In Hthftim 
carmin, In order U A^zuni bright rod c^ontraal etfiiiibig ol ihn aadvi. 

3, ArTEU Daq^b. — Stain for Qre mJDtili?s vilh u1urat«d Lnilln- 
vjiUr-KHntian-viiilet »ohiuon, tli^n for tw&nty-Iour houra In b conertn- 
tratrd walory Bofution of »fcfraiiiTi ooiilAininj^ 2 per ctmt. ol oniün oil, 
Üii-ii uUQ niluuLc in iodls-iodid poUujuin »olviliuii, niid wc-b in alcub^h 
Tht thtVAdi ol Ulo fungi Kpp«ir blu^, Tb« bulhoue onda ^cllownh red. 

I, By TiUtining for 4 lorig Uiua in A enlUfkLcd «ütnticu of or«CLa I& 
at-ctlv tcld ajtd u-nier lumt^l Iiri aiici^etided iu obtuininjE a Buigtuiily^ivd 
Golorinif of tbo tnmiii&l BVellingt. 

Tiio fan^ dcspribed by Israel nod Bostroom were at fint 
ctfmKifJered i^ii^nticuL Furthcr rpseart'h*fi hav& shown, however, 
Uint Uiert» arc? tjiffarenf. jfitcitv«. Tlie Rofilropni ¥j>vfiis, dL^ocnbod 
by Kruno a» ^try-ptnlhrix nclinomyci.«, pIiows etv<tunli»illy airo/'ic 
jiTOwth and beautiful muUiple brnnobing roticuLiuu, and ie iiot 
tranflmifiiblo to animnlö. l"^e WolMsracl specie«, on tho other 
bsnd, ift cbi*?fly nnn^rr^bir. of less artivo growth» and iii pHllio^ji'iiie 
for aniiimlB. Finally, thi' clfscription ^ivvj\ hy Bnm* in"lii."Ht« 
that there are probably more than these two apGcics of acti* 



Tar the prrpnmiicn of culliir*« the cbamctcriRtic graDulcs 
arc cnubcd between Et*^rile g\am jiluli^ aDiI Ihoii free!/ apread 
apoa ibc nuLncnt m^i-Üum. After Af^vcral <la_vfi binall, ^rav ool- 
onio« develop and ^adually i^roiT to opaijuo uoilul«« wjü^ racliate 
periphonl thiv^cla. Upoti serum the colooic^ a^umo % n>d<IUh 
lor ani3 b£4.'f>rni* oover^d wiÜi ti vliiLi^h clriwn (HJT-thnMrl«). 
iftcr A lime tlic L^louieä cooltscc in fonii li finn, wriuklvd 

In fonpltiflon, it mmf hero b* ineatioaed thftt branching and bulhou« 
fc«n*t&onii liAVC icci^nlly \te*-n uWrvi^ io diffcavnt bocUrU (Ittbcrcle 
bftrUUjit, piiimOolt]bnt.-1« iMdIlUH, dlphtlinrb IjftcEllun. ami f^Lüdnn Ittotl- 
IvA): to that fh?r« i« • öinputition on th* ptrt of »m« Hiithoriti«« to 
cto^fy thevc boobcrk nith the fltrcptothriilü. 


III ci>uLrAi3UlincIiaEi to tJie mold», vrLIdi «ill prraesU^ be 
o>ii4LiIer«i!, the buiJuig timgi puisen« ocltlier mj^cvllum nor 

iluUipliwiiun ttrmr» ttjf M*nplt liUfhHjiff. At one or wv«nl pulnt* 
upon th« BuHuo cf Ihc cell appcAr round ot cvcid pr^tvbomncn whioh 
iijtur ur If** lapidlj ulUiit th« hijte uf Lh« molbpi-url] and tliPtt Mpitialo 
fi' iinirj* wiEh fktli4>n 1fi fi-trni rontlnuixtii PlLAlnn or maufti- Thn pi>nii>lM 
«LloL forma upon th« surfitf« «f apoQed aboholii? liifuidt oonninU of »urh 
nuu<e> of yb&dL-Lv^b {tar(}iaiojp[n^t* Cftct:Ui<pf^ tlic nio->t riTigiiriit funa 
of liitdilinj; liniifi. Id ruf» ini,TB.n«ii Ihrfutt ami n^wlium may t.\»o 
otcur Ln biiddiDjiE fiirp- 

In luan ifriul fvn^i oecus moat CrcqucDtly in ilic vomilrd or 
dpheaod |Humc fonFtfrrrj In Mfarttt t>rafrfpulf [dUilatiaix of Ih« aiom- 
a^h]. Jn vhiili ci>ndilii:iin e^^*^ diiwniforl U raiLim! hy thn frrmmtaliaa 
thfy laducT. huFLH* bat nhuvin that In r&rc Jri^laiio«« }Tii>it4 oia; altH> 
hti palhofftyiic. Ut n cams of chf-nuK pf/rmta hf J'tunA n frvixf fuajw« «cJliClk 

tvhpn LfijM^CM inio animaU, produced a dim^*« nlmilar to tliat obwrrM 
fat liiv huruaTi «iifcJcvC 

WlirÜuFT th* >cii*U arc uf cüulo^tc BL^nificaiLCO In nukll^niifil ite«- 
pl«*Tn* is a fp)««iion fttllt vholly without prool 


Ttiwö vi'ry widi'ly diiitribLit4>J fttn^ «r« ehamewrijtfti by a 
rimpli-* ■rb<»naM'Mil tlnictiirc (Ibi- w^^ohIM Ibulliui), oompoAOil of 
flcb]omp]k)]Toii>i L-rlls whiiib Im*«.' grown itil*» iiion? or liws l^ng, 
braachod, aDd aua«toinoeing liUmenta (hj-pha], fi^rmiiig a «leoae 




or R BUklxlün, fkin & CnJ 

VBcaerABix i^Aiuanis- 


rtUrulLim (mycfhttmj. From the ktler «ri«, duHog fnicÜfica- 
t»D, the fruU*carri<r$ (fruit-byplut). wtiicb, by ihe'iT pt^uBar 
structure or tin* kind ol fruit ihoy boar (conidia or spores}, per- 
nxit ijijforontiation of th« vnriouK icram r>t mold«. 

Cultivntinn of Ibe fun^ U ln^t «L^iwmpliuhiMl upon hrfad* 

,fBjVL Dread »hicli has bt?<-n >li(:lil)j tn*»tn3 nt a mixlurate hent 

is rulibed to a fine- povdcr and rrtixrd in a glo^f dnak with sulß- 

«uGut iratcr to icakc a eoft muäh. The flask should th«n be 

Blcnlisod is the At<?flTn Etf^rfliz^r in tho eame mADu^r aa üeaenbod 

FIf, II^ABjtrntillas ruinii^ulit". X 350. 

The bulb-mold (tuf>erffiUti^), bmah-ßiold (peniciUium), and 
muc^ demand the «ttentioQ of Üic physicinn. In the firat (Kig, 
41} tiio fruit^hyphra show a tonmani bullxtUR «wrllinji^ up^Q 
wbich uro «oatfid moro or l««a nnmoroiiA. amall, flask -«hnpr;] 
bnflii^, fit th^ pitrpmitir« of which thp rfiiinil nf n^nl jsjuittw ant 
fuuml- In tLe ptmicitlium tlie gtgmtnied frLiil-bfrir».-r!» Jlrbt 
dirtde into eJiori t>r^oIi«e, tlie »o-called ba^di^. from whit^h 
apnng iK-ltcatc^ bmahlikc protonj^tnona, the aitryiffnah. oarryinc 
at their ea^b a dialn of aporw. Jn the fnucorw (Fi;;. -13) the 
nohf/^iaffi, nonhmjiching fmit'hjphm bt^nr at Ihdr vxlrrciitia 

tJao »pom in »rpEirAtc compnrUncnli, and i« «cpantod fruiu tiic 



fruit*carricT by ^ soptum, the c^iltitneUt. When npc. the «poran- 
giuiu burelA and the &porc6 arc liberated. 

Afi A rale, iiiolrh but b^Moul give riw to patholoj^ic altara- 
tions in tlie human bodj, tor the reaeon Uiat luuHi plication of 
tile fungus can nw«- tike place In tlie living li»sijM. Cüuiwf- 
(]HciitlT, the degree of dieturbain.'C proititctd is in din*rt jPi'Ojitir- 
tion to the number of spores introctucx-d. Aprnrcntly a nombcr 
ol the Ifltter, ercn when they belong io a specie« with imqucfl- 
tiOüable pftthtjgeini' properties, oun hi» rewived into the body 
vUhout Uip nppnimniv of any pnrlitriiUr Wien. 

Of the penicilliji^cfo ihn pejticiUium glaucum may briefly be 

Fig, 4a."Mucor Üor^nihlfar. X 3fi0. 

mentioned. It ib inel witli whorevcr molds are obaervod. It 
fonnE upon breud-p^iste at first as delica^ white fliikc*, whkh 
rapidly dumge to it greetiis!), raoaslike Btmctnre. It puBaeaaaa 
no prifluigi^nlc pmpi*rUes, 

rjitbogcric pmpfTtic* arc known to be poweaficd by the 
espefffill^iS furniffatu9 {Fig, 41), which form« a dirty-^rcen, flat 
Iptiwth and produce« pmnll, bright »poir«. It is obeorved in 
many forms of pnpnmnnomycn*™ (Virohow. Thiwh, and Licht- 
heim) ami certain affections of tlie conioa (TipWr), which Are 
generated Uv trauma and the synchronous introdiK'tii^n of n8p<*r- 
gitloua vegetution^. In pulmonary mycoela the fimguB develop 


as a saprophyte upon old tuberculous foci, hemorrViagic infarcts, 
cancer foci, etc. [According to Roger, aspergillua fumigatus 
may cause suppurative dermatitiB, a special form of onycliomy- 
coaiSj suppurative keratitis, or lesions of the ear. — Bbooks,] 

The spores of this fungus are very common in bread. If 
nonsterilized bread is placed for sereral days in the incubator, 
a very luxuriant growth of aspergillus will generally be obserTed, 

Some species of mucors may, according to Lichtheim, give 
rise to aerioua disturbanoee (ulceratious and lesions in the 
lungs and intestine). The mucor corymbifer (Fig. 42) is of 
especial significance- It forms a dense, snowy-white growth. 

Fig. 43.— Soor [Thrush] Fungu*, X 350, 

Unstained preparations are best adapted for microscopic 
examination. They are prepared by teasing a portion of the 
mold mass in weakly ammoniated 50-per-ccnt alcohol, and then 
eiamining in glycerin with 150 to 250 magnification. For stain- 
ing it is ndvisable always to use Loflier^s alkaline solution of 
methylene blue, which stains the mycelium and fruit-bypha?, but 
not the spores. 

The systematic classification of the species of oidium iß still 
unsettled. These fungi arc of much simpler structure, without 
fruit-heads. On the contrary, the spores arc fanned by direct 
chainlike segmentation of the glassy-clcar hyphiE which grow 


MlcrtüSuUt'V AND CHK«l?frKY. 

Olli from iliE mycelium. Tlie beflUknown apecl» Is otdium lociUj 
MhkU i» cunHiunÜj pntuMit in milk, «wpf-.ttijilly tliut wliich bu 

The tfxrtitli fur\/fu4 (oidittm albicans) [l'iiT- ^3) wm lonj; con- 
fotind<*d with tho o^tfiüni Uctie, It ia fiomctim^j; cliu»ßd wilh Iho 
budcÜn^j ftinj^i [yimnU] (Omwib), ftomtrtimM with Üif* lo«^r 
Jimldn {Piniol.). It >K, lumrvcr, qiiJt^ ju>^tly cI'imhxI with tlic 
molds. It occur« conttaiLlly in the nhik, flccciil^nt or mom- 
bronoti« (l«pO0i1« mH with upon tho mucoue eurfacc of the mmith 
in children or dt>biHtated patient«, capeci^Llly cou«uniptJv«fi 
[nphlhiEr et mjcotk or parasitic fitomatitid]. It coii a1wa}'fi 
be removed witJimil injury to the underlying iiiuoolib iTieiiibrAne. 
It ifi less frequcrtily ohnened in the esoplmgLis ami in the vagind 
of prrgunnt wo men - 

U almost tiover manifeeta pathogenic yropcrlits. E. Wag- 
ner, liov0Y(rr, hflfl oh^n'Ad th@ pntranc« of the fungua into the 
tiflcue of 1h0 psophngpnl mnroii« ni^nibmne. and Zenker [also 
Ril»bert and Ouidi] iltlefl"?d its prewiif* In oercbral atwcwis 
[and by Sdiiuorl and Kl«nipcrer in renal abaceta and t3ie lung 
ivipetrlivi-lv. ALVonliufc' to Senator ivnd FritBch, oTdium nmy be 
found m tho smiUl and iarg^* inU-sliiie, bladdf?r, onxjs, nod mlva, 
' — KitooKS,] Quite recently, nieö. Klemperer succeeded in pro- 
ducing g<'jjiiirjf geijr.'i'al soor [Ihnjab] nivrasis In rßbbila by intra* 
venous injcttii»» of pure (ultiires. 

It con bo detected by crushing a small fragment of tli« 
deposit from the uukous vicmbrano betwoi^n a »lide and a cover- 
glasSn [Addition of liquor potaasae to tht^ epLH-iTncn renders it 
dearer — Brook«.] When eitmmned nnder llie mien^scope auch 
8 pri'j tarnt loll shows grenl nuttiber^ of glus^y, bmnc-htng. und 
piutüd thrcuds, «ilh nudiflrous free, brightly gliglcutug ajKires^ 
Tffhidi fllsc occur imitf*i to the thrcade. 

üf far greater Jntr-Ti-st to tlio phwicinn arp. n few fun^i 
which rtlno belong to the oidiuui fornw of fmigi and which giv* 
rise tn chnract/'rifitie disfnur» of th/i »Hn. Tln^*e wrc th*? Ach&fion 
üefuriihinii iif favitfti tlio trti-hofhtfitfH Utttfinrjnfi. »hk'h iiidui'ea 
tlie anme naiiicd fonn of hfrpc^; and the miavsptjfvn /itrftir of 
piiijna4i4 vcnicolvr. 



FaruH ow>m ilnott «loluuroly upon 1h* htiry pnrliovt of ih* 
\, TDiich more atldoni upon the nuLla \f>tifrhvmfPv»4A fariitai 'yf lA^vr 
uf ibif InnJj. lit Uiv Tir|EiEmi[i|j il iip|H-)Li« 14 » jhIIuw ti'viclw (waB- 
listed bj ■ hjiir, nr ■■ H Hisr(i*tphHiitT piiv yf4low kOBfa iimituliim^ 
■urmuudJnfE B otiLtrully local'H hnir. Itj c<>cilt>4cmoe of nutnrrou« i^aiuU 
mU-iinlvo Kvabi aic ^riciii producrd. upoji the ouU-r rorjo of «faJcli Jin' 
liiwt wululijm Carmatlon nui u«tiii]iy 1« dUllnguliJiiHl- Th* hHin 
nlwft]rii «rqinir luaUrTraii «re brUltt, ond futt out ot can nhiljr be r«> 

^llow, 'Itt« fungous growth OM-vmn|; tipon tljt nnili I»Ja «itU^r unly 

Hf. -M. Arbohvn tkhünMbii. x COO. [AtH^e RfzM<i*n.} 
to clrciiokon Lbnl ^iHluvrJuK i1p|>v«Us 01 to ft deeper ■ffcftiab of %ht Sbll 

The fuiig^u», 5m diftcoTi^rcd hj SchÖnlcia in 1S39, aod 
luiiDOd ftftcT him, Ü found in tbe root-fhcnt.ha and between tho 
fitct8 of Ulq haiMmnk, a^ we\] da Jn th« ecrapini^ from the 
iopf^naib, and wpedftlly numtroaf^^oftf^a in puic culturv! — in 
tlw tiinbilinitcH, ytiUnti tcntulti. f'lr pTrtminrtfinn it i> MiJUrirtit 
ti> mb A frn^ment of a fft^'oii» flnkc with wnlc^r or Ammonint<>] 
otcoKol und cinminc! in jElyccrin. |Thc sctl<v can midily be 
examinrd by moiKti'UJn;! th^^m iti n*H'iio neid or li^unr ]>ot&ttA% 
(|>rcf<Tral>ty t)io 1att(<r) and tiim cnijiliing bctveon a ooi^er-giott 
and «lid^. — Iluook»^,] 




The fungus tt^nm a donas mycßlium composed of atrniglit 
and wfi^7, braiiclilng;, glassy thnsu]« »tjowing here and tliorp die- 
Unci nntiOitiig or niws of Inrge m^il, Mff^nijly rrfmrtirp *pnrr4. 
The Lilir.r filso occur free in greater or Iwttr number, but are 
then u^unlly cirrangcc] id chain» and maeaed. 

Trichophyton Toniuriini. 

M'l\il(? the dcleciion of the fiuiguB of favus i« alffftye wisy, 
the «iwirch for the fuu^uä of herpes toruurans 13 ueunlJy iissci- 
cinted ^vith grojit ditücully una olwayfl r(^qaire8 muoh patioDco. 
Thia is dc« to the fact ihut llie fungous eleniects are never |.in?fi- 
eiit in KiK'Ti rtiiinbers n& m fiivuä, aui] Iho innntuiaatory irritutive 
phenpiiLtuii ore much more eev«re. 

Pig, ^B.— Trichophjlon Tonaumn«— Thread* and Chain* of fiporo«. 
X400k [Aft« ÜfMOiWü.» 

T^kc fiin^cii« fjrotvlti atUckn iHc Mty timl n'mhiirt/ »kin at ictfll 
Of tftr hair and natln. The ctivnsrd eiiirlenrii^ Li afTt<:lpd only in ltd 
«tipojtl^i.] IftypDi. Th? pNmiLry «mivll, r«d. an<l aflrn «Kly fput§ Tlii^^b 
jiuhii«i|i]pnl]j cvnlosce is form riv-n hand biiod tkivaa. arc UAiially ducoin- 
pflTiiiPd by vMicIt «nd |Hi«lii|i» fnrrTialii>n, U, s-s ia oFlfn tiie raaH, the 
AturdfYj fiarf »f Ihn: face ib atturilecd, inl^nm^ inflnuimitt'iry pbciiompna 
■rp tii-iiull.v jiirMiiL la this lucatJTy a» well ao upon tlic *rfllp, where 
Hir infliLnmiufflry IniuUvL* ph^-nflinr-nn arc* always I01* ppi'^rr. Ihv hafr* nt 
flmllMNxnnp luMi-ricaaünd iiritU*, nnJ eubaeqüoiilly Lrenk o(T(hdni!t /Ifr^JP» 
tfni/tuiatk^i. VI tbr liairs may faLl o^it as tlic t^t^U of thr f^owlh of t}ke 
lim(jin iutn lUf* rool-üUfaih* or Hip harr-suljölancw. Tlit^ ftn^/cr-naiU ala« 
may bevome bntUv in pnrt or in totr> from growth of tho fungus. 

Tbo cflusativo oi^^nt of herpes tünstinuie, tliG tt-icht>phyi^^n 
ionturaiu, «as diocm'er^d liy Gruhy and ]kln!ni3teii in 1344-45. 
Tlic oftou long, tltghtly brauchitig tlireads form a distinct m^c^ 



Hum in vliich long, epomlated threads can usually be observed^ 
Collectiona of free spores (as in favus) are rare, and in euch 
instances their arrangement indicatcB their origin from sporo' 
chains. On the other hand, large groups of Bpores are quite 
frequently seen in the root-eheathB and hairs- 

Demonfltration. — The eiamination of one or two diseased 
haira eeldom suffices for diagnoeis; usually a large number — 
from ten to twelve or more — must be carefully inspected- It 
ia beat to examine the teased hair-stumps in glycerin to which 
a little acetic acid has been added. 

Fig. 4fl. — MicroBporon Furfur. X 350, 

Grawitz haa positively proved by cultivation and successful 
inoculation tliat both of the fungi just described arc different 
forms of oidium. 

MIcro^Kiron Furfur. 

In 1848 Eichstedt discovered in piti/riasiji versicolor afungns 
known as microsporon furfur, which ie lookiMJ ujtou as the posi* 
tive cause of this disease. 

The fungi enter «xdueively the uppermost l&yer« of the epidermii, 
giviDg; rise to the formation of smAll, ueiially circuUr, aeldom «umewhat 
«Icratfd, pale-yclLow or brownJah spota^ The eruptioun, its & rulfi. uprpinl 
■Jowly And aiXan remain disHUiinBted, but they not iufrvqucntly coiiUflco 



Ktiil »tt'nd to «ucb a dcgTM that Iho wbol« tmnk apfican lo 1m viti' 
fomilj cDhcitJ «x«fC toi oi^ca^loEiat tnmlW or IfliKtr ivlaadi of llit^r- 
vrniitg iK^ih; skin. The npai* nor nnd Uirh prcAnnt a ddlcate, bnTillka 


DemoTi»triition> — Tf one r>r th^ Emnll spots is inoifttpnerl fop 
oae-foiuih aitikLite with lO-per-ct'tit. cAu§tic potafili »olutiini au^l 
ftoitiL- of tbu nofUnod upper In^^ra eorapod off vitli the edge of 
ft fiini!|>t't and eaamjood undop the roioroftoope with tiljcjul 3.^Q 
mn^üiöcHtiozi, lliero will bo soou numben of clii^ti^v tiic^rt, bonl, 
KPgnirriWT uiu] biunrhiu^. brix^t t1]i%>t<1j( vith llm miimle«^^ 
highly refractive spores arrn-nged in grnpc-like inasei?a, 

Fig. ■*■-— Lciilolhiis flf mid r«i«miüimi* f^K X ftSO, From • 

Xeptolhrii occur* moit fre^u^-atly a& Upluthrix hur.culä, and 
srti» (liscovtrctl by l/>L>iiwouhoek. Jt vi^ry probubly b<^]on^ to 
tho at'ja, not to Ihc fiBtioc funpi, and u comprh^i^il of flonnö 
bLiudlc^ji of «Injipht, fik'mitT, transpnroDt^ uonbnan^hiiip; thronds, 
whidi iiri' irkcliif«*cl in an citromely ilt^iitu^ ütiv]y prnnnlar inaM, 
Whrn cMiiiiiiKil veiih elight iiULgiiilitNilioi^ tlir; inilivLiliml t]n>?ailA 
presifiit, iu their jnteriora. siiiaJI, round, regriilarlj iiLlcmtptiJ 
granules wbich üssttmc a blue color on cdditioi^ of iodin. Thin 
Apparently indicat'^ Ibe pn^tnce of Rlarch. 



Lcptothndal v«jcc^ti<^n>, vhicb arc con«tantlj preacnt in 
it deposklB and oepecialij nimiorou» in the c4viti«B ci d«ca,vf^ 
Wtl^, are oi^Dcenied in Ui« formntiou of tartür aa well a» decfll- 
L-jßi'JiLion (rari™) nf the tpH.h, Thrir lUrnnriÄimlioii in ^ra^jr, 
WiÜi a tovthpif^ or vlmilnr i>bj(<(iH tokr a sauall portion ot ü\a 
deposit on the Inth and pUcc it upon a ^lide, with or wiüiout a 
dtop of [to calb'll phyiiiologic salt Elution, anil prv«M upun it 
A eovor-glftM, If tbo iodm rmction b« rr^gntivc, ncidulnto the 

The Icptotlirix waa ob8i:rrvciJ bj' Leaden und JafT« in |?ui- 
iR(»rt(u-sr gungttns and 6up|>o«cd I7 theiu lo bear an etiologic rela- 
tion to this proce£«. l'o«itive proof of thi« relation I» Ickckirif^^ 
Tlie auOior found a dcnae loptctlinuiai llf>r4 m addition to 
cercon^onflft (soy "Animal Pamaitea") in a froitlily opooed fon- 
,«i^f sh^rfM (Fix '^^)- ^'hi<ihi^r in thin rani^ q pathn^nii* 
locDoe «04 ottributablc to the a)^ or the iafuvDria or whcthf^r 
both only accidrntally nccompftnied the (mppurnHon (xmld not 
be decudod. Tho Irptothri^, in addilinn t« otlior floM of tho 
«ral CATi^, WAS n1[v> found Hy the author in a frtfhlj operated 
^angrenoufl pulmonary canity. 

rOf tho tw<t sTcat j:Toup« of t^io- and ^Mo- paraaitt^, the Ut- 
» of special intrrcAt to the pliy^iciao. 



Ol the ipni?« ol partta^m Imng upon (I1« »Ufia« of Ihr tmrly titr> 
foUewJnfc fiiny Ifi^ brivllv iii^ntidiM^- A fvw ^ctu bud Hri^ki. pirffj* ;/tfnf 
ffan4 ISmlh Ami-rkHi mxt Ij^fci rJi^HMJ. cUiii; fur wmLh li> fW lnhly 
btf miif» to aurk hi« hlitcid, Bfid fXHimtiniiAlty tiuliicv intlHrnmatinn «nd 
al«ntkn^ Anolhor aprci«» of lii^k. af(W« iv^rjvM (Hf^. 4H], the pif[con> 

nitfli, infii^linft |ijf;»<vn:4 <inly, lih» mviihiunHH^ jfVvvn ri«« lii tir;iii|irlilvid 
tfupuon mnA "vvcir tErumtl inllAiiimnlury rdfom nf Uh «xtmiftl ikin «ml 

nvcoUB mtnihnni*. oHh dlBtmBlng iiihm« (Alt), 

Thia lUrlj ffray par»»lle !• abuuf S mllllEntlon hi^ml fltid 7 Oiitli- 
mci«t« IvniE. und ■■ CEir^erU Willi A imhktli'ltk« mLi^II. Il Un^ frntr fAin 
of 1f^; Id fn>til uf ttiv nnit |iiiir I* Ihr- ^inoiil. In tmri ot tin- «iv^ind the 
gtnlbil Apcrlurr. «nd Iv'itnd Uo fourth puir l»va tlie doaoa. Ln Ihc 
»Ub* of fiiBtiiijf ihv tii'W i* flattoncdi [Lftci tucklaijc it U ittniutt «I'livite 
and d1t«n ln<^rrHH<d Ui *l|[Ut Um«» lu fOrmor wvfght 


UlCBOecOl-^' AND ciiEMismr. 

Of IhB «pedM of phlMriui may b« mDiiUon«! th« cr9thMt9 
fphthiriin pnhh), whtch fint *nd orun cxi-luiüvalf ifif»t«> Lba piiLii- 

liiiim. hilt AOCAAlAnall}' alu TnlgraUi Ut all halrj purt* of f.!u> tmrlj nt't-ril 
iho licttd. T3ip fnmuli* diipotiU hnr ova iijion th« liair«, to H'hich tlu 
pttiv^t*« tccj flrm^j attach t^^fijnrlvr« hy fiook-tliapcd cl^ifii iPi^. 40|. 

Atartui ■£]! fU^iinU'j: f'lltti'UltaitTa. th<^ ftij^r-*tf(7 m(fr, o^furf ftl üifl 
l^ttom oi almcMt every bjqck^cpd {comoilo] nod U rvadilf d(>iiir>a«tmt«d 

Ft|r 48>^Argv« niflfxnt- 

(Altw Alt) 

In imtar prepAr^UDna mad« with iho »baccoiii »cirDtioa^ Tbo ffllt« U 
■lnruL 0.3 milliint'tcr luni;. la juldUIoii to tlic kcad, U !]«■ a iTiDnut, 
■ijpplird with timt pnir» of frvl, ftnrl 4 pitti-rinf bmljf IhrH or fnikr UniM 
0« l^ng » the thonix. U u an ina),|TiilliMLat paTviiitv fl^igfl. 50 and filj> 

The Jufco/^J« scabißi Cflüer» the i^cÄ, or scdbir^. The fenijile 
has stjckere upon the two aEten^r pnirs of ]<^gA anrl bristles upon 
the two f»05tenor. The nialo is fthout oae-thir<? ii3 Urge ah the 
fctnnlej And Kab Aiickem alao upon the two postori^r paira nf legs. 
The fmnale an«! it* nva are iK>4t fonn*! in tlm "mite rharvnth." 
To ßod it, the whole channel — the bef^inuiLg ol whidi is iiuU- 
cat«<l bv a «mal), usually dried vi^icle^ and the iurtJter courae 



b)' diirk dotri (dirt luid üsccroseat), luid tho end b]F a tmiillf whiU 
poifit lisiblc through the homy inycr -shotiid he r**Tnovcd with 
■ vmaU «ciiljK^l fliid cniElud In dilute vnui^tic j^oUuh butwf>oii two 
glg^ Klid(%, Bi»id™ tht* frmnln, uJicwir lorjiJum it shown hy 
the bright tran*ii*r^nt [inäiit nt the did of tho chunnH, Ibcrr 
will be *ceü a number of niof€ or lo** devrlr-pod ova «bowing 
granular vontouU or alnto«t ripe ombryoa {h'ig, öä). 


I i Prolo3<iA. 

Of thfw, the nftlahal Plasmodia iV\iiie II, Fii;. 11) are of 
duel tnterc«t. The orgnui^nis, discavcrud in iSh^ by Lavcnm 

villi Ijiw. Mii|{Tii]1niii(irL 

riB- 51.— Tte SuD« -mlih llisih 

and Bicharii and aecuratWy itudLcd by Marcbiafaia and Celli, af« 
af eilrouKJ clinicJÜ importance*. Thfit ii|H<tf'iOc etiMogic signitf- 
auin' in iimlnrin i-nri »m W>:i"r 1»» ilimMiil, Jiml ihaiT ilutctnvry 
pcfiniU the iiiinni«4^ IliAt many other ihfrcUuuiv iJi»oflaM alM an 
produced, not by bact«rin, but by aJmilar proUpUiätnic bodi*a 
eUndiDj; on the borrterlinr of th^ ajiimn] and vi^table worM» 
Tlwlr iTftrmrtlic ctasfiifirHtiot» i« nnt yrt a*»ttlpd. Ac?c^'>Hirig Xr\ 
MctdiDikojTr they ai* very elovelr Hali^il lo the roecidia, tc 
«lucb vit-» K. Koth »6, vitli dertain tliuitulioDif. al*o ladiiied. 
For Itio pivKiit» Luni^\cij it iä ncU to cciiktitlei th« nuUriil 



pla»inodia t£ ü apoci&l group, ol which tbo füliowin^ «pccräe aio 

2. f'hcpciaaite of ttitiunfcvtr (Uvl||L|. 

:e. Thf* pnraMtt oj iropiatt fffver—tMtttoavtuiMiat fHvr of ih& 

4. The matariafoUi jmia&ifr of mftnkeyt <R, Kw:b]< 

«. Barifriäivtn iianUra-fikvi {LabU}. 

Tlie paraeilci cloeeod under No«, i, 5, and ^ which occur in 
monkevs aud birda« njuet here bo considcrod, because in them tba. 
vi-ho\<: proci-ts of development of ü\e para^it^ hae been au 
fnllj «tutlk(T, and their doae relation to the mularml plnsmodia 

Fiir- fi2- — ftu^opt» Svakiei. Fcmnle b«d from AVrovr And B«Iöir, 

of man has pi?rmittod coQcluAiona aa to tlw biologic characters of 
the latter Th-* follovrmg has hatn itetermined ly ILo rt^Hoarohc« 
of MaoC'alluiu, Roea, and B, Kocli in refcroiioti to hilteridiu:« 
and protwtwmi« : — 

Thfii prntoiihi>TiiiL orniira in vanout btrtin («pcrrf>wit^ etc-] snhnbitini; 
VBnn clIniHlri. U iipf>L'aiii in Ilic Ulood uf Ititt? nuiiuuls in tJin form of 
n>iAl!<T or larger ptntDia gmmiloi wilhin the veil blood corpu ad?«, und 
1« nnrUl/ nooj(riir«1i]v, on nUiftiaj^ with Kaiiuir^ciwtLiy'ii nUin [hi-a bol^iw), 
by t^e 1-utiu-trd fl\tKitiiii(in niinlfwi /ii\tl thr Iilmj-Ktitdtr't jmitnpUiAmtt. 
W\t\i gradiiul growtli ot tliu "rlngv" Unc pigmcal |,-raiiulc4 art diipanitrd 
in thcni, Tlu^n üivi^ifm üf tlic pBiiuitr iiilti i, fl. or Itl pkrU l-^kirt plnn;, 
til of w^iEcfi niiiHJht tit A rtiiiLW Hirtjuiv-rln nih'tniH 0.111} prulnpldsm. Tti« 
joung forma »gain i'iil«r rvd blood- oorpvtot««» and Ihe oj^do la rep^AlrJ 




Tn additEcn Tu IhU mod» c>i di>i'dcpmpnt, ivhlr<h utAt di^j^ni"] I37 
P. Koch u "fftt^pe-NOM," K acc^DiJ— '^rjvprnoTfr" hai been dctermjnf<l 
Iej tuuw of til« i>*iii»iir« ttnuil. tkrtadHkf rifidS*'*. tflrrniat*>:wt, uc Been 
111 #4fmp>> from Ihn f timninl lit niii^l-ni«- TliHi** ^Kulif« nhlhit ftrtir^ 
^ilfutlle inclcpcEnlcnt luotilUy, hy imua of nLii^h tkify «ntcr Biiothfr 
l>l»iiiniliitrit. >^'hli tliin (MTiLtii-ruvi dt^tcliiimiinl wilMn (fiv |M'iiiiaiy liii><t 
in, Ah fur -.i^ u nnur knou'n, ■■nni[tM«<). KurDinr jttriix'lli likr* [tintv iii an 
iKUrii'fdiat^ k»"!^ Tbc mtorriiodiatc host hna been dtmonetj-nlod to be 
j& funkuliLr Mprrlrr nf mii/tiuil't. tf tHa IaiUt hii fiii'knl hlotx] (rain 
liini* mck ytiih tiiAlni-iik iLfl«r fritm Lw^lro t» fllUwn hniir» * dmt "ivr- 
«fffcvlar* fonn car be ««11 00 mlcr^BCopk tiflmli>*ttao to develop from 
Lfio punitU« Hii. £h1iHr^A4 In thi« blrd'a blooil. At dnt thftra pntntdi'K 
from thfi tphfrifi pla^modiura 4 protvwi which flUsdUj f^«« UrRTi anil 
Auuin» till? tinm of A vcrmLule. Thb nai|jc« from ttic <D«dn^, and 
■rur lorty-'ifiht hmm llwiA nvw füriiiB Iisva rlU«pp*iu*d- In ih^^Lr plnrd 
»pprarj upon the fjfrrntfl «nH of lAc ntvm/ich, wphrric» piffiieotcd, 
(T^nfrf^fllv forpiiu^lc«. n'hirh. In t.ti^ coimrr M «It rn n*vr^ dJkyA. arp 

tatlie p9iiion [or mlimri/] fftands of thf mf)A*ivito. whcEicc thtj pu« Mq 
tUo animal body vrhon tho mou^iilta bttoi a blnl- 

Thife inoJa of inftiition nf bird« tliroii|*h jiio«i|iiitOM hu bf«» p'wi- 
Ü\«ly dciiKilutj&l«! by Row and R. Koch. A sinkllnr prowort Id ob>ervnl 
wU3l h4^t«n4Him [comu^an \ji cTon^. Tl* young pamtit* bm a <tiim3> 
bell'ibapfd form, which *t(*un chanur« to a ipheruid. The Uood c^qiuvclfl 
U dffvUoj'r^l aod th? pnmaJLr iii^t frn. 

With KoiTunuM^iLj'i. »Tnlii It U pauibi* to dHlmguliüi two t-aheliv* 
of ptaioivdia^ Omt i« i-hikmi-lviirr«! hy a tai|;v, o^inpacl (hTgtualiu 
miolrUL, thp olhr-r by a nmnll nnolt-ut ciü^ly «iirroitndnL by inionvly- 
hJDv4laiacd protoplatm. Out of the Hnt plasmodia {Üit iiialo imitvid 
ua.1>1-^Ih4^» fn>iti thn chitJiiiar.iji nu4:Irtii» — a uumljrt uf L-llJulikr Ixihli» 
d^v^op vhicb trr i<iiditwiMl wllJi arllvo if]d«prnd(<nt mntüity and moon 
«cparale IbrviHU'«« from tbc bodv. Tht*c aponnato^ca fniftify tb« 
«MOfid fonai of plnhiiiiHlm ilhr [i-iimU' ImluidLialKl, wbii'b llic'y prnrtratr. 
Afttr copilati'^n IhP ffmnlr «phrri? piira»i« «rnda out a ciin-E^t, hornlik« 
|vo?na. iiliUHi. »■ in the proloOfomai dcvflops inUi a ^muKutn hhiI 
Anally hnviriii« vgtaralftl ftuni Üift »phtnilff, Tli«: pli^nwnt it rrUini?d In 
lit* TcnnJciilo 

VThpQ [fv/it*>I «iOi R<-iTriinow»ky'» »tain. IW '"tciinlviiU'»" Uhu« 
ft nil>y-nvd rhniintttin i]ii<^lrti*. |>]iir-t.iatnAl prntj^pla>m, anil Id t-bU a 
fw round, tiiiHUi«^ «potn. 

N'othLo^ ia at pT»mt kno^n o| tbc further development of lialtC' 
ridlwn, AmpnIIng lo tba analogy of ^otpo^oan^^ it may I« «aanjnnt 
that 4n intormfdintr hott it required. 

In 1h<^ md-Wrirff piosmodia of mdA> a?-«^. «n4fi7M<>v «nJ 
loo^M^u« J^Wc/inicni most be dtttiDj^idi«d. Tbc fini I1A4 



bivii t^mie »H! invcwli^tctl ; iiiv wx^ori 

: the iiitei'mfdiü 



i« but litlk diiddiitifd 


It is ccrtaiD, ] 

Tlio funäiirrißnial typa of the matanal paraJitäS \e the ring 
form. In v'htch a dietiuc-t imcl^ue van often be diBtingiii^Wrf. 
T\u* *\'jU) o/ Uii> ring vcirii-*^ in H«" OilTinut fnrrrH; in all il ih ftt 
lit^l niiiiill ivnd ino-rL^igf» with iJiv drvrlopiiiviit of the paraaik'; 
it TNrittf between 1 und 10 ^ I'he gfrma lie upon or vitliui tho 
red blood-corpuaclw» In urwlitincd propnrntiflim c/wfinci am^- 
ftrnd mofjtfffT^f con b« «oec. As a rulo, but ^tm pnraü^lo Hm in 
A Wood-wll, tliongb two, throe, and more eomotim« (wcupy n 
Bingle oorpufltrk- 

Aä growth aJvnnce* a duBlUhe pi^'meut, which i» derived 
from diijeaW liemoglübiü. iimkM iU «pjH^aranoe *it the poriplicry 
of the nn^- 'J'hü pij-ment i-mnulo* are ofton ohftorvod to iiiaui- 
fost telive diLUt'iug movömt'nl* wiihin Iho paraaiU', which action 
Manntiborg «ttrilintt** lo n flowing' mn\pinMU of the jiljtmnn. 

Tlir fiiml @lng(7 of duvrlopnjt-nl at Iht? |i,imhi(ts i« j</mrwfii- 
Hon. In ihc fully ^cvHopi^i rings distinct frgmcniiition of *hc 
originni both iiiln frgm 1 to 8, Iti» or 20 pnrte ("jjporcF") cnn 
be popn. Thpw an' hborntpd by bursting of lh<? pnvHojM», nml 
the above-[.T«irribpd procpwof Hpcplnpinpnf is n^ppjitnl, i^ncli spnre 
enlerin^' r red hlood-orjrprjKlo tn grow into a ring. 

In itnutairtrtl pröparation» the lecoguition of üic fr>rrHi* just 
dwMTtJbod rrqwin* j^reat txporknco. On Hit othor hand, ätnintiä 
proparulioiiH not only fütihiat*^ the lindm^: of the paniMti.^^ but 
alio cnnbh Ibe LviiAuiiner lu ilislinpuisli etructuml c!iJTfri'Uw*j(, 

For ttüiifTifMis, ftirriptt sunning tif drksl blond pnpjirniinnsi 
vr\\\i riini/in!»ky s s^ilHtinii Eiiflico. 

Mnch #bnrptrr pjctun« can be »ecnred by the metlwdfi of 
itomftncivfflky, Tbo hitcr found thfll, undor cortain oireum- 
PtÄiic™, briffhi-fftl niiH*'] conld bn hr^iipht out in the fwira^itofi 
vr\ih pnrL> watrry mftin-uiethjlenp blue wihrtion. Thia orL'urr**d, 
h4*vii-'vcr, «nty *hen the dy« wrere fivehly ftiix*!, jind vthvn ihi? 
mMylrnrs hint 9tiltUitm fmil hi:fn fiUrmf hi/ Iftnij yf'tmiintj ntui 
fkc prrspncff vf mi/ida. Notht iinpruvt'd Ihc^ metbod iipm the 
hatfU of hi« oWrvttlJou that the alteration of tht* vat<^ry methy- 
h*ne blue* »olutjoü cän be MttiriM! by h**fltiDg for tvo days at GG" 
C, whprchy tlir gidulion itaenmrw n violpt h\it\ 




Mv fofnipf iiÄUtnnI, Ur. Jlcij(4*r, bus grenllv sSmplltlecl tlie 
lirtHv^lure hv ■ mnv^riii<nt, |)n^]mrMH<)[i at (hf »o-tnUtHl A-methy- 
lcrieb1ue(GrLJU(^r*[f),wlt!chataiafctlic chromatin. It i* «^-mployed 
JuMlvcd in incttiyl (wood) alcohol. lCr>ijtor~f iru'tticHJ u aa fol- 
low*: Tiiv flirdriod Bmoar prcpnmlionA a^? Hm^ by pouring' 
apon Ihf'tn fnrmol-aloafiol (formol, 10 jisrtn; nhbilut^ altrohnl. 
!)0 pArU) BTiiJ at one»? caivfüllj drying ftitJi (llter-jia^HT, (The 
[)ru(«Oure Ukt« atniut llirte HeionOa Jiml ^ivn ihv lif^t result« 
for all TUvthoiU of blooJ-fitaioing,) Tlicv a«i llien plaocd in 
a «)JUciouH tli&U (t-MviT of A Fetri diplij und <?ovoro(i with Iho 
«Uiniai; Holnhoa (difitillod wul<^r, "^o cubic eontiraotere : 
A>mLihj'|L*[ie bli)c-4*»«:ii soUliop^ — (Irübler, — 30 drops) miiinj in 
a ^riiduatt% i\v ngiiittiDg tlie rtUti ns in dcvt^Ioping n pho* 
to^ETApbic plate, prccipjtstion <»f Ibc Hyc *nd stntning of Üjo 
pn:pjirfltion£ cau be battened. In ti\ inMooixs tbc pr<7oo^ if 
oouiplMed in from fift^Q to thirty minut». Finnllj, vrgfh in 
Aoviag distjiled wakr, remove pic»s of wat^r whb t"ilt<'r-pappr, 
dry In tb^ aJT [or bigh abcve the llnme of nn al<riboI-krn[i or 
BuiiseD buruer — Bkooks]. and exaiaine in immertion oil tvUbout 
covcpgU» or After mimntmi; in Cjmadd bulMiin. Tbia tnoUiod 

jpTtn tu cnlin.^ iatic-factiod, 

AnoChfir «ur« and eo&vvni<>Qt mHboil i« tbat of Gii>nn«A, ot 
[utiborg. It I« as follnwis: A(vor<1iiig to iSHjHiiprni^nis, pn'pnro 
an (IS pfT lOOO vat«<rv i^olt^li'^n of a dyt- kiichun ai* axiir ^ (mflli- 
yl^noHixufcblorbjdrale -)- jiittbylvae blue, medlciiiat. Ilochat) ; 
abo a Ur^'i' quaQtitv of a 0.D& per 1000 vatcry Mlutton of «ono 
(Ö («iibic ci-*ntiriii?Urfi ctf a I-p^r^coEit. eo^in fohilioa in lUUU cubic 
ccoltnitlA^n of vnter). DistiUed water should be luod for the 
«filutiont, wbtt'li should be kepi rvatly In a diirk vifiwrb In pre- 
panng tbt? Muiiiiiig inuture 10 cubic crntiiiii-ü-r» of tJio i<<i*in 
»otutioo should each time be placeii in a ^aduatc and 1 cubic 
crntitn^cr of the ozur loltitJon addcil and the volvition fthakrUi 
Staio for frcim (ifm-n 1o ihirty minutiw, VTtfih for from tx^ to 
ten »PcnAd« i:i a «fraii^ »1n<jim of vmtrr, mount in nonadd 
bul^nin, And rinmin«' in immcnion oil. 

the bri^Kt'ted fhrotrtaiiri yranuh^ arv tlieti ditftinctW t^evn^ 
U Ü10 red ooloTfllion of the r»d blood-oorposde* ia obvcured by n 
bliiifth tin^e, it t" advUabW tmbe«quMitly to »tain for a idiorl Unic 
with eoain «olulion, 


In TC&tr^ to the red granules, it may now with ccrfamtji It 
assumed th>jt \kf:\j v^jtresfnt tin cMcntial curufffii«»£ of Uic pam- 
*if*, HA n *iliown Uy the faot'lhat oauh ot Ibu apurw püäöt«*«! & 
«IHioat« clirnmaTiu ntu^leui. 

The dtrorruliii uhHhih u^Liutlv Ih« nt tins »iirfmv nf t^^o 


ringEy luee oftin in llur iulcrior; it iu irn^j^iilar ii) form, not 
iriTrciiutnlLy titig-^iiHiH*], auJ vjiric» in tiKü auU tloplh uf frt«in- 

BesiOofl the chrotnaliu, a rouod, oolorW spot (vacuoU) U 
flnmotimw obaw^pil in tlie rfng-formed pla^modia. 

Xl U prvbab]« tlinT, in A'lilllion to itrnt-ultltioti, m ■«^»iid mod« Of 
propii;»ftlion ommi*. Tin? DbiK-rvalJoa t>iüt vcrjr nctivttj motil*^ flapcll» 
V bii'lj ujv k'niJuiiMy A<'t. ivvn arc iHr] lo drt«|op fiuin lunnj parafcllct 
«]rf<iik«i Ln lavor of thLi vt^w. Ai to iht lurilicr fntd a| Ibuu flagalla 
nothinie ifi pciHiLivrlj' known, but ibc ftnulnK?' with Out *.\Ktvi3 AricTihtd 
procBurd obru-rvvd tn pnilKtsmim nnd liHlu'ridium Ib jw ucinifstakiLtik 
tliftt it DtP^ bo fluniikBod Thiit a «imiliiT cmir>B Is foHovcd Eici'o^ 

Tku!» for the follawing miiUml pldsmoilin haw bu<u Accu- 
ratiJlj' (tiulio<l will» tUo rjid of th*? miTtJioJii ft|poa*3y ü^jtforib&l: — 

I. Th« FarasUe of Qaartan Fever— A^ Golgi iirti «juter- 
minpfl, it omnpl^'ti'B iU (10vclnpm^vl^ in »^vnljr-two hour*, aat\ 
first ajipi^ar» ba a Aiuall, noiipigmeiite^ coqiuiicle located either 
upon or «itbio a rtxi blood-corpuade. After tvcnlj-four hours 
it. Inii brcomt' lurgür ont! fjopoeitt'd pii-moiit at if* ptrnphory ; the 
primarily toincwhul shigijisk amubciii movemeriia ctaee, Afti-T 
pixty hour» Ihp paraeik* nlmust (ills the rud bloüjl -corpuscle am] 
the prorrsa of fljmrulntirrn büpiiiK, tlii' pij^rnrrif- [.^(illwting in the 
cL'uivr aiij n ruili^ile H^i^'iuuiitstioa n^aking ita a|>peArarLCG w 
*' daisy 'flower" f<jmi. The plaamoJium then divides iiilo ten 
pnria (^jMirrs), which become free by burating the oapsiilc, and 
b«igin tho ay^-h aui'W. 

Z. The PBiosUe of Tertian Fever, — II develops in foriy- 
dgbt hours, nnr) hfpnt^ at h\ qiiurtiin, as a dt^lieate, itclivfit/ 
mittiir lirx]> witliin II lyd Mood-corpiisclp. On fiirtbi^r gnwlb t!ic 
ptinvaile piWuco» vct> irrepilar riiiff fornu w^lich eomctimea 
apptMir Long: ar oval, eoTiietiiai?« supfdi'^d with prolongationsn 
lU^rc dUü pigment beooiiies vi*iible with the loes of eolor of tli« 
nffottäd red blodd^c-orpuhde^ and is tisuuUy irrvguJarly dts- 
trfbulf^d^ Tiat^r on the ring fonn becoNies indistinct and tlic 



blu^f^UiiHt) nxnrginni son© «hor« very irrfT^ilnr »nlour; w> 
ihjit Korcoly onv piastnodwm r»enil)l(« anolhvr, Th« rod chto- 

Till.' ^thrh^iU=« o/tui fill the wbolu bluoU-i^dl ; eometiii^fti tli© 
klU-r *oems evea to be vular^ed Ihccvby, 

Sp(>n;[iition takes pI(U:c a* follonst Th« ptgtncni uflually 
voilcoU lu a hint\> in ttic wiituf of Üw puru^ltö, und the trody of 
th« lAtt^ dividoi iuto from 15 ia 20 Gpor«fl. Tlie pliifimodium 
UiOD pnwnU u rrdjiin rnu^mbknoe to r muHtfTiy. T)m ymtitg 
form« dJ»«ciuiDaW after bursting of the cQU'lopc take up dyes 
yery Tcailily, nni) wboD treated vJÜi the BoinanowAky-Nocht 
vtain tlic chromatin micloua la b^^utifiiUy «howc. Sporitlation 
forms are found chioflj ot f/i* iinie of fiwcr The author hue, 
bow*»or, repeatedly mot i^iüi Uio jmraBiTo* in the varioui »tn^ 
of df-rti^hipmirtit at tha namt iif^ß tiiLlLm^t Üir frivr maiiifi^triig 
«ny deviation in iU conr^c^ 

In /ftf^^ prr|vi ration« ßngrUa can readily be duUngiiiEho^ iß 
tho tertian form. 

Aa Colpi flret dmnoDstrated, the occurrence of febris ^tt^ti- 
dUna c«n ho e^plnfocd by tiK* dtSly maturing of tu'& gon^raUona 
of tiTtiiiti ^irinuili<9i or nf tkrtt gt.-riRnilioiiK i>t LjuHrliin pliurtiodm. 

Strange to rvUte, ieoUt^d coAca arc met ^ith in frhicb all 
9la^ of dcYclnpmrDt arc aomctimc!* tccn t^irclhcr, ami tJie fever 
DOTcrthclcti? pur^iica a rogjiilar tertian type. 

3. The Paraiit« of Tropical Fever, — In addition to tlio ring 
fonii (tiTisi parnfiJ1i> aIiowh, fhlff of all, iW ppruliar frescfut fnrra 
(Lai«rim) nhidi ia charAclrriälic of it The nn^' it» ileticate and 
thin and provided with a tmtiM knob (chromalin nuck-ud). On 
furtlier development the rin;^ roienible thoac of It^rtnin ty]>c; 
tho lar^ piginoited fomu, l^owevcr, an wantiuji (ilio fvwT- 
cnrv» also provides n}^m«l {«onftutioii), Tn tho ünal ctadium 
of Ihi» ring ihvTv nmn^an. ut n point n]i[jrMilr thr nHi'Wt a rmu 
(vstlikc swelling vliich at«inii blue, nnd nov and then contains 
some duattike pij^nioit, and occasionally two or three coIorl<M 
poiula (vacuoloa?). Tn fipo ruin lion, dimon into IV or Vi porta 
ftvcnrs. If tbo f^tor has futi»itcd for Mvcral days, th^re wiU be 
•een In the blood tlie poailiar ''crew^entA" which R, Kixdi aiMo* 
efat» with eiegenoua development, fa frnh prep» rat if ina Wm 
crtmx^ib appear a^ ryauauge^huped. bent budicH, in tJ^c ccntcta of 


mviimiovv AXi) ( UKMisri:Y, 

cAoli [)f ^tiidi ift loL-Hk'd a vrt^nth 4>f pf^iKint, which» HIce Ihe 
pniUipliLäm^ triJuiifcHtM iK-tivv niotilLJ)'. Thi- tlKvHii]init?EiL iif da- 
^[flln can ftbo bo rirtn. On ttAinin>r. the po]»i And nuirfinn) 
Ijürtioiin of the purasiUB rt^adily Ukc* up the dye. ChmiTiutiii 
fitaining i& »oldom distinct. 

The c-n'flr(>iilj; n]so occur within Ihv vt-d hloml-cnrpii «■!*>, hut 
the lattpi" ih ii&imll/ »« fnr ilcs'lnyi.^ tiiat i>fti*ii «inly ^ suiüH p^gp 
uf it reiimiiifi, Appünritly thejr rcprraent lajfliug fortM, MUiL'e 
they are ofkm fltrll dcmon^trELbk after the attatk iu tbt' af^hnle 
periods In ^lich c-aao« a recidivc ia usually later obciervoü. 

Fiff' AS.^AmiHjB l~cli. FTCkm J)^Tpni.vnc toluol. Kvi»« t; 

oil iniTnotniod. ■/„. 

Amieba ColL (L«Kh). 

Th# ftiTHT-bi coll likpwiM boloit^ t^ \h,t rKhnpoda. It appcan ai • 
motilv mtH of protnplnini O.^J to U.OJfi inttlimct«i In »iu. whkli inh«biU 
olilclly t^G hunum GoluD, li in nimmt mmmntlj iirtwiit In t^jihlltio 
UvaX abuc(^M44iii, in tlin iiicviii}- nnurbji thvm npi] ilhuuHv tw «tion. in fldiU' 
tioTi t^ a JtlicuCc iiudeus and nudc^ilu«, one. two. or mom bricht Bpot4 
("TBeiinlft") about the iLu' af llic imt^k^LL«. lit palhoj^nielt^ hn« nut 
yi*t l)t*»ii fkOMitivnly u«tubliNboil. It !■ vc'ry prt'^itblAt htiwuvvft Lliut It i« 
&n clioloE^i: rnrtor m m&uj fornc^ 0/ ^^^nt^ry (npv en^livn L>n "tntf«Liiii| 

Kartulia arid many oth^re do not doubt the «pwlfloity of the 
(tmipha. Tri t^xatnlniiiy ilyäent^tc ilejet'ttt 1 have /requently »wii 



«nucbic in such Urge nnmlicrff a^ to ]cAd iric to Aicribo an d.io1ogic 
role to Uiese tiiicrobr«. On tlio other haatU however, tlic objcc- 
liOD timt tlio)' nrfl only hnmlp*« inl^^ltitAHts of tho inl^tiDc can- 
nt>t with ?:i:fliri<^nl reasons be d^-nW, MpeciB)ly in view of ib** 
bacteria] flailinga il^cribt^d on page SO^ the ntuaulWo ni^nifi- 
canCG of ^v)]tc1] htts bevii ho stron^l/ ooiifinutHL bj tlie Wiilol 
retctioii- jAi^cortlmg to Ifogi^r, Mnrclioux sucfocdod in produc- 
iJijf efiiioiiä d>«(fTitt.-ry ami l]<^patic absci^Sfirfl in cnta by introducing; 
dy«eu(^'nc d'>j''cttt info thfir digttstiv« OTglii!?. TixntJ syaijitunu 
ilci licit np[if'iir w1u»n tb*^ tniri» di*jectH aw» pmpUijrd nti**r huIi- 
jci?1ing xUi^m to a toiiipf<rature wbkh kills t.bp anifpbte without 
atT^ctin^ th« ACCompaDjin^ bacteria. — Bnooics.] 

It is Dcottsuy to euminc quite frtAh Jist^hiir^fA. Undor 
such eirouTm(t'm<-<» with a tittle cure anicJioid niovenienla of tiid 
edb will h^ «^s?ii. Afidtf Trom th^i tlow pro^ri^ton movemmt 
■III] pmtniAinn nf |n.<-iidn|vKiijiT ji ringUkt* rmistrit^titm nf 
Ml i* not iiifTvinirritly nbw^rvod^ Ibrougli which tlic conlt'ilui 
of one-half of the cell w Njuecsed into ihc other. 

Thir rtpw* ^n lelfTciH» lo many paUiotfflnli? tffppt* atlrtbuttd to the 
•poTOjfia li«^i>D)riiitf tit 1h« pruloiAH nri* »111! ta Ikttl* alii-nJAlivl thiit <>iily 
a IcB wordfl will Lif d«Tot«] lo ihwr wttniJr«*tior. Thi? Uirt kmurn An 
tJu 'irrr^riH'r;' whtiTli nppMT &■ «pbttla or oral, «Ugbtlj rHrnetlr« 
bodW IjS to ^ #1 In «iiic. nnly without fiurtciiH ainl mjinil*. Itwy o«««- 
«iunallj oci'Ltv in thv Ihrr. und. AiumijE «^li^n-A, ihvy arr M^rtlilrti witii 
111« unvliiHlnfi of nttiUumvm ttmltiifliuum 'VThtthm Ihvv lakr pnm En ll(# 

Orcftmona« an it lYicliomooai/ 
Thufi far other lower or^nntinm bnlonginj^ to the c)iv« of 
infut^fia and wbieb nre ia part («jiarnto<d nnflrr tbi* naniQ ;tta^'^ 
/aiflj pottM« \ni\ n «K^ndflry inbnvt for tli^ pbjsiciao. Tliej 
arv ii]il]irT)ü ot uvuj^. unicellular orgauiim», «liieh, in aiUliUon 
to a *hort, tlitu cwihl Üirf>aJ, po***»* o:ie or nion; Wicale fln^lla 
by mcam of wbid) the infusorium ia tn't ia süIlvo mofi'^u. Thr 
form» provided witli hut ona tlagoUiuii nn named oeroomouai; 
the complii'JitiHl f-»rtiJü, Iriobomonas. T1m-\ Ihrivo bo*l in the 
□lUeous »ix'n'tirn nf the? Ta^inu mid iDliutiiiiT', but llir^ are aW 


fottnd in Hit dom^ without giving ri*c to ajiy jmtlirtlogic miini- 

fifone. Tiiü aulfior foiuid thorn in n ir4:;pililv ojwmtl taitsditf 
ahectH Aud uliin in Ihc sputum of a pnltcnt pr(SL>nttn;; the 
fi^uturifi of iTuiltipU' piihuiirMtrif {f/ntgrenA. In tlio inlliT onw? he 
could ahti linfl Uu»m in Ihi? fifsk put tak^n ai ntcropyy from a 
fntall formten pniof Dmt ihry did not priin»Hly mlrr thn «jjii- 
liiin froiu the open nir-pasSA^cs or the motitJL Tliat Ihey &\crt 
]mtlioü[t'(iit' cfFcda is very qucetioonblc ; at Joflet the autlior woii[J 
not attribute to thorn an otiolo^ic rALo in thi^c t^vo cüj^ls^ for, in 
Acliliticu 1o tliC' <x*rvon;onfli^, rniiiicToiig tocni. wliii?h in tfvery wgy 
KwanhW Ihy flora of the ornl i-nvity^ w*"re »Im» piva?nt- 

11 i» i)f TurUirr i-linirnl itiirrtsl In note Oinl Uii-w: orgrttiisrH? 
hA?e a!*o been ah?icnc"l in the {rc*h nrinc of mfQ (Mfirchand, 
Miura) . in Ijoth inF^iancoa the patient» were ddorly iodividua]?. 
Jn Miurae qobq thoro was good reason 1o bclioTO tliat the orgaa- 
itirns oütrupiod tho urethra- 

Tlie aiithrir füund th-^w llagi-llated hotliea to ho puHioLilariy 
Blimerons ir» tin» hriglit, dirty-yf'H*>w-i^t!nrc(l fThk^-Hj vni^itij; in 
»ixB from niinuk ^p1.!^k» to that of ix. mtllvtäccti or hran. They 
coulil ho r;camirLcd at onc^ in fresh crush ^rt^iinrnliorut. The 
ovoid bodiL'^ were liMiA-f^ri (ind 13 /i brood and unneily IV ^ 
long; th<] Hagella vera about one and ont'-half to t^i'o and ontt* 
half iinxLH n* long ut the w1iol& body of the orgaDii^ni. 

Tin? pitj|o|.hhumi iH i^iiiitT [jL'i'f'.'ctlj homogeueiiuB or, wliat ift 
most frctjutiitly thi- case, filti'd with gruuiilts Jud suliII \acuolts. 
An oral aperture cannot be dcirionät rated, läomutiini^ a dmtioct 
undulating (aorraU'd) aeom ia oba^^rved alc;ng onu dde of tlie 

The 1la^41um is emplnyi^'d rith<T for twisting, revolving 
jiirivumrnL"« *tf \]w ti.'ll or for fixation i apparently a]«» for entrap- 
j»iiig. When Üje infvjforiviri baa fixed itself ly aid ol tlio flagcl- 
iuio the cell-body ofti^ii performs iho livoliofit revolution«. The 
cell thon nppours to h« som(?wliul fcphopic euad with Ibo poneen- 
Irically CTiflfd, mnlilr fljj|^*llutii upon ils siirfiif^.^. Tu {\u^ author's 
ntttG of tonsillar ahsfcji* tlic bright clumps of pnTtophism observed 
in Uit puft tinJorweiit iiiauy chjingftf of form during their nigra- 
tiijDa between tlio dcDäC reticulum fonncd by lefiüt/inctul thfCiUt 



SUiclur of ttio iih^tnU I» UQQfcriitiif? mil dllBculL KADUmbrij; 
give* tho follawtng dtirrctionß^ 'Hi» iJiinly j|inu4 maiork«! It riibbtfu ti|» 
n)Ui ftboiit 1 iitt-*-niU ttthi^on of iioilhim vhll>nll'^ A ilrop of iIim Ia 
fmljr ipraMl U|wo 1 co%f-r-|;lDM or allUc iind drird. Stain wiUi Vritvrj' 
■atiilton At rnftlliyhTiolH» wAth id unt^T, und tmi tlio iindncd prr-par«^ 
titrn «ilh cuiuxTUraliil Hivlic HciilpulaAaLUJu nufuUi^ii. Tbo ifrolcii^fAmii 
Lwily Hhnvt d^aiiiict b1iu< cuTorHtiiiiir 

XltLrrhdnd rer^oDiinonJ« ilALiimg wiUi wvak mvlhfltffic blu* solution 
after iitcviuuA Lic^Uiicut wJth acclic «eld and tbcn |jkdiitf in uüiioeii 
rr»ii*'i1 HuMmiiilt* ftoliitiiiti in fmlnr to hrlngf ocit lliv n^i^iilla Hnd raiidAl 

Ea LriAQj cawi of ^eorbvrvv, and ctpcvlallj Is sniff ptrtitclcw 
UT\«tniPt. KldbA «tiriba!» bpi<ci4l Aignlllt^ntfl la a iimiillAr form ot f*r- 
rijmDiijtH. Kirb« found thom k« "plitiid or idi|Eht1j nvAl, jfli^t^nin^ I^hIi^ 
about fluni I ta £-S m ia Aiti^i tvLieh uiADifcaltd hcI<\« iTutteiiu^ moi-p- 
ravTiti» hy IUp *UI of ano or two (fagnllfl- I'hpy pFr«i^ni(d do i1tiitlni-I 
■Irucluml pMiiluHti/m. Sinw *"nunihmi*' of Ibi'i» ocrunrJ to tht: bloüd 
In miiny «>h nf nnitc ti«nlciuuB unrmU. Klvbf Iwlb'^vd ho Avaa Jiintifl«] 
in dulifnalLng lb*r» aa iha cHn«aiiv» nf^cnU. lliiii tar only Kranken- 
lifluvt ■III) S<^4"vii lia^r rurordnd »imilar ub«i VJition«^ KIcb* aUo u1^ 
■pjTrd ihpw of^rimiKinh it» lb? blnrnl \v irfc»*re «■*•» of •n.irbiiLu« «worn- 
pankd bj DialtLfi^c dlb^ommattd bfrnorrbn^c. 

Aiu>llicr iptciu fjf iikfu^iko. mcipi4totiia mf^p-frvn, 16 ti> 18 ^ |oii|r 
and M to t^ M brnAd, I* ncwajilonall^ mflt with iik rfl/jirbni/ kUkiIa, 
Okjirdnll^^ In tlio golMinoid tnupoaa dojwLa obv^rvvd in L^liiMrpb, It U 
]q-iii mIlhiivlL with a mo^uil'Ej' (apfiiujf puf^lviiuf part-, and a* orRjtivi of 
lih'oirHitioTi pithVuH four jJAlnt of dnU'»tr< llAgi'lla wblrb aitr\ ilhlMfi tin]j 
After tr«tm^ it xetth 10 piT otiit. vida voliili^'ii und Ütv uw uf (h* oil- 
lEniumlou IcuL ExAinin«! upou the w^tai ntiAc tbo olfiiniAm «ui be 
mn in a/-ri*» ntatii»a- Motility pnv« <ni cuohng na vrtl\ am an hatting 
tb« pTTparaticii «buvcAO^ C-. Tbc organiama lODiKlicftUtjidF ut tbc budr- 
Ttvy UkUalljr appvnr Ji^ Ihv »UkiIh ''vniryqU^" m« drfuuE«» uvoid rggt 
aorraundad hy a dinNitri piivi-bijf TbHti twn iru>HMiiti> Hhikiii 10 (o 13 /i 
In t«njrtb and 8 tu D ^ in w^dlh (MoriCit) Pvtbog^ic proprrt^ca art nut 
known Thrr bavc do^ub^tinTIy bi^j^n fuund In luiv** ni)ni(im In 1^o 
atoobi of bcrf«cUT hvallb}' irdivtdiiabi Airb liiidE.l«iu dig^tLiniiH 

2, I nU all ml Woraia. 

Uml^r thi« heailing iltq dietiiigvidhcd panislt«» obtcrrcd 
GflpeclatJy in tbe (Dlwtine and lU d^jectA.- — 

(•; ftonndworin«, namatoif«! (v^iMrrthMnd |«l«t<, fOiin]J. 

(bj TajHWonna. eMtodoi i>*#r*i = n girdle (rlSoi, fvm)). 

if) Skjcbbitf vutTut, tj^matoAc« *tttStta = liolr, hiubf r [«fJoi, fonn] ), 

Wliilc Üw youiij; fürin» o( tho prciioiijily (J^'winbcd parasite« 
ftre CAp»Ll>1u nf n<im^ iiijurioiiiily ujion Üio hoet nt once uud t)0 


Ml^ROPaiPV ANP t^ilKMliffUV. 

tho epoti the oial>rvttt of Ihc inU^tirml ^orma c^nDnot <lo so. Oo 
Ih*? Miiitrfttj, fft***/ m/i^( [irti ay f*i rupfte fi rnftre itf '™ pe*rutiflr 
#HT;;rtfHonj. Thc»c nr*? qiiitö kumjiIo in tbo Ciiio of lite triebinie, 
tili; i-mlir/ns nf wliiHi flu nnl iliwrrt. Ihp boil^ of tlir Iwwt, bul oiih 
unndoT nr hit ciinii'il mUi othiT *jr>,'aDa, a^ wdl iw in Un- ninr 
of oxj'uris, Ihc ova of which mu&t rc-i-nlcr tbc intwtinc of Üir 
hoirt (bnt alwayia prr m) in order of^am to prodvico living 
embryod. Th^ prootes ia more eompljoalcd la upcartri hmiliiri- 
onMm. the f^ggq of vhich mufit find romuiu for -ioim^ tiin^ In luoiit 
Efortli bt^fun? \h\^y fntvr tbv ial<»tiiie. BiuiÜHr i*»iuliiiüRiL t^iint 
in the üow; of rmi'lLjlrmloiiitun nnd trtdiot't'pliJÜLis» nnJ i}ii^> ure 
much more coinpIc:x in ßlariap 

Thi^e woriTiH are i'jfUiiJric, hli-in^er, aiiil oonBOgmeoied, 
Th<j üifll »(N-rtiirc, whiHi in «Iwiivn Waliil üt tiie tm! uf llic 
bcnäy, i» pniviJc^d witb wft» hut umncwlmt linii, lipa. TLo 
itraijcht iiLt<vtiT)Cf vliic-li ia dividcil into phjirynx nnd c^hylgosteTT 
rnMy opinis nt tlio portprior RKtromity of tho bodj, but uüunlh 
«ompwhiit in frnnt of thiH iijion Ihp vcntnil aiirriuT». Thp Iwn 
to four tine« ziottci^ubie upon tlic lar^^tr fonne iiinrk the counc 
of Üic ojtcretory orgaii? and nerves» Tho malce usually prtecnt 
a wJMI cüudal &xtn-'mity and h c&mmön üno-;juaiui opi/nin^* 
(dcHien), Tho fL^Thak-« ar« u^tuilly qiiito miiriäroii« and Ur^n 
Tb<< vulva ia ]>lncvd nt about 1h^ middli* riT thir VE.>[ilrril !>urf]uu\ 
Tbl» n\n nn* »i-ry n'?-istftTii nnd Bi]niiunil(*i! by » Irnni^juifi-ut, 
ßrm chitinrpuB oT Jiiuc^hcll which rs wmetimca covcr^a with n 
roui^h, atninfi! nlbiiminf>us cnv^^lnpr (flEcntis). Ucca^ionnlly 
aniall phk^^ itv |hTi--i'rtt nt ÜtC pojra (tiulriini'iit ?). Tho proopw 
of devGlopm*?iit ifi clircot; the embryoB cw\ be plninly reogm'zeil 
0» round wornm. 

Of tlie ntiunb^Jea tlie followiDg may bü inetitiouet] : — 
AngruUlnJa intestinalis occur? in tiio emüll int^atine nnrl 
liYOfl lipon \hv chyrms aud not up-in the blooj, It was fönnrrly 
looknd ujwo an the eauae of Coebin-China diarrhea, but nlonr 
it flppenr« to bi* iiionpah!^ i>f proihiHiig injurimi^ ofTK't'i, Tt \f- 
important In rote tluit it oeirura in cmijuiicLiou wÜh aiiohj- 



Oityuni V«rmicuUrU. — The maU i» i miUiuwtoTt loitf? and 
hiui n Munt cnudAl extrv-mity (B*^^. &1). Tho fetncU moNsniTV» 
jilKiiit ir> miUimi^kr» in IrmE^th driI ih pmviilf'cl nilii nn ii^rU 
frhiii)i?d t«iL rpoD tJic c^-pbalic end then? arc Ihrw »malt lip«, 
Tlie inalc pi"Wi>^r8 a rcni-^hapoti Pj>iciiium (firm copulative 
oriCiLC). Tbi> ovxi &IT i>.'^iS millinK^tcr long aod about balf aa 
brimi (Kig 50^ &)■ The yw^iiryo is UiWv dei'^Jopoil u'h<3i the ova 

lul>^ FtdQuln anil äUI«. 

T1|t 66^ AnchylMl«inimk DiiHjJctLftk. 

are df[Kwitn!, Tlir wnrniK livit (i|Hir (!]<< fc<ni« in tlir luyr* inlni- 
tiQfi acid nvsft^rr »bf thrwu'jh iht antts at ^'enirt/j and nt^kt. 
Ttic ova «r^in ^Tüfrartrc to the otftutk from toiifd finger», and are 
tufnfrfU^nliy frtftt from thfir rnrfi'jpt!i by tho ^ottftc jutctm 
Tht hbtTüted emfiry/a th^n migrain to the eolon. 

An 4* mini Ik at ion for oiyuria nDrt ib ova U ikmancM io 
pturltoa aui uL tuIv«, irriUtivc codultlioiu of the ^niul n^Vn^ 



Anch>lo»tornum Duodenale. »• Stroficylu» f>- Dcchmlu») 

The fitrang)'ll<lfle piv^ent at the anicrior end of tho body ft 
Jipllinl iiiriul.)i-ra|Hiilt' willt jiivv)iko tliickniinjir*. fnur nlmnji. 
cUwliko Jnnjkti, h:ii( ino i-i'tiijinniti^rlj' dfli*^B[* Ut-tli, T!ig trtjl 
f>f Ihc male itntiiwniiv in llic bwr«! cnpulfitriii. a quite LromJ tri- 
lohöd pfifrknt, poculiiir to llifi *tronfi.v]ida', at Ihe bottom of vvhicli 
oppn thfl mti^tin^ and viw dpfs^rcne, aoeoiH|>a[iii?d l)v lwt> lonj; 
Epiciih. The mlvft of the f-^male lies behind tha ralddle of tLo 

Tbe maU attaine a length of 10 ttiillimdrra; ihv^ feviah, 1^ 
millimrtoD. The ova (Fiff. 56, d) arc 0,0S3 uiiUluictur broad 
and 0-044 tniUimijrtvr long. 

-■^ 'O 

^Eig. 66.— E^ec« of Kgnifttoilci. (Aft«r L^'rJLvirr) 

The-*» piinwito« Eiihnhit Oie iippi^r porltui» t)f tbv Ktnall leiten 
f iui% M !irn?, tlirnii^'h the Ufyrnrj of l!i*"ir armed uioutli. (bf v /nii:h 
tha tfli/ud, yrriducinff ddnj^nrvux unri /u/ui fi»(imia> Thry *Terc 
discovered by Gnr^iu^r in ISGl to be the caiiflc cf ISg^ptbn 
chloropie, Th*?y are wiiiclv diefnliotod in the tnpice a« well 
m m I1a1}% ani] «jnce tlie coD^tnicUoD of the St. Qothard tiitmel 
tlioy bav« giuriLHl eiilr^Q^'e iittii GETrTany (Wtirxbuf)?]^ Tlicy 
mvTv bnui^jlit tti Aii-U*Clm]H^lb? ariO CobiK'"'^ l»y Wwllciiini« lahor* 
era in brick-cUy, vbich, n5 ij> vrdl kn^wti, la wnrkcd in a ooi>t 
atato. Their morphoLo^o and bioloj^ic charoctcrUtic», tA ircll 
aa Uiotr relation to many f^rnia of nroro obronie aDoinia, havo 
baoD iiiTe»tigatec1 by PermndtOr BiiKi^x^ro^ Blumlor, SaUi, 
Mayvr. 1>teb1eiir4terDr an^l otlieiiL 

T}m^ ova are found in large iiiimb«n in tlta fecca^ an<1 TV4|iiIro 



vator luid nioiet carlh for Uioir furthor d^^olopm^t. Tlio }-oiing 
womifl ««cape from thö egf^i^ll and crwp aroutid ev^rytrhocv, 
get upou ihe hnnds of ^artk- (i^U)"-) vork*?rs an*J lh<>nre to *hf» 
nioiitli, or lb«j «re lpgp*lpil witli (Irinkiiii^-wüliT, Tim paraeätÄ 
wi*rr foiitiil by RiluiitTer in tlit; inlratitKr ttto 3-fuini nfti^r iitf^ction 
and bjr i^cnxincitD (r\'en four jcnra nflcr. 


Trichoccphalus Diipar. 

Thp ptat4 i* fmin 40 In 45 millinirli't^ Umg; IUp fenuilr. up 
fo 50 nijllinifil?-re in Icngtli, TV cum an? 0.0r> to OMA milli- 
meter (Fig. 5S, ^) m su?. TLe anterior portiflu of Ihe body ü 
thrwwilÜE*>; the elwrWr poätorior poriioo Hwolien. Tbe female 
f^cnitAl D|H-Huro lieft tt tbo junction of botli. 'i'he nmlo hai % 
cplculmn 2-5 tuilUtni^ti'» long. I'hc «-orm is muatl^ found in 
thn c^fum in Jnimhrm vnrjitig fmm fnur U> tm-lv-v T>ip thn^nd* 
Ilk« anlerii»r eml i» buried in i.ho timeout inriiLl>uDO- When 
prwoit in Urge aumbere. violent reflex cerebral pltc-Ttcnena «r© 

Trichina SpiralU. 

Tnfff^on of man Iskps plarv tlimngh the in^tinn of triolii- 
ooutt pork which is eaten rav or underdt>ne, Tlie aijtoult« of 
the "mti^de trichind" are dLisohfid hy the ^»Mttc juice. The 
Liberated tnchinn develop within t«o or three days into "sexually 
rip^" fomu, vhieh eopulati; andj during ■ sojourn of about £ve 
vr«0kA m th« inlifitinfi, bring forth sHorrjtrftig numh*n of voting 
tricbiuj?. Thp Tnntiiri» worrun nvn of bnirlikf* form, with b wimp- 
vlial tWeXuüfti, round bodj-end The tnah ]a 1-5 inUUiutHefA 
and Uie (tmtih up to Z n^Ulicwters ^ong. The pharTmgeal por- 
tion of tJic intnline isgrenlly dovelopod, and in the m/ilc occupied 
about two-third» tiie lenjj^h of the bot^y. The onua i£ located at 
the poft^rior c^tri^mlty of thv body. Upon t!io t^aiidal öxti^^mily 
of the mal? b«n rcmir pnpilhn mn hr Kmi, and hrtvn^n lhe«e foor 
Hrnslter oni^ Spieuluiu ia absent. The vulva is loeult^d in llie 
anterior third of the body. 

The (^jubrvoa [wnetnito the inlwUnal wall very soon after 
birth^ and migtAte to the various parts of the body, wher«, by 

'AoHiniiM Uf LbvnMndinvrAvhutiij, II to i|iai« ^ lubablo Uvl ttanlMWMiB* 
■A »J |«al«nW 1^4 i*ii«iu munbruv «r tt* biBvUft* uA thcn^ar U la« <4fli maa^) 
aofoa.i UHtrrvmi- T1&« trmikbdrnAH Ihn <••«•]« A* «■btj««ii*Hiid. 



wlU(iinrnt in tlir itiukHits llwrjf cnirfic the pljcnomrua nf ih*? oHrn 
fatal " tndUnosig," ttic general nianifc^tAtioiifi of wLieh caimot 
be diacuMcd in thh ploce^ I'hc part» of tlie muACuUture mof»t 
bevQf^ly flffpcted are tlio d»a|>fira;rniatio, ubdominnl, ccrvicwl, 
UryDt'**!!!, Jflcial, and ocolar iuoscIm^ nl) of vthkh nrc more or k« 
dUlaHioi! in funudoii. The iiifwl mmua'cmi: (fiUectiors urn found 
in T.hi? lu^igliliorlvHnl of tomlmciUK jLHnrhnicnrjt, Aftrr »hout 
fourtocii days Ihc joung trichtno; develop wit^a Uie priinUive 

Pl(> B7,— Triphorrphnlui lJi-|mr- Fig, fifi, Trirhiiw I^pUallB, (JltBf 
(After Uurktiil.) Chiua^.) 

a,Hft1o. ft. fviuLlr. Itutb in Ttblunl 


miLi^cle buniltM to miituru "jnuxcla trinhinar," wliich coll Ihem- 
Hi*ln« Up ill spir«! fom. Wil.liin Llio neat Iw<j or thci« wei-ks 
ilegPULTiillve ami ioflainmfitory di^hirbane™ occur in tli«? atir- 
roumling mustk-tiwiüc. a» the rptnlt of which n tpindlc-ähnpo^l 
capäule ie f'>rtiiori aroimd tho muaclo tnchinftn l^neapsulation 
ie ^Lmernlly oomplc-teJ at the end of the fjflli w^k after invasion. 
In the next sucttvUiu^ uiouHia distinet Ihickt'LUig auU gradual 
tctcilic(ifif>n nri-irr. Dm lutter brgiuaiiig at i^i^ |H)lf« of the 



^|>in1llc'fl>nT]nl &ttctlin^ luiil «lowly AilviutciiiK lowitrJ tbc ct-jitcr» 
nhcrirhj the \img Axis of th^ Cjrst Mm id the dirvctton of tlit; 
muBck ßbers. Th<; cncap^^ilütod tritrhincc ivoanin cnpablc of 
cIctVEflopin^^nt inr tpait (eleven and iroiv). Tli« onldß<v] [<iif«itl<^ 
]» 0,3 ta 0.4 iTii]liTii«1i>r ling and jnrt vinibl^ tn tho rmk^^ i*_vr; 
within this but one tnofiinA \% found as a rule; occaj^loDnli^, 
bowcTrr, tliwe or ioui «re pretwit. 

For mil knuwftfiljiw of Ihin prucvn vt« wrv iuJobUd to thv re*«ftrt1ivd 
o* ?!^Tiktr, l*f«ek*rt, und VSirhow. 

'i'he diä^oftiä of trichinosit la sfi^irod Uy the detection in 
Till* foL^H ot M'lunlly m^ktitre wuriiiF« niiil of Ih^ amjfll free embryfi>i 
whirlj haVR fniM to iHTiif-lrntu the iittr^tiiial wall ffi^i: nLfni;). «h 
well M by the cXAminatitm of fraginrnts oF tnu^Ie. For this 
purpose either & piwse of the pnmfiil nnd Bwollm mu*ciltt! "f thß 
neck IB removed with a hktpocn or the miipclo is expowd hy 
iieifiion and ßat portions remoTod in the dir^etioD of the long 
ti\U rf the miMHisfilt^rs with f-iirvod «i^iftflori. The^L» fra^in*rnt?i 
ari^ (hffii Ihormighlj tenstd, clfiLivd with nlvrerin-neetic add jiiul 
euuaincd with m magnificalinii of SO to LOO dijunetcra. 

Jn tlie obliffntaty trichina irMpi^cIion w ponduottd in Uer- 
aunjp it i* the riiK^ in rnrinvp a mimhor («ix to eiglitl of mu*clo 
Mmp]e8 from the frwHly ftlai;ghtj>red swinp, Th*» TBrimia provin- 
cUA regulations dJITpr in regard lo the number of samples ss well 
a« to tho n:uH^tc9 to bo examined. lo every ca#c it in iiet^i^ikMry 
tbat a number of wunplea be token froni 6of^ Kaltes of the 
t»ody of the animal, especially from the mtucular parta of the 
iUflpbrfifEni, t.h>? «hdominnl nnd mutii^ulory niw^:'!» (or ej^ and 
long«« miiKel™) ; n SFimpli? ta Ihon ulwi tn be taken from the 
1aryii^*al and int4^rvn«^UI luuaelw. The pieiM« of ntiuele reiui>veil 
whb curved «cifoora altould be about G to fl ceoliitirtcrs long and 
^5 ccntimoteK broad; from tlK<«e ore th<m mnde traosparvnt 
propamtioiiB iil>out 0.5 eiMilimotor broad and 1 centimeter lon^f, 
which iiTc ti be vk-vM U:\nn*<] iu wnfcr and enrvfuUy fiixaminod witli 
n magniliejttLori nf AO In I«i0 di^jrHm. 

Aacarfs Lumbrlcolffet. 

The »mla i» up to $5(1 miUiiiiHirni long and .1.2 miUiiRelf^m 
thick; Hit fcMuate. up lo -100 aiiUinictrr* long and S niilliruetera 



tliiclc. The worm i* t^ylindrii*, tapering nt both cstremlüiw, tuxti 
liriK \hrrp lip» üpfin Wie. f^\>huV\c Ptiil. The viilva U looatinl in 

thr midcib third of the body ; tlic atiu» at the |^o*tcrior ejitromitj, 
The ntolc hat two dub-ehapcd BpicolA. Tbo vorais inhabit 
chi«£y tho sfnaH tnUetine, and an* vory frcqaoat In cUildron and 
the insari& Th@ ova arc 0.05 to 0,06 millimeier in diamcicr» 
Tbcy are dladiar^l in large iiumbera with the Uwit. Infr^Uon 
of man 'wnirid when tUr ""-g^ liHve reiiijiinei] nlioiit. fmjii fosir 
to »in wm^k» ia mnut eurroutiilingn, wh^rc Ihe cmbrjo dcvcl':»p* 
und the nn<Ju!ar, hmwnieh exlrrnal vhtM ia not loat (a« m po^- 
«hlo in wntf>r)- Th(> ombryo iilno dpvdftpfi within the ep;g in 
which the eiti^mHl BboU is ^eslrovflj, but it IB then blled iii tlio 
■tontach by the action nf tlie gastric juiw. ProlecteJ by iht* 
tibsmaX »Udl it poaecs (without the agviury of an ini«TtnL^t»ta 

host) through the «tomach to tho email iDteeline, whore it hor^ 
thiNJiigh t\\a sliiiU hy nn*aii& of ;!ii i-mbryoa«! npicule (Liitt). If 
tlio embryo is not devclopei]» the ova wliich have rvached t!i6 
inUfelinc by the mouth are diacharged from the body umlt*j<tTxiycd. 


FiUri« BAfiffofrll— FlUrl« Sangulnl« HomlnU. 

Tha ntntutu. Ill c.'mUinetcri long Ühform worm i« Ir)!!!!«»!! in llio 
subi'ulimi'ouft r*Hiil«r tiieiic cf the mirotiim or Ug», where it indu«» 
intriiNO a^ivHIin^, i*n[»e4MHirj (if Ihe ittniiih, CUnif^lUv^ thv t'mfiru'M {FIje, 
b\)\ vlnvift r-rclufiffly flrr "I inl^^fHT. uceaute ;Aüj/ eirmiatc in the ülooä 
and in addition to cUfinifion tcith otknr ftrrn-U^mJ» ntv dhcharßed C9pt- 
<*itiVu tCfith thr urine ami pmduo? the cfmriii?tcrbtlt: dmfvria and 
hi^malurin [Vihmh mn*, pftm> 3in}- 'Hiey dtp dfllipni*. tmniipnii'M, tyUv 
drli^ tJiifUiiULuii vKti rouudpil hrnc] and UpEtiii^ tail, A nLnicltitcluMH 
«h»ih |ijiijmHfc trii^and both rilrrmitlri. somrMm^K Id tlir« fornt oi a 
AaEDllufn, Boraoiimfui h* a hoad. wilhin which th? «mbr^o uiiiglt^ movoi 
qiiild bcUypI/. A<airilinff la Sa}U!Ube, th^j arc 02 mitlimetpr lung and 
Q.004 mklElEiicIn' tlii'^k. Th«; «r« »id to b* faunil tn ihf blond at ni^ht, 



and in Ih« dft/iimrt ahIj «hiin thv p&tiirnt «lovp« during tlii* period, A<v 
cotiliim tu ll;r ti'xciiirhrJi vt Maa^iru, llin |>1ii'tiLjriM<(iitti ji|k|pflttni tv U<J|WikT 
upon UiD vtdlli of the capillaiiH. Ih* dtamcter o! which U UkUJillj- 
^T«t«r at nifht. The ftUtlkor. hovercri ita« able to find thr pAraultB 
dLtnii|f llift dftv r\'pn in th# ahcfiir« ol tho Al){>vff-nivntJnnHl pmvUo. 

patimt duriiijf Ibo iJaj, llm i^«u aoour»d In Ih« pr«fll(W of Dr, CL R. I^ 

IFi^ 0(lL— FHunft S«ni:umb 1l<^hiiiiU in llum^n Blood. Fnm 
PhoUrinicTUicrm|ih. X A00.| 

Pulnitn, of Hint Yvtk City, and thr vcmriuieD Irom vhich rho pholcgrifih 
■UH tiiV:r4i nn» irrt^tpnt'sl to m« lij him- — llntM^lEd,] 

lliv mi(*iitUo(i 111 til« rjiiljTv»» i* «vr^r ]HfiiTiHr, Thvj «ntn the 
intOBlliLB of th« motquilo during the md of bluutl »urkinff kin! nn dnth 
of llic ma>qiLtti>, vlilch cxcan «xip «ftci the dppuBltli>a of il> ova, Uwy 
gftiD teow to vfti««- Wh#th#r (htj new «nt«r a vr4tcr animal aa hoil 
or ImiDCidiAivlj [miM iiiW thn hunun ilimucb witli Uua Jrliik Id Btill ad 
tIBMtUVd <^UC4tloll, 



4b J Ceslodr«. 

Common Charaotch^os and Attribatci» -'I'hcj arc vrorm» 

withonl Di'iulh iitid iiiUtitmL* aü<i Ata ofua eomposi*tl of a l'>og 
chain of injividuaj aaimaU, 'J'fia antrrior nci/incnf. the heüd ot 
tiuilex^ j>n*'jit» u jM*L'iilinr »Iruotun-; it w pruviiM with »uck^-r« 
wlkirh *vT\K at, n nu^ntts of llxitlion, timl Hunr'tininA a wniilli nf 
booklet». rAij ^rsl ss'jmcnt is to he looked upon as ihe mothft 
of all the rtJii.aince it prodztcej the uhoh chain, 6ir<tVilh. by bud- 
din;; and fls^iOD, to that Ihc oldoet Bogment it farthcel removed 
fn>m tlio liofld and Iho }'omi;ro*t iiuniodiatcly odjao^'iit lUcrrv-to. 
Tili« ün3*"r at urniii^^mcHt nW (^iplaiiin tiic (liffrn-nt'L* in wiuiil 
drvrltijimrnt of tlic indivitiwil fitfftnfni^, Tlir ymingcst tliow do 
wxcal irlantJfi the middle sf?g;nient?* inclose fullj developed 
scKual organs wbich in the end ao^eata revert to the originally 
inuoh emaller utorue, wliieli is hero doveloped inle an oilejwivo 
and often multiramifi^d ovjducl. 

Thtt indimdtmt arjmcnts are aiuntfJi hr^rmniihroditii^^ Tlit- 
oprning of tJic teximl p«>*H|rc \% cithpr nt thv «iilir (Umirt) or iii 
the middle line (bothriocrphnliMj of Ihr segment. Here and 
then the Tinsliealhcd penis can oleo he &ecn, 

Th« tnaluri? epigmentd (proglottides) are capable of iodo- 
pendentlv leaving the int>>stine, and then innnifeat qiilte » «trong 
rniiHculaLure (tA-iiia »nginnla), 4jr tli^y e^eapi' etk-nully in Ibe 
fLvcs (tfrnia Bi>Iiuiii). Thtjf coninin vmny ttintuiands of ox^H, 
within Höflich the atihryoi are. already fully drvdvrped. If the 
ova cnfrr an ft|>jiro|irintn ho*t (rnttlu^ »wine, piko) the emhr}-i:i3i are 
Sot free, penetrate tbo inlrtitinal wall of the host by means of their 
ail hooklett, and pass with the hl^ji^-eurrrnt to tbe other organs. 
They tli^n develop into a VE«ide, which ofU'ii aUai[H i-an^lderable 
»i»*, and iiuilt.ijil; by budding. Usually but one bud ih prodiicoil 
witiiin the cy^t, but rot iafrequ(!ntly many huudrarin arp formed, 
ooch one of whieh prt'STjnte thf ürguniöitiou of a twok^ic. Jf euch 
a vesiole (eyeti^Jivtif, eehiaocüecii&) entors tht- iittphtin«? of tho 
original lapewnrm hnsl* iho vi^iiflr* is di^n>ltd and the seolex 
H^niri begin* to prodin'c n wgincutrd i-limn hv the pruew* of 

The cestodcfl are üouriahed by the chyme through en- 
dcBincaia. Their produeta of metabolism or the toxias pro- 



diiccd by their death and aubeequent ptilrafAfrticn ar« probably 
more injurious thaa the «jiup!« abatraction of juicce \>y the voim 


Tsnä« Solium. 

Tlib worm (Fi^. GI] mcioauren 3 to 3.5 mutuni in length and 
up lo S millimrterfi in hrrndth. It in iNimpost^ti of ^00 or mc«? 
fipgraiTiU, nf whicli HO in 100 afi' spxihiHj mJiJiiri». It h Ai9- 
tai^ui^ei) by fl uTCti^^ v/ Aoul^cU plawJ io front of tJie poorly 
dev«li;|H?il ftutkere- According to J>ULkArt, Uiese hookltU tciay 
OGeiittiouaU> füll off, Cifmparcd u-ith Uit mginata. the utr^rwi is 
but sii^htit/ IffitncJitä, Tbc ova are roLind aud Uavu d thiak diclL 

Fif. OL iWtAtn ^llnni. (After r>ifrtirf.) 

The projflottidcs paMod in Uic »tool» enter the intestinal 
«anftl of «trin«. The «mbryoe libcrfit»! from Uic enormoufl mim- 
b^ of DVtt Attack Ih« mnsolw of the aninuL and d(*vt>Iop into 
V(«id^ Ä tn 10 laillJTnet^n in *iie, which are do^ignal^d &» ry»- 
firffrcut cetlni'Mff^ or tv'tnti nr ^f^r^ fnivitte. Biitn is alitü »uhjtei 
fo ifH'd^u/A tfy iA-fl tyjifiVrr^rv. If H-'iiully nmlun: pru^Mtiiltv 
Cain fldntiasioD (by autoinocuhition) firr i^f to tlic ^(^rnin st'/macK 
[antipt.-nf-lAl»ijf dunnji; vomiting is iü«o «aid to favor thii^?), tbc 
ühiTiitfil etiibryud cnn tt'ündi^r to tlw vwriotia porlion« of thfl body. 
H*^idi« pTyti^^rri of lh<' *kin, v*'«f*"l™ loniljng f*i n«»rirnii disturtv 
anc'i^ Mrv found in the htsart, brain> and ej'w. fn lhr> cy^liL^erL-us 
wwldca {^., thow? rcmovfvl from the ftkin) Uie li«ad i» atwayv 
inra^iliated (Pi^. ü1, c). By g«nlle or firm prowurv and ftrok- 
ing with a bni^i dippod in water the tcolut oin turoiilly bo made 
to protrude (Fig. 61, 0- 



Tliw worm (Fig, G2) is fr^rn 7 to S tneiers long and sofrxe- 
iim^ poäsusfs from ll'OO U JSOO segmcnU from 2£ iv 3^ mUH- 

a, Valufkl ili^ of tb* womi >t UilTijroi»! kvjHufi*. t. Haiirl (witk plgnicul cuakhtmllj. 

meters broad, cf which ISO to WO or<f mature. Tho heud prc>*enta 
at ite miädl« ft pitlike excflTation (no hookl«t8) and four liif^Uly 
developed muscular tiurtere. Theve ia ocean fr.n ally obe^rved upoa 
tW lii^aü Mxvw or lew OilTuHti untl mttij^t jit^mr-nUiiion, v/]M\ is 



luiirilly attribut«fl Ic Ibe imbibition <rf iron «ilU (from Tnc^lirA- 
tnpnU) ; wbftlipr thU v\pv in ve\\ foniirlptl nr not w gfil] nni1l^- 
cidod^ The ludtuiL' ai^giiieut^ wlUdl frt^uenUjf yojts sjtonia^ 
nemtttif or witb thö fece*. are Tory mufiailar; tbe iiJ«ruj pn^cntg 
very numerous branchings. The ollipUc ova, in ftddition tct a 
strong ebell, uäuülly poea^s a ok*iir (yetlc) eldu. Tho oson-'twl 
Af^(*ntB poa>i¥s tli# powi-r of civejjing high up on Mnd™ of grt«, 
with vhich Ihpjr nn." i^iitcn bj niltlp, iü whom Ün^j- cTrvrlrip into a 

IV 93h— TntiU N'lM (After 
LtuckttTi } 

FS^. «■!- Titnlft Eehlii**npeu« of 
tfi« DviE. (Mitt UmküiL) 

c)fttccrfUA rctcmbliog citvrnally the r}-fitic<Tcu« ocllulonCf bat, 
of GCiirfO, bnnng the h«&4 of tani& sftginaU. Thnr davolop- 
toent in mnn hn^ thiiH fur not hepii ohfiprvod. 

TsDia Ka^QflU (ae^-DirÜDg to th^ lerj n^lJuble ob^^rvalmna 
of Pcrroucitij] grows dunng the fint month uUout 3 l^uü meters 
Atiii in tlio »t<cnd roontb when the paroAit« Attnin« niatiirity, 
mbOTit 11 ocniinu'tcnt; in other vordt, each tja^ itbont 13 pro- 
glotUcle« aro Addod. 



Tannin NiiiiJi, 

Till* pHrnAile (Fig, C,t) is Ihr smnll^t bjinwiTTn thus fivr 
ob«ciscü in mm^. It ih O.Jj juiUiittetrr Wirad aiid at iftMt IC 
TniiHmetera in hngth* It h compoar^d of from 150 to ITO f«g* 
mcnte, of whic^h from ^U to 30 arc luaturc. Tlic bood prof«ntft 
four rounded aacker» anU a r&truelU'> rofttelluin armcil with n 
vreath of liookkU. 

Tin? worm fn^niii-ntlv (iwurx in lurp* niiml^t^i» In thi? intjw* 
tine nml m/iv thi?n ^vn riw tn »rvcrc oervous di*tiiTluincc*. 
hniz Qteen-ed io little diildrco coiutant diarrhea nccompanicd 
bv foWr-ilo nltock«, which coflwd aftpr removal of Iho worrap, 
vhich wore ueuallj pr^ent iu largo ii)mLbv>r4. In tho oxpollcd 
tapeworms the l*ond is freqiienÜy oporlookod ; ojiaininLition upuii 
11 bla^k pUic is, llieii-fure, ahmduli-lj Tipoissarv. Tlii» UfHTViiriii 
wn5 first nlwrv«3 in Egypl and S^rrin, thm quite nlnindnniljr in 
Itnly, und recently also m ons wstai^cc in Gtrmcny. by LnkhUn^ 
st^m, of Colognu^ Tho modn of devrlopniprit je ^11 umlotor- 
mined (the miJcprcue is prnliaMy present in snaile, wlijch «w 
b^re and there eat^ raw). 

This parasite (Fig. 04) h a tapeworm orljr 3 or 5 mlMimct^rs 
In l«n;it!t. l\any UiuiuaaJft of tJitm oflcji ii^e in the inlestiue of 
the dog. WIk-i: taiiiu ova i^itcr the Auman guatro-intv^tiiijU cuJiul 
from tliG dog (bj licking, etc.) the cmbryOii duvi-lnp in the liver, 
lungs, and all the rememing orgHns often forming nn cn^rmoLU 
nmtfr-VfMcfit, which iu siirTontiik^ci hy n whiU^ Hpstir, diatiridly 
hturllfited wall of Tartahtr thifkm'w. Upon the inner surface «f 
tliis meinbifliLc one or a Dumbei of amell scolicc!« bud forth, The 
ncohct!s, however, are not always thus directly developed, but are 
cfton fonnotl within dauptiter-cjßta. If tlieeo be exauiiucd under 
llic mionwc'ope thc^re will be seen between the four siiilftirs nn 
invtiginalrd «rt'iilli nf ImuklittH (^r>nnM)ft»?d nf l»o sirios cif hooks. 
OLhurwiw tim vtAiclt; (»ntiLinti a triiiiFpnientT wntcrv fluid whit'h 
h lietinpiii^hcd by thi: tilmfnce of albumih ^nd ilic pre^tf^cff of 
podiiuu Chlorid jnnd «uceinic fluid — Bkooiuj. 



For th^ di^gnntih of ocbinococcic cy&t th^ dif^liftr^ of wliok 
vt^ticlA is d«icisiT4>; otherwra^ ntti^tion fthniilij ht* iViti'dnd to 
fra^ineutÄ uf lueuibimttf, huotleU, üuiI the AuiO (see alfo section 

BotfaHoccphaluB LaIu«.* 

Thffl |>araBlt^ ma)r attain a length of from 8 to 9 meters bul, 
aa a rule, it i> miiHi »liorti-r. Tl injwtrtöia 3000 und moro ttv-g- 
nn^ats, and i» from 10 ti> SO miUma-ters in wiilth and thick«! in 
tile middle Una tluin at the marffine. The feiual aperture lies in 
ihn mfdüin Hns. 'Il^c h;tnr1 it flAit-^ntHl and pfv^^iMV u^oti the 
*idK two kKhIIow fiUffJon gmovi« 

The oval oggs (Fig. 5t>) are O.OS niTllimeter lorg, and 
D.035 milltmriur Wund, and iiirlmrd Uy one aIipU only, which i* 
pn>iidcd with a U4 or optrculum. After tliey have entered 
waU-r the ciliuted enibrvoj* dt^vi'lop (iiid, Bwimmin;; m the water, 
iiivuidv thi.^ pik9 'tori it« mu»cuJjLttiN-r whore Ibcj ^-row to «eoliefi*, 
which mar attain n »i/l* nf 10 mülirneirnG. 

Tn ihr slonh nf jutkoiih nffeplnl with hothriowplmlim the 
ivlalivclir lat'^ ova cm readily he iftu (h;ü ^'K-uiiiituatiuu of 
Pecce"), In addition to uumero^a perfectly pwwn't<i ora, doI 
a few art im^l with lU which thi> ltd ho* burst opt!». In olhff» 
tho lid in (o firuily odhirronl that a lUfurv, pn^lseed pr>bably tiy 
pmuurcf up<in thi* mvcr-^ljiia, »qi^iniU« tlic lid and eimti^uon« 

InffcHon a/ nmn takes place ILrough the ingntion of inaufK- 
ckntly amokd, boil<^, or roaatcd piko; Aaid« from the local 
intertLnol diatnrhancett, wr^rf anemi^l (q, v,) b known tn oc4*uT 
u tbe reault of bothriooephalic invaäion. For tJii* teauon, iu all 
CAM« where deubt etiata, a ean^fu) aearr)i Mhoiilrl 1>e maih> for thp 
mm or, afti-r piwioua teniafu^ tifAtnieut, tot Hie <.-hararti-riAl]<T 
Upnrorm n^^mmU. 

fc) TrcmatoJc«. 

The traanAbodaa are parvnehymatoua luekin^; trormn vith 
blind int««tice and 4e\rral siit^eri*. For the jinu^liiinnpr a lim- 
it«i] intarivt i« aiuiL-tt^d by di^tuma hciiaticiiiii and lancx^olatuni. 



(hß<iva of whUh are foundiu the feces. Distoma hifrnaMiura *. 
Hilliarziji htrmnhhia tau] dixUuria jtulmtitnilc^ w}iicrh an vpry 
prevalent in tropiüU countri», especially ia Jrtpau» Chinn, TmiU 


Flg. m.^BallkHoc^phaliM IaIiia^ (AftRr tntrJtarf.) 

•^ Vfu'iu, 111 Huilnna ; itktuntl «Üb. b, üt*i i Ui«r»l and fiuii ^ItvL 

[dod Africs, ßrnail, Wrat Im^ies] uro forme which are of greoter 
ämportaiioe, Iticuu^o öf Üio decided daturbiiücas catwod by their 
prflience in the body. 



nutl« b from III to iC mÜlükctcn long, «jUndrv, «ntl U «mrnni (for pur 
pOiM of liKuiKlftttun ] in « dvp ibAnnr) fovBuIbt ^jm*toophanut IomM 
upoB tlif ventml 4iirlaiv nf ibo ntsiltL The ntnlfl uriinii mAftAurv« fnim 13 
to Ifi aJlUmctcr« m Imffth. TTw mnluTt vi>Tnu iii1iib«t Ih« Iriink ab4 

rig, iKL^BUhAntia HiirniMiohlft- 
(Altor J><KTJtaH.) 

<Jv« vitb p4l«T »4 tftbniJ -|ilr«lA(X 1», 
FmrAbrTDvlLtiOtiJl iKMl- 

¥ig. HT-^Kgg of [liitomtim PuV 

iiion&lv, LhI Sprung, Spiitioa 

hruivliCfl of thff jPDrfAl Vfin And lUe renoui pIcvuB« of tli« OtIbu^ U^' 
■I^r jinJ n*rtiJiri. f'n llir uf-licr Iihi»!. tli« v^k. LmiJi'* Lt'iiijc hrnnd in tiw 

And— vhat 'f flKjKHn^l^ imfntrttut fr'ym c ttinivnt i/tanJfiinl—ia %\it 
prJnr, trhkA l/rnrraifv prretnts tht sißt^ vf i^^nrc'i itHh httnaturia. A« 
|h* vntvu« vvuriU «r« oftrin di?nvlf flilnl v1th thpte pnratit#A» citng««' 

Ii»& and tiad«, «>lh C<Mr»pQ of blood and ova, cHViir. fJI« laitrr m^^nn 

«■4 « loap, vAirp tpirW^ ^o-tm «illi ■ infrral «pinr if« oflts «rvu Lb Um 
Waddcv VIÜ), The ^Mrthc]] b Tnudrnl«!^ UiUk and tf>JII»»Vl « ff^ 
WiAlda lb« Im ovum tti« rttibijru i* * t*iUt «ml ofua uianÜrtU arllv« 



nwvcnii>iil)*. // iJiviii'tH fiiivt tiw! uhr^l /»niv wAffi thf nvttra enUrt itiftrr, 
und tiifffi? it bunt^ the ^hc]l longitudinall/. ll bu il wcJ^ »liApcd form. 
« ccplihUc ]tiLpjlla. euiil !■ L'uvtiAl wiLb numriuuH rüi«- Tlir viiiluyo* 
(ipprar Tu Itf itcptrifilil*» In Vm urtar^ U* Aliiffi \hfy iüm nfiT iw^-nlr-fniir 
liuuriw Tmn*ini*MHn »-('17 prolMbljr ownr* tliroiiKl» tlie agvucy of drink- 

Ih* Ota wilhlH a f(*w minulfn. Wlivihjif tlia «mbryoa Hrnl nmi^ir* hii 
inUirnüvUtAlti 1io*L or ri(»l j* ntill uihlrtrHrtiiinfd. 

Oiir ktiiiwlr'lj^ nl it« Mnfngii^ tlioraot^riftiocH otc, hu bovri iiirfi^tiuad b^ 

S. DLiE4)a« PulnoAAle {71^. 67^.— TIih 8- Tu U-riiillinii-rir Uu-s 
v--nrvD it Hiioflv ^oput*'! in X\w upprr BTr-pft**opfH» nom^timo« wilUm BriiUl 
<avJUt'* ID the lunjf» wUivh Inrc hortt produi-pd b^v ii Tl U <'x^<'i<l'i^ >" 
fomi: Uli» iLMti'iiiir i'm! 1« diTJilitilly niLiiulnl. Uir- iHialvrior li*«* nn: iiid 
piiiHfrjHi'iL vn nml «hd nn nbiloniinnl <i]i'1i<in liiHo. 

Tlip o^a All-' i:lt^|:flK' aziKl pDp<"t7?9 a ffnurnish-y^Ioto aUeW from 7t 
Ifi 1 ;i ihifW. witlilu whidk tJiH rmJiryo in not fiiHy d<*vpkjpi'i!, Imii. of^- 

m^^a^r^^u*tl hiii nlrcMidy Dtirtirn«d. O11 pivhHiLn' u^>rjn tlie lOv^r-fluiH tht* 
rln-h \\Miali uitcl ihv tbiilcnti vocnjK? itnd inn imdJIy bc teen. «ilLi a lian'l 
HhCi^f&ryiTiß glu'i'ii K* ll^liE liFüWn pninin nvrrnflng V.IM millimrlfr In 
hrcjidlli und OM iiillllinrUT m tiMiKlh 4 f^i-boub« ) . In ikTi old pi^t^pnmtinn 
Vl&i-tJ nl Llip autbLtr> di4]^o>kd.l lj>' ^'>iri;Ljf nL^vct&l wutv found tu tfp 
*inly niHÜ niillimctor brond imd tllivitl TnilfiinMir long. 

FuliE-iit* ik(V»'U'd vitii tlijji womi suffer n^iTint fnNjuoptly from 
icwuiTTJiL hnn^fttiv***' Tbn »|JuUini, ^tüHi ix i^huhII^ cHJau'd im'^ in tbi> 
odt]/ moniinif l>y IniM'kinjr, in Aimitlimtw i(kii}f)i niicl iimrujd und «(n»4ikm1 
v^Uh bloüd. toniclim'^t nü]y Mwtly, I( nUe^at/n c<'nl'iini* nuTUfi'mi* (In 
onti imjiHinUoii uuv hxiiiJrrd niid nvrii ovjl lik*' Jh-ise described *UiVtt, 



IfKitTHT art«rüil blood ihows the Iri^lit coW of oiyliomo- 
glriliin, ilue In ovi<ktjofi of Ihe lieuiOi^lobitL Tlie murf* oxygen It 
low?», the Oarkcr it bövriuu N<ii]ojiygT'jvxl«l lliioil in Tlk'bmtc; 
it ftppearv dark k^ by tmiurmiltcd light and gnvn by rrlli.'Ctc<1 
lie;ht> Oxylic'Mio^löbm b fontKHl by mircly shnkcng n solution of 
bon:io>;lobiii id Lbo pn^^nt« of Air, but it risfliiily pntts with iU 
oiy^wu 4**p(»(rifllly in Üit? prrKcrc<? of yellow amjnontiim tnlphid 

Ihe Bnotlon or Uie Blood doxlng life u JUvati Alluilliie-— If < 
»trtp »r r*d liumm jifjH-r llinmaulily nioii-t4>nod wilh nnnrontruU'd »ahJ- 
li-jn 4f «wiiiini ctilcitid i» dmurn H-^ml limw lliiouuh blood -ind i.}ii.-n 
thp AdhrriMil blocul c|iurkly tvaihrH nIT wlTh thr ull loliitlon, n iJUTinct 
Blk«IinA r«»ction wllL cl» u rule, tw »A^rt^ UtlicnU^ ulttbutUr or i^Uy 
pUt«lH>9. BAturHU«] nvitU kitmuB limtuK. upon wdi' h ■ (]rii|j itf ti1<tod in 
ft1l4i«iM t<i ni^t lor M moMTaiJ brfAn* it i« tva^hfid iff wmS wit^r, ivfr ijiinI 
fur till? »aniA puqruto. Ijindob'* method ia qu^tc ^cU alApUd for th? 
f*ilJiMJ>Ui>h "t Ell'' tlri/ire Iff iilkjfcliiülj'. 

[DflTC't H#ma-alka.1lmftnr, — Qiiitp r^vntly Dr JVrfhiir Tlur* hu 
imfcrtfd BD intlnimput for d«terinJning th« dcgm <tt ftlka^uiilj of tho 
bluiiil. Hi« ilF*frl|ilioii of Uw «ppaistui Uid lu u>c pi iflvta by tlic 
int'iinti-ir !■ at rnllov*!'^ 

"Thp fli^l part [Viii. flft«, P) mnhi't* oi a *lf7|iHT ilir^uch wMi^h 
p»uip» ui ■utniniLtc i.-d^illlarjr bloud'tiiprlk-. tunltliiLnj; ZO üiittic- tnilll* 
ovEvtH hy voliiino or 1^ nLilli^rnnii by weight {of normfll blood i , th* «t* 
pof<4 fn<3 nf ^Ijidi U ifniiml to a t«ptfiiif! [mint, llir rjfilwir at thi« 
Iklltr tiilip rfnulo* the hAiin« Ihmii^ihoiil, Tliin «lnjiirrr mut 1}|*- ronUJmHl 
blood pipcl Id arc fllt«4 inlo a rUiir gl«" toatdiFie i|i^g. («Sa» .4) 4?oiiUln< 
iPB 9 cubii: i^ittiiurtrr«. Ihi.- upfvr cud of wMdh U cvpanird ItiIo m bulb 
mnlaininiE 'ni iv» ^^iil* ■ iitiniiU' i>|H-Tiln^ (K^- fi^. O for Ilii> purpni« «if 
adokitlla^ AJr. Thv Uip of Ibi« biilli in placed dLd*o to ihf» ilappfTp »llow- 
iqr tliv cKfülUiy tcbc to pAti to th« ctnlfT of Ihe bulb. Tb« te«t-1iibv li 
fmhialfcl in oihb rtniiinrfi-i«, ildiI th« «qulvftlrtnU In mllHgiani^ of 
K*on to llX) rubU- »ntiinrlora M U'tuU nn ftJio rtprotentcfL 

"Th* second part of the inxtiUTTjmU fi^ fVO0O»l pO'''"<'f wh^hI- oC 
4a tppllajtßo niA<1f np r^f ft irl'«» ttihr trrmlnttlrv wif>i ■ mblur bulb 
And harinjE «t Hu oliiür4^1r*mSty ■ pin^ M ruUm- lu1>inH Ahirh Uta ovvr 
Ihe iih«rpni«il tnd uf Uiv cnpJITaiy Uuvd |ri|ii'lL« pirvioupJy do«nbbrd. In 




Quo»n poalLdt «p«Dtro»copa ftpswcrtng «II purpoies- 

"Tli» Iwt JialutJaH lu l«? ouniluj-^-d i* iiiiiJii up ** ftJlow». — 

Ai-Mi liiruulrl [\t4*ri-k'K roaenut) gr.] aOfiS^- 

AWhfili !vj S4 a.tiM. 

Jiqwc cTcftlilEutir ^t ». S^in SCO o.tfinh 

0.3Tft t<> I, littr */tn of n<3rfnaJ. 

Th» nIcoTiol U «ddfd tu ]i[vt^imt the fQrmallijii of fuiigou« (lowtTi, but 
not in ■Litßpl*nt quaniity t« pToolpliaU th« nlbumln Ol tlio biood in iLny 

F^. VSa.— llfxuo-olkftüniAler- lAbout on^balf nctUAl tUf.} 

,1« AlkAliEneft lutn, ^, AnüinivHc blaad-p^paiLr. i.\ 0|*DikJuj( fur fha 
idmlnlnn of p|r. H, a«n at »[Kvlfiumit*.^ IdIo vliii'h U10 ftlknriawiDr 
liiM I* pliHAit nt 111» L>Diiit J ^ LIdII ]iflJhBliur<ia IT^ ]*\mpitf$iin lA 

"MffruOD or £urLOT[N<j tub InHTuvunprT.— A drop of blood U 
Dbt.iliinl fjuiJL Llii^ riDgvi'tip <n UJrD of Üi» am iu The u^uitl uimturr. TliC 
lAnL-liifiH U hell! IiininonTH-lly, niid iTh cfkiifniiu'd !»lin>i1-|iipi(iti> flll^ anLO' 
ni&linnlly tijr <'n|-tiT]Ary ntlnjrHiHi wUr-n t}\v f\u\t\"'iU'il rnd in toiinhi^d Uy 
l\ui b]ood-dri>i> ikb it cmi^rjjtt hina Lbv wouDd. ^^itli an ordiiiiiry luJuiriL 
ptpfftUi. wtlh a ploFD ttt ruhltnr tubing nt'nr tlir frrr rxtmnlly. uarL tliL4 
column of blnüU int» tbd t«H tube witti djuUtlcd ivaU-f up lo the paint 
C <£eru)t nrhidi n tb? (ItnL divi^iui) Fiuiu Llir bultviu, bulJici^ Ibe l?tt-lube 


TertJcaTly. Go» the opcniog in the bulb of tbe test-tub« with tb« thumb 
and invert tbe tube HvermL times, to caube a thorough mixing of tbe 
blood and water. The reaffent pipette is filled witb the acid reagent, and 
tbo rubber tubing ie fitted over tbe sharpened end of the blood -pipette; 
bj compreasing the rubber bulb the aoid solution ia forced through the 
pipette into tbe test-tube, tbe aperture m the gla^e bulb being closed 
before the pressure la relaxed, to prevent the mixture of the acid solution 
and tbe blood. Having done tliiA, the test tube is inverted several times 
white Htill being attached to the reagent pipette, care being exe^cL^ed to 
keep the reagent pipefta in a vertical position, to avoid a gravitation of 
the acid solution into the rubber buTb of the reagent pipette, thus pre- 
venting a ehemic at^tion upon tbe rubber nipple with the formation of 
a flocculent precipitate. The interval (Fig, 6Ba, A) between the closed 
end of the tube and the first marking (0) ehould be ploeed in the eleft of 
the Hpectroscope (Fig. G8d, D) and observation be Inken as to the exist- 
ence of bands of oTiy hemoglobin. Should these bands be present the 
careful addition of acid solution is neccrtsarj. As the bands become 
fainter and fainter we know that we are approaching the point of neu- 
tralization, and it becoriiea necessary to add the acid, I drop at a time; 
then invert the te.^t-tube and examine with the spectro^icope as before. 
After performing several testa with this instrument it will not be neces' 
Barj to apply the spectroscope so frequently to determine the point of 
beutT«lifalion, as the eye quickly learns to detect this characteristic 
change by the color of the blood- mix turCr W]icn the Imnds of oxyherao' 
globin disap|>ear the ohservalion is at an end. It is then only necessary 
to read tbe result from the scale on the test-tube^ which is graduated 
In cubic eentmictei^ and the eijuivalents expressed in milligrams of 
«odium hydrate to 100 cubic centimeters of blood- 


OF Blood to 2 Cuuic Centimetekö ok Acid Solution (7,», of 
THE NonuAi.). 

Ccnu, or ilgi. ofNuOII la 
SngeaL 100 c. cmi. of blood. 
2.*1 3^5 

2.4 ,.. 3iU 

2,2 2I>2 

2.0 2Gli 

1.5 2^9 

LO 213 

1,4 i:ü 

],2 Ifln 

IJJ i:i3 

o.H*> m\ 

O.tJO Tfl 

0.40 53 

O.'iU . . r. . 2ö.fl 


^Ak & uitifunn Tinht i» bmwuf fur pli^biuluuic ti|>fritnriii4. orii- 
flHal 1l]uinkTici(.[oii vhoiilil bp ni^inrlEKl ■* hdng alaa^t nvnllabln; nit aprn 
^ii%lit waa eiuployed in our oiptriiticcta cnllrtly, anil Ufcc nUtlon at 
lUs hiJi-rtiutcupv tif Lbc »uuivc of lllutaiitatioa kopL «Iwjlj« vouMojit,"-^ 

Tht' specific ^avity vari« wElhin narrow HidiU, Tlic «TCt- 

»etbodi In ^hict <^nly 0,1 grtiTa. about 9 <tropB, of fclaod i» tmplo;^»]. 
A fine CApUliiiy jfU» tulw about L2 qvu1j[|ic1ci> Tony. l-£ miUimi^brm 
Iblfitr, mrnl «linwit rmT ai. ihr' vniU In 7k^ fiiLl11ii)<^j>r 1A atVTiiitlHy vh^uIk^I 
Lipon tt obcmic m^nlcii, tlivn flilvd with dxitiUnl tvntcr, ni»3 nanm wpLfihni, 
llio npHUry lube U tbcD clcdiivod. H\M wlib blood, ami Uji' weight 
jijfntn doltnulriftl, Tba niimbpf ohifltHPil atiir »ntktrm^tintr 1*^«' wPiffht 
oF Uir pnpillAry liiliv i* rlitiilrd hy tht- nAfiirnlrly d(>t'<nniiiiti| ^vpiEht of 
thp equal niTiüunt ot diaUlW nater. The quoUl'dt fthowa the tipvdilc 
gmvitj ol llio blood. 

Whilp tMn mothinl rpqiiirw vpry <1i*lirAlP ncnl«**, flnrli «g nrö 
foiuid only iii well-eriuffipecJ laboratories, the mtttuKl of iiom- 
merschhi'j ttiit ffc pnicticed h^ arttj pht/sicÄtin. li iß basi'd upnn 
tho Ißw thnt n boily which floaU stationary within a fluid ponsoatce 
Iho samo fapoctfic ^avity fl8 the fluid. Kor thta pur|>oäo n mix- 
ture of obloroform («poe, frtav.^ 1.485) aiid ben:(rjl (^pec, gmv,, 
rt.saO) irt I'inplcnifl, Willi wbii'h l.ln? nddcj dmp of hhyy] does nnt 

TBchniijue for thf Vrthod of HHOiinerBclilnff- — A gln«B cyliinW 
about 10 COIL til no tor^ b^^^i i^ li^tf lillod viLb ji luixtun of vMorofai'ni 
4m1 lieii£Lft hiLviiJ]; u «periHc ^n^Uy ai l.OIi') to LOLlO, IdLi? UiIh fluni 
II rimp nf fn<Bh Nttitd ilmwii uilh n liini'fl i« jiHovftl lij f-UI vrilbiirt 
touoh-mg Iho viki] of tho i?j'lindor Tho droj^ wiU tillicr tink to Iho 
|njLlorn a» it tvJ bi"«id 01 ri»D In lliir top, Iti Uw fornii-i iit^Enpur, bri'mino 
I ha »iirTfiiinriitip UuhI i- lifflilfi' Tbiiu thv Mi>ri.!, rlitofufnrm is Bibki! 
'/r^/r Aj/ Hro;'! m the IaIVt fio-oc brtixol, ^tbiln bv unrvful n^tnlinn of 
Lbo glana it ia Muutit ta viakc Liic drcrp flout iiA^tuiiary in the body of 
Lha liquid. Whvn tbl* 1»< ittt«.mc(1 tlxo tpvcitlf? grnvtly of ih« UuoJ mid 
rh« mixture ü ntuAl nnd run be dfeinrminnl aiUi jiq Mivimt^t^r in tbc 
siinu' cylinder or, ufltr ÜHnitlüit, iulo a Uilkr oylLndpr. Tbc tUIcirofürtn- 
h^niRu] iiilxturo IB tii]ftlT4jo1«d by this pTooeilurD and cnii ha Li-i>d m- 

JInTnncrsrKlrtg ndvist« the obstrvBiiCG örcurUin procaiitiom 
whiHi ih*^ author folly indorsts. Not tno Inrgo a ilinp nbould 
bp taXoD, for eurh will much more rcaJily break ujj üiIü jb ijuih- 



bi7 of K^tA]T1^^ om^ Cnro should lik^wis« bti cb*crvod doriiig 
agitition or ihf. cjlindcr tii M<'iirif thorongli Jidmiittim of tlic^ 
bcDftol and cMoioform and also to avoid aptiUin^ of Uio drop of 
Ulood. TjiLJilh, iu <r«rv cuv in vhidi the blu■^<] ßoata upon 
the Burfaoo Iroax Üiö bcginiiin)*. it j» ftdvifinble to cftüse tiio dn>p 
to tiolc by ac)<lmg an <^oe«i of benzol A&d then to make it float 
tüilionirj' id llir' fluid by grudiml »driiTtiiivöf rbluru/ürnL 

By fTty|in'iit rr|irniicin of Uh? jtroc^sn ^ultp n iN'^trc-n of *^rx* 
tcrity c^u ff^ya be acquired; $o that the m«tbod is etrongly 
rccommrndcd to cverv phv^iciciik accuEtomcd to make carcf«! 
OJcatumatinna of the blood. 

ITIitt ToIIohIt}; tAblf» give tlic ptrccnUg* of hcmoglubin u Imll- 

rftU<i by th« ii-willo g«THyr^ 

^Bt. Out. ItlHMbOBDr. 

1 ttv-i on - lo-M 
i.nH—i DM > a a 

LUH— VMO * H-tt *• 

i.tec-t An — 1»-» ■* 

II. (Sonu/LTS Avn PKir>ir-) 

fir«a Oiur, llKiir»ii4*H. 

ion - SOnwnAV + — 
l.C» .>■>-' 

tau — u 

1 II4U - W 

LOW - » 

1019 - « ■■ 

t 001 - <« 

l.QN - TO ■' 

LCßaO - 7B " 

l.QM - «0 

1.(O?0 ■ VO 

I,«» -l«0 

— BROOKft-l 

Tlio total unoQiit of blood to th« haman body Eimouutf to 
Onc-thirto^fith of the body-weight. 

Compotiliou. — TIte l»liw>J cunaisifcof the plaiuia. holding the 
fibrin in »olutkcm, nnd Üit ci^ltukr elements: the red and vrhJte 
blood -corpiJK left 'md blood -pbtm. 

Tho r«d blood-corpntalei, erythroeytet [V/^^^, rixl; in^>t, 
coll], consist of thcY *ironin^ whfrh t;) r^^ndlk fijlublt; in fitb<ir oad 
Chloroform, and th*» hfrmoglohin npnn whirb thp enlor of the? 
blood dt'jM-pd«. Til« Ulter ia an ulbtimiu body cloK'ty rvlatoil 
fo pElobidiiL It i» combined with nn iron-conlAining coloriag 
matter trhich »m ri-^<tdily be extracted by orjdi and stropg alkalies 
aa hfinahn. VVhih thifi «ub^tancn if, at a nite. obtained only 
a« OB axuorphotie, brown powder, it* chlorin dorivativo, hrmin^ 
^Q he ificTtr^ in chnmct^iAtid rryvl^illtne form, n^niogloblo 




am b« Aeparated from the Btronui of the blood-ccHs by liigh (cm* 
perÄtarü, electricity, decanting with carboric acil water, InttQ* 
voMuUr infiuioa of eoiuni o£ another epoviea of aniuifllf ft&d 
*>thor procöIüicB. The blood a^fiiniefl a "laky" lint. If 0\iM 
oc^un in ihn Hviny bndif, grpat thmj^r ii thrmtfnrd iy tha lib* 
umifd siruuia (AloiUindcr Schmidl), 

Honltlij blood shows a deoiiled apeotroscopic chiimetpr, 
which pan rnaiiily sind ([tiiakly be dpt^rniined with tho hanrl 
specLroscopt? (Zl-iss) (Fig. (\9). A frw ilropn of binod an? niiieil 
with Wfll^ ill a Icst-tubc, and tb^ latter u heM in front of tie elit 
of the Bpcctroaoope, which ia ^»eUl toward the li^bt. At once 
absorpt ion-band e nppear (bptween tlio line* D and H) in Iho yel- 
low and gre*?n of the speetnim (Fig. 70, a). 

j-s-r? — - 


i\ ML-tbtlllUlllOblll. 

Fig. 70.— tipccLrum with ibe Zeieii lia-nd Spe^tToccopo, 

!f n few dropft of n ftriiutifjn <*f yellow nmnionium sulphid cr 
tnipric Äulphate arc nddt^tl, ilio tiinds disBppeiir and in their plaoj 
is seen ft bro^id bund ptK^ulii^r to deoiidixed, reducsd JicTno^löbitt 
(Fig, ?0, 1/). By shaking in the prr^t'iire f*f nir h>r stirriog tiifl 
rniitnre with a glaaa rod, the abaorptiou-bAnila of o^tj' hemoglobin 

THK Buyim IS itiriAvrn, 


Uioroioopio ezAmintticn of the blood in comluctej (t) vlth 
frcahjj- drav-n blood or euch at bM bc(*Q proivrvod ia a molftC 
diAiulirr; (2) with dritiil-hloo^ prnjiumtionaL 

HkroioopU ExunLnaUoa of Fttth PropArMttoni. — ('«rofuÜ^ 
cJe«a»« tliH Jl[i|>rEai]» dr. ah Um* AUtliur girnrtiUlj |>ii:fci«> bccAUrc of lr»t 
liability Li infvi^linn, the lol« of th« Mr, ind drmw t 4m«il drop of UmmI 
witb • lui»t [notdlc or other contcnirnt iiuljumrot] ^ With m p*iv of 
fon^pi SI"""^? IL torn glawt. tiHXeU It to Ihu drop of L!iiiril. Mi'i [hrii f-lnh^r 
it MB mjuii II.« poHHibki ü|i(in t jr^<*'* klid«, U U AdvUAbI* >o to «rln^ Ui* 
^rop thnt ihe v>ii>lc npnte ]»t«MiJ the CQVf<T-iEl*'* *<^ ^IJ^ ^ occuiöi^d 
bj A UQlIOTm, drIirAfo lAy«T o| blrvxl; pT««Murv aptm tfa« oavrrnlAut 
«hOtitd ^ A^oideil- 

AVith A msgniflcfttion of flhrnit t50 or S5n the Tfd blood* 
€0]^Tifl<rIc« CRH b^ HP«] imljiti^d nnd tn mtiWiix, unA hi*n( miil 
Uiere i>cuj&ti>nal t-ularlpflfi blxnl-cellfi [leucocjtc*: Xtü^ov, whiU; 
HvroE, cell] ; finalljf, small, pal*, round or olliptic shaped bodi» 
vbich wore fir»t d^cribotl by Buootoro oa blood-platoe- 

Thfr red blood-corpuoles' (erytlirooytei) arc )>l<N^Ticave disk« 
with rouTjriod oiljC'*:- Thi-y JijijHJir tu cirnihir pkti** wlii-n »k'wod 
fmm the ünt surfAn^ m biwTiiit'chnjKnl btirlif» vihvu nn-n fmm 
tbe eilge. On careful focuftini; Ui*^ flnl Mirfar« of the ccllf thoiTB 
A central doprcMion a» a dim Hiad^w, boc^ntiDg darlcer toward 
tbc periphery; othcrvieo the cwilor of tho 0*11 ia bright «lad 
tbo RWTgiü darker. B; arratigemtiLt of a niiiubor of blood-coIU 
upon 0idi Otht'r, rlivlinci oolumnar or nmk'HUx formiitinin U pro- 
dncpd [mm* Pig. 71], Tlia imlividuul nüU 4r« nojintirlrmtnl. 

fi* JAmuM — ;[iTini" [thfl kteiurr «' (he inl b]r<uii<iirpa*iJ'B !■ alUI in- 
■ fc rn J^at« i» J i lTrln ni BirWniir] 1'. -rrf tTi-i'-'j, mHH tra* Lo-Ja/, Iha Tit* 1^1 ih' 
n4 «cul o«1ot1<m Mv«4-<*II* h* fTui* th« bAClankr^ In« »iMffelvwD-cronp« ia ih« tovL 
vi^hbj \'f mr4>('1pparJnfe, 

Jn»ni4«-x ■" ihc Alitfir tI«v, vriirb h««nimiilr Ti'vh >lr'i-r*4lj'fl h^ >{. IJiilltr, it** tr^ 

IflHo LeiK!<krji« *■ wrIJ m »rjUimnl«»— in tl» Ww-r invuii« hr ihr rrvr|i1l4^a iM li«u»- 
jcTvlrlii, *yn Llir viixv li*ii^, t^uja itnil Lnvtlawuiu* tbv vir«lcmv t-f Ivv dJIfbiutl kliHia 
«f viWJfw •f'liiHiUr jr c«Ut flruo» »n-1 crjfhEoUAatft h»4 iI^Ai li» IhfJf iif«4 *ifilp aalu 
Mh lo-Hnty tq «MBA >lu |Ru<»nitvitt»rj if f^ «IviL^ Inlo «olaiwl npr|kti«l>rt -«wrv 

Urd liHiAffiutiflD Ulrn iitvr« nfilr I'k IM bon^mim«; ■nrnnUhfitf l^ifii, onTjr In Oih 
MnMlBlMoad. Ilarmi^ bamr^i, nbii^lAr» ihp hi>niaEnbt*rta ihirAi^iAiMt v Ihr Mir 
■MMiHii Of Ite r*l ti)>-i0^irriu«.'lnV wIl|1« Npudueüi »4 bluuaiF'r'j pr>fv« all Oam 

»a «Mb Hllblv lb« boD^KUtvir« 


MicROecopy asd cukmistry. 

homo^iK^iii», nnil jrllowwh gnvn in color, Accoriiing to the 

ttiickncM of till? prepara(zoD Uicre will sooner or kler Appear 
near the margin of «mall air-bulMc* or the coTOr-glflÄft rc<3 Mood- 
oorpuBolce vith acrrated luar^'iDe [crcDalioo] or in thff form of 
thorn-apple«; tliia is a ngn pointing to the ocüurr^riif« of i^x'npo» 
nitioQ. SiiL'li bnr1i(fi nre iltio verv rapiill^ |>r'>Llitci^H en addition 
of noiliuni »ulplmte, ivhUu Aildition of wtitiir citoi^f« a ^plieri^ 
twdlirii: cf the corpuscle», with <IiBnf)pearaiii:c of tlie central wu- 

"^ ^^®^ 

o«°^'-\, sTo? 


Flp. 71— Uukcmim nilh Ijirgc Bplenn Tumor, XHS9. 

l{r#iiiilar loufWyit«, ■■, Ma pfOif-™ili f. T.jinphivij«« /i, "l™nl'|il»t*i- 

As a ruli?, tliQ räii biootl-L-orpuBolofi Jiic quitu iiriform in ma 
an^ fonu, AeoordinÄ to Bnnn>rotia rpB^arch^ by OrÄtn, Lnflchc> 
QrhlxT. JiMil otlii-rH, Üiu n^eni^- <ne ta 7.H /i, fLOil m llie »4Hme in 
men ami woriirn, firjiin f«uml Oio ilinmeter incwi frt-Viuciatly 
to b? 7.9 fi, 4D<3 rarely 9.3 /i» Tlie änialluet dmiticter may be 

The white, or colorless, blood'Corpu^clei (leucocyt») always 
ooour iflolntpcl in ttie flelrl of the raicroaoope. Kven without the 
n^Wilioa of reflgnrl* fin? gramiliitionb and irregularitiefl of 1!ig 
»urfnfp cnu be refogiiizi?*] in them. The uuokar figures, whlf;U 
hTC oiUn, vüible in freah prc|)araliona, are plainly brought to 

T11K BIjüüD m HEALTH. 


View on ndililloD of Oilute acelic Ariil. Whi>ii eKamineil upon tlie 
warm nt&ffi tJie kucin-j^töi uflt^ii mauiföt ai^tivK independent 
motility [ameboid movemeuU]. 

AfconlEUjE to the tiw of the oeila, which may im hi^twecn X 
lUid 15 ^, and the fonii and nunLbur «f tlidr nudoi, four kinctit of 
t^'uencjti» fire g^n'^rfllt}' diKtingiiiührd: — 

1. Smflll, mononurlcAr, round celb vJth comparatkely Urgo 
mind nucleii£ and uimll, nouL\Jutmctile pciIplieiBl uta» of pn>* 
topbem. The cclle atv fuLulk-r tEi:tii ili« xvä Mood-coipu^clc«, 
They arc dcvif^Tiat^Hl un unail Lymphccytes. 

2. lATf^ munoiiucltur a^ils vilh palo ccl^bödy, at looat UiO 
«IK» of A n?d liLxx3-cnqmsple or (omcwhnt !urgcr._ TTi« niiclriti 
ifi usually ovoid or cnint'nt fcnpKx], and sometimes ebowa bpgin- 
sin^ lobxUatiou (large lymphocytei). (See Hale IX, f\^. 10.) 

3. Leucocytes vUh a stinuwluil more refractive, ^ijrjy granur- 
tar, eontnictilo prolophi.'m lUid raultifürmt'd noolei (polymor- 
phonueleai Jenoo^Tt»). If Iho nuck'us ia » divided that th« 
tndivHlunl pjirrs afp nn Imiyrr unitJ^l, thru ihi* oelU arp rimg- 
nated a» polynoclc^r Icnoccyt», The#«^ twn fortnA t^iTiAtituto th^ 
great jirajorcty of Uju eoloiltaa b!ood-s:LM-puHle*, aaJ they may 
be dvi^iated as leucocytes in a strict («nfie. 

4. A amail mmibcr of the forms dk^aonbod under No. 3 arfl 
distingui«h(^ by decidedly inten^^ jrlifitcninj; gramilntion of tho 
f*(|.body (coancly granular LcucooTtea — Mwt Srhiiltjpc; thftsii 
an- the cell» wh\ih Khillrli di^i^'iiat^a oa eotinophil»; aee Fij.'. 

It may heK be Temarked tliat the Analytic elaining uwtHoil 
of Khrlich haa rcnulted in a diriaion of tlic nhotf^-rnrntioncd poly* 
moipbonitcluar and polyiitickiir l^eooyi«s into Ihtvo group«!, as 
foUowv :— 

h li«u(Mryl«fl vilH iu>utroph]Ji(i gra-miJ*«. 
ft> Leucocj^lca with povmophilir jt^*nu1r'i. 

5. tiUMwyUs ntlh tuiopfLLUc gnuulH, 

(Coniparo page» UO ti ^07) 

Tbo blood-platu divcovoriHl by Biviouro are very uD^tabTo 
Itodief, with a Umtlt^ncj to rapid dmnt^^rulion. Smo« th«y col- 
Wt at th*» matgir of ihr nound vi*ry nipidly aft^r puncture, the 
lii>l di-jp of blooi] (hat exudes murt always be tmployrd fir 



P^^finimftlinru Kvcn tlirn tlicj nr« reuflily ovi?r^»rjked, Wauw 
Üwy rnpicjlj disintegrate iu bloud ^■r^'imratiom luudt? iu th^ onli- 

In onliT \f\ Hffiirflk tlivni la »n unallcivii bIhIp, it i» ■dviuiMr' t,0 
oqIIcpI Olc Ar^i ilro)) of bloocl directly in a |vrcvcrvAtKc Solution wilUatit 
txpu9iur{> iv au- E'W lUU pLU|rüiu tlio lolluhlitf «r« rrcaniinenilrU : 1- A 
L-pariviit- wuici^' »tilution »f omiLic HJ-iEl, !f- A iitiitiLr« cti)itifkct»t«) «r 1 
purl oF Om'h mill i partii cf phjrvioloKic aalt «oliition. 3, A H f<rr cent. 
milciLjoij of imi;«iic«|iijii lUlphiLt«- 4. A inlutlon ot 1 |^nrL of niHb^l- 
^iokt in ßOUO |iti»lt uf phjHotogtc «nil ftoluUun- Wrih Ihn iHÜtf «ol«- 
tion til« iKJiJiviL H|'tJ«^nr wril »i^invd. [TliU mitjr aUo bo il<»n« bj pliLCinE 
n ilm|i tif th« prfiw-rvaUve «otutton np<m the fifigi-r-il[) tind pirnotiirmj; 
through thfl <ttop, I'bfl eluding blood miKc4 with tho boliiUj^ii iullI Ihu 
iijJKtuiT can tlidu bv «iAEiJiiLi:i unJcr n cover-glit^i on a alidp, — UnuOKS,) 

(^lightly glistening, circular or ovoid disks, 1.5 to 3.5 /^ in sixe. 
Thcv lie cbk-fly in groiipe of from f<^ur to sii. 

At the prtiwnl time dinj^noelic er;^ifii:nnce cannot hü ntlrib- 
iil«d to them, for the Tensfin thnt the tigws as to M^TtMhrr thn 
jilal«* Brp inlpgrant coifsUl iiiiTita of ni>nHrtl IjWJ (Hi/Äownv 
I[iivemr Afiums&it'ff, aiul oLlier») or (li-'iuli?j,Tüliou pruduot» of 
cclorlwrt l»t<>od'<:orptiscIcs (fjuwit, Wij^ert, and other?) are tiK) 
niudi nt vnniLncc. There is, howeyor, no t^m^lifm but that tht> 
\iow of Hjiyom, who [ooks upon (hu pkl*as as the nntoocduuts 
n( the rod hlond-corfiuscle^ aud thcrofore dtsignntea them liemji* 
ti^dadl«» Jiiit^t 111? wIloIIv n^jrrN'd. 

Not iufri^i-tm'iill^ ütit\ pcilä liudits mutJ] bmallur thuii llie 

blood-pklt^ ftr&rnet with in Bpefimciis of Mood prepared u-ithnui 
pre^crvntiviffi, I'lietic are ^eUL*riLlly dtcignatwl im clemeELtary 
granule«, Thev art* prolt-id borijos, und an? not rarüly tirraiigc^d 
in «mail irmnpfi, Thcj art- cjniti* justly cnTi^idniil as dT^inl<*gT"Ji- 
linn prndiU'U of the lencoijyt/« aad hltKid-pliitts for the rtüÄJii 
Ilml tlii-'y do not ot-eur in »pei;iroens prepared uoder the ppccan* 
tiouA above* mr:niioued» 

The pn^purulion and etainiti^ of dried blood apecimcru will 
Iq conviidcrod whi:*n discui^ing the e3:flniliuLtiou of di»i^aatid blood, 

CounUnff of ihc o^lti ot^urnng \tt noriruil blood i< of th* gr^HtiHt 
liii|ior1u]ir4.'. A^ a luU'. «ii oiUiufttt; uf tbv numbrr of co^piioolca tn one 
cubic uitltimHT of Mninl U mad* anconllTig to t>ie mHhofl of Ytt^rorilt, 

TUE nUK>U 1>" }iKALTll. 


WirIckflTr and oibcr*. Ab the undilalrd blocd la »hdllT^ unadaptod f«r 
Ihia purpoK. bCTAUic of Ihff mytitd* oi blood -i^orpuwl» und Ihn tmdcuff 
of thft JatUr \o t^rin roülflnux «Jid UTidurgo rfl|iid crhaq^v <»f «hup«, tnrli 
rtfUoL muMt bc n&iU with A niotu ot l««t |:rT«tIy diLiitoJ Hippie oi \Aooä. 
Tlir (ollüS^iiiu inlutiQü* Art adnjilfd fc^r lUhiHn^T^ 

l- A Sj>^r<Tnt, toIuiioD of aodiutD chloirid. 

2, A 1A> to 20'pvr-«nU »olution ot lUAgneiiuni «ulphate. 

A- A ypet-evni. iiciliilkoPi ai foülara itul|>^uta- 

fSoriU cliloral, . IJ* 

A^, Oo-Üll. .., ,,,..., »XU» 

C. FflCEnt't fluid: — 

ffjvlnirg, b&fhlfiT CO 

godU dilof^l. ..... . -to 

OlycEiJni . ., , -- 20.0 

£&rb •dIuIidii U A|>i>^iubl^ Hajnin'« *v]i;tion ducrv«« to li4f r*|i*- 

riftllj r*".'iiininfndfd, lifj^mmc it |nr*(ivci tili- Inrin oiid pvIm oI Uh» blood- 
e4T|'ticGlc« vith «onivrly any alt^rntion in thpir «IBO, 

CouaUiijf !■ uiiJtl ixiii\ciiiciill)r Juiiu tvUb Üiv TLüma'Zcim cuituliiisf 
ftppiir«tu>v wlur<]i nijijr ^ ntjjttnlnl ju ■ rrtmhrimtKin Af Mir ifapurtiiit «kf 
Mflinwpx, Hnjcni, ahd Go«iTf, It ooti4M(« «tf a mbLor iFi|-. 72. Jf. JVJt 
ih It-In» ilidv witit LTuLiikLJj;),' diaiubcr f^^, auü n (jUih- i:tr^cr ilIv») iDt. 

counting BvO aiood-corpunolei.—Hy Tni^aiit of Uw ntlitii-r liil* 
kUdcljtd t« Lli? uiix^'r, upciii wkich Ihu nitinbrrH t?^, ', Mid JOI »rr tn 
jEFBTcd, nirk up the blood to tbc mark J oi /> Ibc» liaiilily vfp« ofT tht 
lipofth* [>iiiui.TD «nd M qui^kLj- uH |34jiulblB dnw vp Ul« dilnUng Bolutiaa 
1« tlm nuirk JW/, In »ückinj^ ihr< hl-t-t^ iui^» ibr piju^iu ^nwil «re ihu^d 
be obBcrvrd nuf to draw \a air iloiig wttb it» blooj nr Ui »Uni» th* 
djlutliig t«luUon to go Iwyond the mark I'fl. \'r\i*f i-rnvilit pipvtio 

Is flllH ti[> to IliU mirk, llic Irikd mtitt at unra 1w mlir-d i* ihiMi:iii|thly 
«J poifJbU, «libU U AfcomptUlif^I by thulinff Uw pipAtlr mtd hj tlic 
m<iviini(rnt« (if tJir fUhji l>nid o>nlAinf^l in fb? mulnfi cliABiber. Duiing 
■httfeing tj!i# biuTfr opcnmjf of Ihr pi|iptT« vhniiJd be dOKd nllb tb» 
flnj^r «nd thr tijl>lK'r lübf PQrDpr«<iud Just aboTt the iD^rk tQl. Av- 
n^inif iv ittiL-Ihcf Ihc b1ui>d Uim bri-ii ilrmvii up to Ihe marlc CJ or t* 
lTi4 dlliilion «ill hfl I ta iitÜoT I to l1IU>T«i«[W*llvo1y, Iv^iixih tbo r^BpHcUy 
of tbt bulb brtwmi tbc inarltB fand lOt io«xaclly 100 limc* urr-.^t't Ihan 
lb« ciifilfntft ttt ÜIV cAplElftvy tub* friitn tlio tip ^ to Itic nitrk i. 

hvfun t drup M Til« l)l4>ad-iTiSxtur« it |i}44vd in th# counting obftm- 
\*t, llir flmd in tkr ropüTary cub<* of ihtt aiixt^t toiuM. Bnt be blown out« 
bt«au*D 11 coDBtaCd oEilj uf 4imuihnl üilutiiqe luliitlom. A drop «tf Ih« 


sircRostopY asd chemistry. 

Llotül-mixliirv in Dim plictil iji ihe couiitmjf cliAnilnT «nd nirfully oov- 
m'hI u'illi H Piivfr'^%n\ riin< liriri^ IjiIj>ii Uiaf, ra otr tv Ktliitttifvl anil 
lliat th« drop just ßUa the spncc b«t-4'o?n the «uv«r^laH4 and dito [non« 
iuijüinn uvcr iüto ihc dmund aiiTrounJicji tbc diik — BoooK»]. Mtcf 
xinitiu^ a fnw »liiLUlH fot llic Muod ccirtniivlfiai in hJllta, Um i?oElDUttg 
ib bqfua wUh fri>tn 1^ to 200 mii^)i1iitii1-ii;n. [In «lU^tin^ ihv our|iuh- 
Lrlci, A Lri(z rl, DnuM^h auJ Lümb V.. oi ß|j«iwr 4 milUnict«r Iciis »bouM 
Irt' uatfd, fti ilii^d iflLe ld juBt odd fipid tff tlitAon MOtll ti|UBrTfl. Indiiitliig 
iJw lalrtnl (iiviabti linen, — BlidOlta^J 

Tilt! uoUQlinj! diumlwr f&> ibcivfs tlir fiillovtiiiiE ■riiinKituir'Dt: L'|iu» 
ix Btrong, HnüotJ» grnnmJ *lUfr f«; i« <*ffmi-nto<I a *<]rjiirp pt»»< pTiU {IVJ 
with a (TnLrnl ctri^iilcir opcaiDg, Upon tka ballom of the tuvit/ ihii* 

in IhLdtncw th»n Ihe surrounding pUL« ^^J Thr uppiT «uHaiv nf Ihii 

0100 Him. f ^^' 

^ J 

1 • 

Fi™. 72,— TliniTu ÄciB» Plooä-oountmg Appnr*tii>, 

ditk prMi«Titii a mir-rriwnpiri m(>ilo «• »ec« in Fifl- 72, r. I'M* *( Mtnpo««d 
cf iUtcen tflTgc squnri:*, caeh üI wkioh inclui-pj »Ulocn »iHfllbr «jUHrvs^ 
WiLb ll^i' pii^^i-pttiii) iif MiiMft i-iTiitli-i] III ÜIV tttlrmnl initr|^n* nf tbr ni1r*r1 
linM, tn<.'h larffr i.i|iii]tli i-. ««pnTotcl ttntn the cllivr? b^ a doulrlo row i>( 
rectftilxIrB to IfliiUuie countlug. flhc- t-MnitUng chatuitiir iiE^^anll^r inlnj- 
uitrmt by Tllrok [v much int^r* convriit^tilH since k bmt HP|mrKlii itiHhian« 
fiir «ounting thv lomxioytM <i3nir)ironouifl/ with tb» red oetU (*«« Hg 
T-IJ .— DaooKfl. I 

tn o^ttitiEing It 1a bMt ia tikt* #Afih of Lh« fmit aniiMmfinuHl towk 
of amnll i*niiiiwi in onW nnd cnunt nil tbc corpuwlpi lyintf within und 
lilfon the iipT-ef And kflUiiud tüic oi rneh &mii|t squuiv. and. llrully. tdd 
th# cella ly^ing upon llii> U»wtfr ami rigfit-hAhd mnr^ui <»! i^Hcb Uiyo 
oquArc In oriW (o nvnid rr|ittiti"n, it is bcH to begin with iiic^ upprr 
Irft'hAnd ii|i)Jiri*B ind [^oiicit n ■tijflldr.-iit n^imbfT of Indlvh)im1 iquiilVA 
to giv» a tolaJ roont ol nt [«■■! IIUU nd ooUi. 




At tfap tlvplh uf 111? eouixlluii: diiLiiibn it Vt. »jiUiinft« »iiJ Ih« nr«« 
«f «««b tf[Uirc \'m r)U4dnmirüiivt«T. th* «iibio ronT«nt nf psuh «innLinit 
to Vh( cuUc QiUliiDclcr, Thcrcfon. In or^tr to nlfaUtt the mimbtr of 
Vnl tilo^uJ-voriititicU^pi iti 1 nuhW. luilliriirtcfH Ihir ItiUif tiunilvr of r^ tlood' 
mTfiu^cIn counlod im ilivldftf h/ IUk niiTiibtr of «fitAll tr|iJktM cauntMl 
•Qd lilt quotient iniilliplM>J by 4000 DhJ Ihm. awonlini^ lo the JJutlon 
UMd. h? 100 Uf tHO, 

tAKiiipto- Avumiftfl thni I5WIirJ «^HU \rpre i^otiiiud Im I5s square» 
«rith a bloott dilulion ot 1 to IW. iTi« lollovtpg troaM bo ««cured:— 

'^ = IS-S X 1000 X 100 = 4;&20,00O 

Thtnfnro. the blciml r%amlnp<1 wouttl (^otJt»ln 4.P£ü,0O0 rvd blnoil 
C4prpuw1rn in I cubic niilliuitfU«, 

Aocorduijc Iv lliv< (IiiunrB oblainrj hy tbf TlicinH Z*Ü4 inrtbuJ tlkir 
mrtngf ror « niui U ^fl^tJXXi. and fcq- a wntiiMTi «hOixi^ivmi to 4.bmjMii 
ltd blood «orpuvLc« p^ «ubio aiLllion^ter. Wh«s «kilEfullj and rmirrull/ 

l^ = 


IT " 



p _ 











oonducUil, the tbnitt of «fror v«rf in tUa ntcthod al moti iciwnii I katl 
S prr rsnt. Coiuddaablfl tocreBw In thr nunbrr of r&i b!o<nl mrpowl*« 
K on lli«^ obülc, rwalj obotrvM; howuv», from I^IMKKOQU W T,i>>0,00() 
TftI i,^Pi|ji;»L-|f-a pft rubji! riiiUimctfr bai« b<-«a obxrr^ in ptffrcUjT 
htftlthy InrliTldtuKTH ||il^lUcii]i [Hplyfylli^iTiin). 

Ad rttH c^^unt h poHibI« «nlv vhpD Iho oaunling clLAtubcr and 
«■pecialljr thr mUbtr plfWll« U icruf-iilouij; dmii- lliiit lun b- lUT'im- 
plitfafid Anlj tij blrrving oitl tminMIJiUly afvtr U4# whaiPi-r nmy ililt 
lata in tUit tub* ami Uivn wjtthtnp out ■art<«wrf<Ijr «ilh the (ülutinji; 
aolntioD, water, alcohol, and «tber. thetc flukda beln^ auelnl up Ulo tliv 
jtlpatt* and llir^i btown out. Finally, the mU*T Ea to he thnr^xiirlil/ drM 
by fflTTmjr air tn and L>iit oF lUo fimpty apparaluR. 

Xoii?,— In (III? iiilliur's opinloat the luelhud rHoirinimdeO by DcJin 
for tba rftlniatlon of the tiiimb^r of blood^0T|itr4di>a wllh htmiairvnl 
DO »drantajf«»: ia all <liietu>ea (d vhkh great variaiiun* in thr 
of Ihc hlonJ-rpllii iFxihl it la vholly iuapplJralilr. [I fully indon« 
f(av.— HftAOEILj 


MirEt>S(1irV AN'll CHKXnsTHV- 

In cauKtiii(f th« colorl»^ blood -oorpuiol» ihr «niiir i?ni[iifir|^ 
Hmmln*r in u*i^il, \nit uilli pinnTii^r nJiiiig pi|n'tlc'„ iTprjn i\w 
Utlei" art? luru'ked llie [itimU-rM OJi, f, mtd aliov<? thy luilb /f, 
Uii?4]cr liaa IulJ cünati-Lidoil for liim hy Zciee a shorter pipotx« 
mlupted for Iwuuty-ono »itiice divmon^ For diltiting. ',V ^"^ 
Vj-p^r^'*'^^' aoelie aoiJ i» u*cd, wlif'reby l)u» roi3 blooJ^orpi^M'W 
iiti? di^f^tvej. A HtUn ;,"p|itmiT-vbU'l «oliiiiüu may he juliiwl in 
urHtT to ^Uiu l.hi* Ii'iimrvUv Hii<1 lHuK firiliUl«? cunriling. A« a 
rule, the Ifbcfd IP dilniod in flic pnnprrrlion of 1 to 10 or i U* 30; 
^hd; Ihcrc is b ^rcat iiLcrrrt»c of Jcucocjtce, na in kukcinia, A 
'JiiutioD of 1*^5 to 1-5Ü ifi advieatlc. Oth{?rAi>o the count ü 
inade in the «ain^ manner as with red corpiU4>Ice^ except Ihat in 
ÜK' fiiml rwktunnj^ lliy optTator miwt muUi|ily vpilL 10, 20, or 
tOf iu*CMrrding lu thi^ dihilim] rmpldjud. 

The number Ihti» ohtAin<*<l for fhc aWhjlc qunntitj ollwie> 
cirtce ID 1 cnbic millimeter of blood varies between 60OO asd 
10,000; tho flvorago count for an adult ia &U00; for cbildron, 

The «ourcea of error ari^ j^rt^Jiler Üian in the MtiuiATiun of 
lit! uumlhT tit vry ihixic} im, Thrf ttiw uf Üie! cnjiilUrj tubt; is 
oi itaclf the source of frwiiicnt error. NttvertbelesSj after much 
|iracticc and the ob^rrYanec of gtcut c.nrc compjimtivcl^ es^t^i 
rosclta may be obtcinod. 

Tlie lenflaoytCB may b)bo bf connted in an indirect vsy in 
tbe fullowinif manner: Wilh the niil rif tlie Zri?^ luii niirjil^i- vt-r/ 
cflittfuUy count tlie nainber of j&} jtud white bloud-celb iu n 
■tmD0<3 dry preparntion. Dcicrminc the ratio of both kinds of 
CoLls ood thc^n colcuUt«; üxa \oUil numbcT of rrd blood -t^orpiiti It» 
ID 1 cubic ceotimioter by tlie Thomt^Zoit» nLt-thod, VVhcrL both 
Amounts ar& dgcf^rtflined it \a o.tty to coinputn the number of 
Inucocyteft in 1 njhic millinidrT- All tluif in n*-<'fs>rtry h to 
ilhiiV Lire iiLiiiiW uf «TvtbTocjtcs found in 1 cubic njllUiitetf^r 
(p*ee Fig. t^, ä) by tho deromumtor of the frfldion obUiüed 
ftoni the ratio of vrhilc to red connipelt^:— 

If 1^5.000,000 and the ratio of white to red cells is ^ 

tiien the Dumb(T of Inucocytea per cubic millimeter wHI bw 


niK UWüU IK llJaLTH 


|£tikhorti-lApoTtc Blaod-aoQntin^ DiaphiagiiL— TIli^ Uc>od- 
ttfiioare lift' miiiio iii tJii? ugiial inanimr (»ioif |iujr* 150), W'ilhoill 
(itatinn, «fain for fmin twn tu tliriv minuti-* in Ji^iitji^rs r-ttua. 
Ativr wliKrtin^ villi a lov-povi^T leii» (l-t^-ixi Ko- 1, Sjinwrr Jti 
uiu., Z^itfl AA) a firli] in tthitlj aEl the corpuKl<:9 Arc tliinly 
u^ evenly ftprouJ, u^< the coiintinf^ draphra^:»! with a jfci?« DU* 
ocular 'if or LoiU No, ij, ociikr I. or Sp<rjn«r 4 mio-, oeular 4k 
(«'« tnll'^). Cmml all tbo lt>ut'Ocyt« in the tiiUve fitld, and alt 
Ihr m! mquiKt'h» in Üic i-nilrt' fqtinrti ajiprturt! m om? of iU 
^OAi]rAritit wiibont, moving the ^ptvinti^n. Then jn^tvr the rlidc 
for the width of one f^Md ani ngntn cmmt the white colU id the 
«ntire ftclU and the or7throc>'ti« m the aquorc. ThU is to bo 
npeated notil ab'>iit 6 Brjiiare milümetGrc {2G ßcMs, Zeiaa; 37 
Itddt, Leitz ; 46 ficlil», Spencer) have lx«ii ooimted, To find tlio 
number of leucocyUft in 1 cnbic milltintUr fViü^ti Um ioinl nurri- 

|Klg. "5,— Einhorn"» JUQod-corpiiKlo Cotiolpr-l 

ber Miuiteü by ih& DuTiLbor of »qunre millim^ton cnunh'^ «nd 
multiply by the average factor, 400. For example: if 416 Ifiini- 
cyltt* wt'.Tv c<i[]i]tn] in 6 square millimeter» the fnlWing uoiilil 
be the procc<lLire: — 

416 -?- C = «9.3 X 400 — Sr,:30. 

Tbo nunt«! of red oelli ia a£c<rrtiLiDod in the wmo naimor, 
p^cvpt that Llii^ n^^ulltu^ quoht-ut i^ miiUiplRiJ br tbo figuroa 
irdi<«tij]g tho nmntn^r of time* th« field of tli# oculir la Ur^r 
ihnn thiit af tlii- i\M of the t?jiint>ng diaplirAgin. WiUi 7iC>« 
DD l«n» Jind Qcidiir 3, tlil^ i« 10 ( T^t-ili C. ivitlnr f, 14 ; SpirDcur 
4 wm^ ücuLat ii* Id). For ^xaniplt : If 233G erythrocyte« were 
counted ui $ o^iwro millimotor« the M|aattoa vouhl bo as fol- 

«^j^^xie-^ti^aassx^oo — 3jii4»GKi 


UK'ßUSOon' AKD CliSMiSrnY, 

Tablk (riviyu tUB Aa«A UP PiEU> or Vabioi.^ Lens 



Arn ittn 







5 EU 







»J. lUIII, 

■g, (Dlil. 

*q, Luiii^ 

■q, mm. 

■q, lUdb 

■q OfMI. 





























Tfiff« ifl ao eJ0Cf melliotl for coUHtiriQ tJu btaod ptfitfl*. t^niitimim- 
fton hIL^i thv Tliuiim'/^PiHH ittunLiiii; i-hjiiiilirr flvvn uitLVditlJi r^ults, It, 
liriff«vt-r, iE u «leiirqMf In iifiili^'lBkv Iho l^k, il iB AliP^hiEvly nA4>»»snry 
10 «mplcy one -^f tlic aWvp-mrDlioncd prenpM'aÜve f\Hi<U. Hjijph» pUcc4 
ibfl noriual nuinlwr it ^iO.Ouo per cubic mUllnti'lL-r. ^hilv. cLLTontiug (u 
othtn, thd nuiubdf vorlu* bclvocc 200.n0O anil ^6U.rHHI. AwordingT^, it 
maj ht AHHifrui^d Irhat t^iry nrc ii1>uiLt. LUiitj üvc Utiit» iiium aufiicroiiit 
]i«T (7i)blo ntintini*t«r tJuin are thfr iFufocjtea, 

Tn the estimation of the (relativie) hemoglobin content 
rij-ini'lii'« iH'ino^loliiuoiiiL'Ur ts ndapteJ for olinicnl pui'jTOF»*. 

Tb« afittiiTHhiTi (Pit;. TO] c{>iinUl» «f a «ituns F«ol supiiurUng u UMp 
^f/ Qjrh A rfnlnl r-in-iilflr i>jipniii|f, t1ir»M)*b wliii^k thi^ lin-ht from il go-^ 
rlamc «r candle U nfloct^d frgm tlic njirror (St. On the uiiHrr surTaco 
or Uiv tubto la a m<ita1 fnnut /rj wbich cud be jui>vc4 buck and furth 
in n tfroor« by on'iin* of it Ihuoib-in^rfw In Thit *tdp o! Ui* frum*- Tie^t 
to Iht obwTVor i» in*t^n«l « wcrfg« eUiipiiJ 8lri|i of jftiiH« fffj vijit>roii 
with ('flaaiUH"ä "irrld-iiurple."' Ill iJie chtulin Liti^i^^ti^ In tin' Ulilo iwi 
ho ailjnsiml A ryliTh^fin? cup ^Q/ cloac^l at the hollom with glmt unci topn 
TLtcd into two i?f[tj&1 chaiii^Tcrs by a lEit^tal partition- The cup it m> priivnl 
LhftT- the imrtllion Muiiiitt ranilltl *itb tlii- ffuiiL «hIk«- uf llir IjibV, imil 
ibe pünli'i-ior hiklf of tbw cbarnber^tc , thftt purlifin ni'Xi tlif nh'n»n">»f— 
jp eiacLly over llic coloicd fflin* w*<lKr, Tl"»t »"nlfl of ih< {r»rnc nr\t the 
(>o]or«d glAAK wi-il^H Is marked wit]* a Knie from to IJU, lin- lljtnii-* 



nf nhkh can be mul t!ifi«iigh a uiuil) iipcrtur« Ta^ In Ih« lAblt vbca tbe 
rramo n movtd l^fli'k nti*i (i>rlJi- 

In makiikF an mriiiinaliDii both Italirn ot iht cliftmbn m« fillvd 
w'lUi «aler. In thv tnttt half immrdliitply oivr ihc min-or ^omc bloud la 
diiflolvcd, Ihc unoani of vrhtcb U ooeuratpl^ m^a^urvd vitb th« ftoceEa< 
puiTSag «rpftll pi|Wl1cw, Ai^vnlmjr to Sclimaltxi Uiv InlUr huM «boul 
<Ij0064 r*nMtTii*l<r cl c1i«ttil|iut ¥«14^, Tin* n>Tnr of tlii^ ieIa-ia wi-^f^ nh«n 
■rf tt Ui» *i-alc nunib4*r JOO corrQiipOMJa to th« «olor ihonn li; orrtqj 
blood nltcn diluted in the front ebamlj^r n Above ilcacrlUrd. Tbc nuiii^ 
bnr« ftt thfi Irft of 100 inillfftt*: what iinwnug* of tha nflrmol jirjionBt 
ot HvmojiZobin [wUi«!i iv^nLg** La mm, 13-7; in wornvUH 15-6 grairm \ti 
lOO cubic cchtimvUrp) u contAioed in tlii blood «luminrd. 

Arrarding lo Iho r«««nfhM of Ddilo» tlii» nMlind nf ^-ktlrnKtlan U 
attctfidtd hj hiab; ftiTO», which inonsM with tho docLina in Uh i^ount 

FijC' "fl.— Flfiithl'» lltfiiiofljIoMnoTUflcf, 

Of Ibv hl4>nd4*o1omig mtillfr. Wltb a hemoglobin ponicnt ol 01 p^r «cut 
ei 1h« normal, Pchic found »n «rronooii« dKUue of f-fi \tt:r tent. Ec lec 
omiucijdi* ttfttlnif PJich irtolfuiitvut by prppArtiiif h -ivi'k hijIuElun: f,r,. a 
lilood 4ii!i]lii>n uhtrh corr0«|kond« »4'*tlf wilb th* nmrk KHt of tht 
lirmontrl^r, THi^ no'tilion fphujctd for Ih« inotrurnrmt to be t^itod I* now 
dUiLlnl by drcirtvt t>iih fmm 19 to SO piftrti oit vittr. and vtUi «aic^hdflu- 
Itob vhfttet«r dttTerrrcra Ibc hffmAm«t«f «bow» wtth 4 knovn panj«nta|E« 
ttrv r<*conl(^. ta UJi w«j tlio toiirr«« ^ omr niajr bv «1n>oit whollj 
onrtouv in xo f«i lu Ibiii i» ]K>«&ib]B iq • (mtiiriitiHrir r^TirrinTlon 

Tho dotj*rmiii*tinn of IiMnoglobm by Qowcna method in 
nlio boAPfl ^ipon colonmrtric octimjitioii. Th« fimall appnratufi' 

iTAUviriB FieiKhJH iDidtbr bdobor;, Vtcan^ ejtu tO-Wi 


mcnimxfvy anij chkmistky. 

\ia& tf](? adtmiLtngc of the PlcJj(chl m gro^iter simplicity, hsoäl 
All)] ciicApDees^ for vrhtch rcjuon^ the attthor WAtrtly rerornmcarh 
it. Lie Iiaa uaed it cicIuAivcly for hsn ycnra. 

It o«n»lfiLs (hpo Flff. Tr| of ■ g\tt* hil«. tbonb pli-^itn fipntiiniTt4*n 
li]ghp upon vliith it uigiLved » huId vHU tJA flua divitii^tii, VAcjh of 

TLitip ountJiiiiM n "xjiriiiilK MrTuthin" {|il(:ivi'iiE'Tiilii^|E^jfivr[nj» wliii'Fi corm- 
vpondt to Uw «Kilcif ol l-ji*r-ertil. «olutiOQ of tu«"mai blouO vipw<*d in Uiff 
iiivOMm ing cylinder, 

Tb* «rfnmpanying caplllio' (»JpclU Is flllod mbcÜj up to thp tniiik 
f0 Ouftip uirf/li'rrfrfj wllh blood dniira lioia tJift Öngar-ttp- Tho blood 
b ftt onvv tnixvd wLIIl a «nail amount of »«Lur in th« mcMaudnc tube. 


I , I \i h r^ * 

il •: n n^ i; 1 1* b i " "luo I ►.' r, j 

Tilt f*llflp i* then viewed alongsida of the "loDipIe Hohilirtn" by r^HnrlAl 
lif(ht o-gaituit iL ibcct of wliti« pcLfwr in ordf^r to cUtiiJnatc confutifOi from 
r^fli-vliun tiui» llic hilicv, Wiitor ts now carerulljr uddrd. Jiup by drop. 
with Jt pipfti«, tli^ iubv hi-m^ '.hti\i*-ii. iinlil Uii» I'cdnr oF Ui<r »olnElonk 
in bot}! taW la (';(iictty uliko, If this ia obtAidcd with il dilution n-Mih 
iitg tlio lOU mark uii tlic ttciilc, lb? hcmogluU-U conU'iit of tbc Iduml 
oia-tnincd I* nornijkl; il Ihe «olom oorrBapond befor« thli lunik |i rrmiliod, 
Ibfin tliQ line tu wbJrh Ilid «t>1iili»n riHi* will ind^Vfrlc Lhn pcfvontag^ *tl 
□orcnni hriitthpTciljin iirvtsriit in Lli«? bl^ttpJ emiMhied, 

Ai with aH poloTimctric p^timntioriK, thu mnilmd it nUn nllcndnl 
by d'rlnin «thu». wlikh, ftocoidiiip; lo iimnj ofFiilr*! I^ila, amount to fi 
por f^jU Fnr m rHtvfiil iicTfiiniuimv *^t \\\fi lr>t it It ncteHinry {nfUr 
quickly wiping nvny M-ny Mooct ftdluirinfC to thti mit«idr) ettrtfullp In 
ivin|it.y llie blc>od la tb« pipelt« int-j the wntfi prvtpnt In the |i^aduatci3 
litrw 7hU i* done bj pljit-lng the lip of the pipetta JuAt N-nfittli Ibft 



flurfac« nf \)tt Mr«Ur in Ihe tube. bloAinn the column of blood out, *ud 

tlio lube. t[] urder 1o n»b out itny blood wM^L m«/ nutbin ailhcring to 
tlie iiiKiJti i;f Ihr isipirUt. 

[Fig, 7f^— Dar«*« üomoglobfooiuctcr- 

ntt 9ff*i Hff* wti nw it lA« laalniiiHil n^j Iht ■■* fMv-liiir 
■dIkÜriHt. J?. Miii^.|,Hjbr*Wabtt<t««lDr^ff4n1»roiaU4. 4«U» 
taOlMliif «aln-priatit, mh^vwUta ttM§t vpvt vhMh t)i«Hno4^r^1adlilBL 
r. ll0*BliiatDCfiiiot.*i] tAr«A«L iWtifD 4ra«n onlwinl «rrrffrt ihi #;■■ 
«f otanw VtOD itifl \it,tii. WbD ii«l tu i4ti ILaa luporlmiKikPit uinci ihn 
«IrwUi pnai rtK > T, T>li«a(iitlof m*r«-caWliiH»iildn ftrocuilDk 
llou» i, 0|4it^ii|t In (irWiu U4H, «dulUlBi UjEht R^ IDaJufteUuO vf vtüar- 

v>df«l<lM. >', TVffl'hialJmii'lL'l^tiilop. X^ 1tacUfifQl«r«t«*i((if iB «df« 
•4 OH fet taMlDf faoniiicUitiln pnwiUci ladlMlaJ bf tflnlaabMH 

Thn iQiru flfitr* 1i Uin «nlor'fplt'm Jt r*iiin 01 ?ali>n«l c*h^ 
ff >WtolfBt< of »bin kIhi^ 1I11] riltffl arrjlTiriUv iBdfi ul hnanvlbtuii 
pvrt*Bi^* «bbffil tadari«<l it with hUct. 1;^ lloWia vfiMi tiul-lt Oiri 
wllb mUf r vHh^n. (revolt lni«iiw«r 4H« bBld tfttfolHa nmtxin 
pUn) gUAn of hmp^loMB luu BHf m <Bfc*J NbUcfc J^HUnf 
«ttHafflt^vblcli ■vrm lb* Ha» pdrpoMai In Ui li1««A-^t^«ttd^ biHlH 
ÜI* flan al 4invl 11^%^ «hpI nim\«liM ft «Ml« butpntil I* i1t* Iha 

[DaT«*a Hcno^Jobinomclcr.'— With this Appantus a Rim of 
tfnt/i/ulifj iJooJ IK employ^ tor cciiiparisoci ittit]j a gradtialcil 

ntlklAlpEitj VodlcAJ Joaniil, «iftea^t n, >m, 



oolorftcfijo. Only aecoall drop of blood is require«) (Fi;?. 80) and 
tho oxnminalion can bo inaile in a tav miiiulce. The pipettrj» 
coDiposed f^t two nx-tangulftr plates of j^liu» — one wliit*, tlie 
vllier eleiir, — vbltTh oau r^c1t)> Ife IhL<?u n\3iiTi und quidtly 
i'lcpUit^l, i« flo ndJLifited oa to form & chamber holditik; a ttmliLm 
ol blood of uniform ÜücknttA. The Iotct of blooJ is vicnrd 


FFl^, TO.— ärclid» uf ümvt l]i;ii;UKluliiiif>iitH(-r. 
TXm Ittgor Bgiir« rtt»irtTLiU a liviliuuirfil itclluu iiF Uif luUmuviil 

of «HidttbuMcr 1»lbhurv«(ju>l l]luu>li»Dl^<iDerMuo't-dlai and ooli^r-ftfiau- 1 
A', WlklU glA» dink of mror-frflam, /^ (Vitoi-priank. JV, A]ipriD»chn)n«h 

lUunbulMl mtlcfprltiu U rlDncnL .Vh Ln^LscIiilile bctr*i.i>^|ite laiiK^nMUilKi 
HkKOgb vhlcili itio (akn, pliu^ liiin«<>n tally, »Mp bj iliK tn tIowp4. 

arblou4-llliul44*Hiir»iuia J\ 4L XeMl Kplmu Uihrteo Uaod-aiu auij 

Tho ■iiif'li*f Ajcuf* •■■'■»»•L t'li>vil-i>fp«lla. A, WblL« j^t» nf pif^Llo, 
A', Tflinil|ifcriinl ^nu of ^1|.*M*. f^ t'l|Mll* flnmi», »»iiHrliig i1ilL]ik(| imioiV 

iiuiiTiiii prraturu <,", üriuie Ei|[ii»(]i<^b™»(Ti"*iiiuuJHitf ivlili'inii Lheititf« 
(t/itif]iit»iruiiii.^m>1Nr. hM^üii^c tbt (»Ilptk? firmer lu irtmiuojk, f, i>pitt*ir 

agamst a vltifc bad^grotm^ bj* moäiu of a camera-tube und aitt- 
ficial light (»ce Fig. 7Ö, U), preferably m a dnrkenod ixwrn, 
though with fwrtajn prooautiona daylight *if*<*a not iutürft^ro. The 
perucatii^'i^ are iDi^ioatfd by a graduated scale r^d through a 
rocUnpilar op^^nirg npon the side of the matrmnont Full diroo- 

THK hUnm IN liKALTir 


tioDB ae4X)]ri|ij[Eky uidi Hpjiurutmf., For rapL<Iity, nc^uncy, ami 
Bimplicity ttiin in^UummL fan Tjc la^lilv rfXTJtnmeinjT-J. 

(The Taliiui»t hcmofflo1>in igaIc, wl^ch 1m« rccrnÜj come 
into ti8e> grcfltlv äimplifir« thr r-Mimmntion for hemoglobin. Aj 
the iUtislration ehowe { Fi^' ^t), it i« mn^o in book torm And 
can easily be carried in Urn jHickrt and iipcd at the bwlfti'lo, Tho 
liook conuinfi fift; ^iii.'^lfl of A/ii<>olh HlU-r-jiMper, eacik tJiviilod into 
ILrti^ sriinller NhtiLie. t'^^^^g ^ ^^^^ ^' ^^^ hundred Buä Gft/, It 
4Lk> couIaidb a doih of ten color» for compariMn. To mnkr a 
tot, A «haIL ahoot ot the filter-paper is Ironghl in contact wtUi a 
drop of bbod uid the ktter al]<iwe4 »lowl^ and Üioroughlir to 
bo atiAorlxid. Ab floon aa Üts bluod-ecmked piipi-T hai loflt its 

[PJf. m,— To Fill thfl Au1«in>llp HiietUL 

vbWilthvl<ICKi*bwl'Uii^li'uie, niafllhut BlUiriifpflwialUniJUHLn« 

moißi gloM» it is compared by direct da/light with the colored 
acfllc. Th9 tf9i tiinnot 6« rn^tiit iri'M nrllf^l Ughl! The 
n^unbor opjfo^it*? the color which corrcsponde to tJic red ©f th<j 
b1ood-f»akeil paper ^tea the percentage of hernogtobin äinrcU/ 
(Fig, All. 

Ift-salte art obtauied at oueu, and Üw erroiH do »ol exceed 
10 per cent. Similar errors, however, occar with more cUborula 
uppuruti», euch as the lUei^clü, Uowcre, Dnre. nnd Ulivcr inatru- 
inentri, and, therefore, this objection apptic« equally to them. 

Aa tttch «noil alieet rneaaurea t '/« hr 3 inch«, bjr lurng 
only A portion of a «he«it for an «;iNinina1iciin Üu^ borik can Hn 
m&dc to MiTc for aevem] hu&dred eaaminatjona. Jt ia uiiquc«- 



tiouflblj tlie beel nictliod jrei devitetl for Üic uwf of tW pracU- 
lioner. — B rooes .] 

Vnrirttinn« in Ihr* ninnunt nf oxffkcmn^lnhiri irv Fnt mn^ly obwrv^. 
DiuilnulioD ii» rnu<^b more frequent ihuq inorciL»«'^ the (gnucr fit i'?rj 
cojiiiiioii lit üiUiruihlH auü h-vere aiirmk «cmUtltru», whilif Uir Ullii U 
iiiK Willi tihly in cflna» in wJiieh ihcn I« t*fl*ixt4ii*nt irx-rviiff in Utv nimi' 
bcr of bEood^coj^>ii4i:!ntr It tmy ha iin'nUoni-d tlijit in nddii-ion io Ihe 
pniDüUDecü UiciVBAP ot prylbrucjtw lu 1^^00,000 ui BUciTrcntatloii uf Ihc 
bnnoglDbin conti^nt ut i^ |wr «ntt. hju «vvnl lim» Iwoii «btais'td in 
pulmon*!? »tcrjuiiiii. 

Fig »^— 'iui^iiihL lU'imijflohln 8iAltt. 

Estimfttion of the Dry Aesidue of the Blood acoordinp ti» 
Slinlwog.^ln ^ft^oeml, a certain jt»t<?r<kin'initnt ri'htbn csinU 
bclWL'Gii the nunih<?r f>f bloo(l-corpiist'|p*, tiio spi-riflc grjiviir, nrd 
tlie heuiogloljin «nit^-nt- TKo jiflralli'li'hm is, luiwrw-r, nrit abftu- 
!ule. Thii is prubn.ljly due to Ifie furl Ihut in Lhu l^xU m u I luii 
of the ln^rioglolnn Ihe nJmaming protcirl bodic*. of the blood 
(wliich, aw^jrdiug ti> ßiiu^'O^ flinouöl to 7,57 per tTut, in llio 
Bwine) ere ditrognrded. Therefore tlie eeUDrntiou of tho diy 
ri?*i<3<]e of the bloin!. wliiHi Iihh rLvcittly bptyn enipluvfd for cliiu 
icjil piirj>oses (using Llie smjillett pciR^ible mnouTtt of hloodj 
d««civ« fiillwt ct>n:iid<Tfttioo. Further rrjicftrchcs in Ibis dire> 
Hon ore grcatlj^ nooHod. 



«lU nf thr> Hn^n m ih« flii^r'll|i drew {if ncopALArr, bj iriod«reln 
]i«HUrc upon ilxc mMillo Jolnti fi drvp* <0.£ tu 0^ s"^<'^ ^^ Ul^vJ tail 
|i1ftn Li a |[ftiH ili>ti m-iirhtiiir «bout Eniiti" nnd |]n>vi<1>"l wilfi n IjjfMlj 
ßltilifr coivr- fmiHnJJorrJy/ «ru>r wUtK^niAiil cif Ihc btotiij Iho 114 i« pnF 
«It» «nd Ihc ftlln] diAh H'eij^h^ knd tli«u pU««^ open in n dr3-lD^ I'liamltr 
at OS* \o TO" C- fi^i nluut twenty fmii liouiiL Aflcr IliU timiF Um tli&li 
b (jufcckly eoT*r*id, Cflk»n from th*' c!rylng fhnmlrfr, find t^uin wi^jKlkful. 
Tb« AKrIhod of cnlculalme i» obiJoiii«, 

L'criAin Boiirvcji of vrnor nrc unAXoldjitilp, but t)ipy pLn? an iinini 
|ioTUnt rAla, »Out af on* liitndrfd *nd th^rl^-nlna Joubla «Umnt&oafe 
MintxiniE taand an avr-r^i-f iliJTfrtfnnt <rt 0,14 |H»r csnl,! It i» tir<T«<»iy 
«ilBiij-a to miil;<> Iwa pirtillpl «■•liTHiiiiiiTifl htuI ti> ('»mliiol tfir wf;eliin|rK 
■4 ijfitcklff <t9 poraiftic in order I0 at mur^h ai pOHiblo avnid wnpotulion 
t'l 1I1P walvr uf Lh(t fifth bloud find abHtirjitiiJii pf «at« l>j thr drj 

In heaJthif individuoh Stintring and Gnmprvvht dotermini^ 
t!je folltiwiu^ vtLlui lur tiie Jfj nwilue:— 

Av»™ «Ji- «mum „,,,Va";S^. 

Tn men , - . 
tn wrimni 



78,4 pCT **iil, 
nOL2 per ivnt. 

CotuUut and often pteal diniinittli»! In dry re»idu« oc^nir* 
m rhnink immiin. In clLlnrimix tlu* dry rvjiiliu* ü jÜjio reduced, 
liut not M) Titui^-li Aü Ulc hrrnnK^'^^^ii'' 1>^ Irukeniin tlie dry roAidue 
is KvlAtircljr hi^h m c^iuMyiucPcc of the incrcn^xl numbor of 
louoocytos. Honooop^^1<H] valTnUr hc^iirt Iraion« tro cliiLrac^ 
leriz^d hv inorpn=»*d wal'^r oonTi^nt. 

Th« Uolvcnlar Conocntratioa of the Blood. Itetenninatian 
of the Freeiinf- poult, — AuoLh^fr impoiiaut püculjaritj of th« 
Mnntl^ w)ii<h lum r-.veaUr aoi^uiivd iwjRvial cUnic^d aititi^^'^Ulci^, 
miurt be mciLiivncd. Komnvi was ll\i? tint to <:?tab]ijdi the tnlcr- 
t^tinji: fact thit tho molccuiar con<^ntrathn of the t^hod I« «n- 
ptAnt undiT nominl e'^ni^liiioTiii^ but I« dijin^frd In t^i^rTiln difeVii«<«, 
nnd nlmrut pk hivivfly in ELiTrrliutiH of i\vi kidncjK. 

The organs which cspGcidlj srrre is rc^latcrs tif tbe molec- 
ttlaf coiupoütion of the Tilood and ki^p it t.<*n»tMDt are th« 
Icidttcy», and tbb c^tialixatioa it i^xpiaincd uyon tlie tlicorj of 
estncUc pr«Mur^ By the latter ii rn^ot, a« is koown, that wh^a 
two Kilutioni of dlftetOTit «mcentration «re placed on* over th** 
othvT in »tmta or arv efepaxuted by a permeable müifibraiH^ a cf«^u- 




dvn occurs, ihn mulet-yl« of tiic more conccntmltd solution 
flowing tuwurJ Hie Ivt« mDctntnilcd untÜ an equuiization ot tho 
jQoloüvilitr t'ornpoiitioc i» ri^m^hod, 

Sinte tho osmetic prcfifure of a soiutiou ia proportional lo 
the number of inoloonlps, deUsrnniiolion of the former voiilil gSve 
i\\e luokciibit wci^'fjL la priittit'e this >5 jiCL-iHuplinIidil in «n 
indirect manner. Upon the basis of the fact th rat the Inwrriiij: 
oS the freesiuff-point of a «olvcnt {€,g., water) by adilition of 
foreign eubstocccd iß in proportirm to the osmotic pr««uro of tho 
eolntion, a determination of the molrcnlar woight is dirodi/ 
obtaiDed liy meaguremeDt of this lowering. 

DeL^raiitation of the freciing-polot U done jn Beckmann'» 
epporatuB. Thia coiitiats e^cntJaUy of a vory ddicatu tlttrmoiii- 
elcr gruduatcO in 100 parte, in which each Colßius d(?^^roe is 
again divided info 100 dt-groo*. Th* thermometer ie phoed io a 
glfl^fi cylinder in which the fluid to he e^nrnined is kept eori- 
stuntly OgiUted by xne^nB of a platinum alirrer. OIjlss ryliiid«!'. 
thermometer, and fluid are then placed in a freeing mixture at 
— '4' Q.J and tho fluid cooled under constant etirring, A 
Daoment then arrives when the flujd ftnddpnly congeal*. At tho 
point of change from the fluid to the solid slate heat is liberated, 
which c^iiisefi the mercury column nipidly to rise to n ivrtain 
point, where it remöina stationary for some iJma, — tlie physical 
jrtfzing-poini. Ou ttmg standing it again ainks ruid acquirea 
gradually Iho temperature of tho eurrouodiTig frecatn;^' mixture. 
If the freezing- point of distiUed water it now dettfnninod in tJjc 
»ame mntinor (the scnle of Büdcmnnn'a therinQmd*?r is im nthi- 
traiy one and tlie point ia not speciflcally dctignalcd), and the 
freedng-point of the Elution is eubtTacted from tliat of the 
vatOTr the £guro indicating how nmcli lower the Solution freeze« 
than tho water is obtaiued. In blood this difference is — 0,£C' 
C. We »ay, tlierefore, in brief: Tlie freozing-|»iiit of tht» blood 
amounts to 0,56 nnd un papppiji] designation, therpforc, "JJ/' hii» 
been selected, while "A" bdicatcs the freering-poiat of the 

The procoduro in blood-cxamination is aa follows: From a 
eonetricled rein of the arm (of course, under aseptic precautions) 
IS to SO cubic centimeters of hlond are taken by mean« of punc- 
lure with a almrii cannula. The blood ib tlseu pUced in Uic gl 



cylifi^er usf^d for Tr^rxiug and defilfrinnled bj sltAJ^ing with the 
platinum rin^;, vhe^n the frri^^ing h ot nncc bcginin In a M^coat] 
kEu» cylinder the frcc£ing-p4>iiit of diftitlcd wnt^^r ii) cktcrmmi^J 
QicK time. Tho latUr prtK^iMlur« vtq consider necoseary bocativu 
thfl pn*itJon f>f the mercury in Ihe ü-sbaped Beckmaiui thflrmom- 
ctef is easily Ribjn:-! to variations and bBOJiiise the thormom- 
cltfn with fuied iiojut appear Up mr. not to be tcllLible. AiivT 
hoait practice the whole procedure, including venouA puncture^ 
roquiroe nbout thirty mmiite*- 

The mole^uUr cmrc^nt ration of the blo«^ in health ic «hcwrt 
by a lowering of tJic frtT^ing-point of — CM to 0.Ö7* C- Oo 
the othor liHud, tht« value ujidorgoe* an €«Aeniial change— i.e., 
t}ie fiwElng-paint ia lower when an tffecLioa of ttaih kidneys 
eneta The degr^ of difference in comparieon to the normul 
frHrzi»)-- point of tlie blood ie in proportion to the wwritj of the 
reuiil uiTc^tlon. M'hilc In mild dt^^s^ of n^phritiA nommt 
vmIiici nn? itiU faundj the frpexing-point b^oirc« lover anr! 
lowor with iDcrraB&d insußldency of the kidni-yR. Ijoi^erin^ tn 
below 0-TO* C. h«Ye beoa obeerred. On the üÜkt baud, the dif- 
ferentia) diagnostic and prccuoetic fuct is to be emphjuiixcd that 
In uiiilaterot rentil alTection, even «hf<n the luttcr hji,i advanocd to 
eoEiiplcte dt-itruction of the organ^ iho fn^o^ri tig-point d^owe Uie 
normal hi^jght, provided tho otll(^^ kindrioy h h^althy. 

From this we obtain th« ini[x>rtaDt law tliat a lowering of 
the frt«2Jrt^poiiit of the blood below — 0>5S" C abuoat inyari- 
obly Indicates a biUt4?ml nlTcctioa of the kidneys. 


The altenliom to be dealt with in thia aoctioo uro ueoeifttod 
particuULrl> with the eorpuacukr elem«nt» of the blood. Con- 
M^uently the methods for the preei^e extmlaation of the Uttirr 
will ivntivif drfUik-d cuiniidiTnlion. 

A microscopic cxnminntioi] of the blood ia often alone deci- 
idve in the diagno«ia of discoao. It informs us of dovlationa in 
Uie mnaber, colon >&d ^w of the bIood-coi|^u^W; of d^gturl- 
ftnco« in the ratio <4 red and while eelb, <4<>- It ek uceivKory to 
etaminr* both the frech blood (»ee page J3i) and stained dry 


MicR054--opy ANU i:ii^:Ai]?n^Ry, 


h t!^hii*4iJ m Ujnrr of blood a* thinly and Tiniformly n* pohulilfl 
ujiiiii A <.'ijvct-^-liiM [ur ÜM«]- Tt U HmC Abnolutoty ht'Uvurir to euiplof 
only tliopjij^hl/ drained oovtr-gltEuo* [or nhil^^J Uv* from grvaitt, 
vhScli h«v« Ii4-H'u wait1i4'J piWrtuMy in A(i*alLiti* [ur O^jwr-i'mL) iilL^i'hit] 
or iJ11l|(« nilrir nriiä, biiiI jmlihln'tl wllU ■oft (mithiT lorrWn, iinv»rr|iKl 
linm, «ilk, or eoUon «loth]. Tiw |[laMOt thoitid bo gro«|HiiI wklli fanwpt; 
if tbi^ finjfi''* A"^ uitd till'' wiiiiu Ait jji^rii olF ttnin llivui i«tU fnvor dU 
llirhiri|f iLllHTuMrm« In U\rt». wliwh ncnir rt'julify mouffh fxt-w wi1.hi>iir, 
BLiC'h u^ency. For the umfl nsxton brrfllliinig upon llic ^'n^pnTatton »hnuld 
hv BiuiOiil. A *iuull diop oi bloott ilitLwu fnMii Uk Gii^it lip ur [yW 
Of the oa.r U lukan up vIlU a ctiVfr-gluM [»r «Ikdn^. nnollttr K^»^^ pliirinl 
0«nfuU^ np{>D it n'itboiit rrc-uiiiv, and the two quickly dr&ivTi nparl. 
Or t\w drop of Idoud nmy W inkon irii «jn Uut ml]^ af a vovoi jfliiM or 
«muolhly i^riiiinif thtlii flnd qui<'kly H|>ri-itEl into k itmfonn, thin Hyrr 
dpon DDüthtr corcr-Ela» ar «lidt. 

ITm uprmillnff I'on alwi bf drn« with an wpmially oonatnirti»d nd^n 
■f>alii]iL, or a flm« puiiiMV-hiiir Itrutli. by dippin^f Ihtyt^o Infllnimi^nlit in Ihit 
btot^d mill thvu alrokJTti: tlit «urfu<]e i>f ibc «tidt; or tlJVl^^M:^u^u^ EEli.O('l' 
lunl Ami'Ai« Pun b^ laaA.* by dipping Hip ^ntl of a *,Trlp of plgarstli* piper 
in iht blood nnil (Ikii drnwinjE it 'jtiirkly ocron« the Burfiicu of o «tid« or 

AIJ of th«Q ni«thiHl>i ^vlU yitld Ih* roiult d^altoJ; U U a iiutlur of 
titti« iinfjorijuii» vrbirh ii icnd. The mniii thine ■" thr ptTpArDtioQ of a 
drilcftin layer of bluod In which tbn veil* Urt inoluli^d, H[id fM>( «ipCTiW- 
poflnf. To ucnra aui-Li uprcadi riM]uiT«H gniAt ctru and no IJttiA praoUe«, 

S. Aflor i\i& pr''pai"rttionf* Iwve been thonmglily *lneil in tin- 
Air tUey axe dubjwl^d to furthi*r fi^ndivn. If it in du»iml lo 
make on pxjiininatiun un quickly a» jKiwible, fUaiion hif h^ai for 
a (fl«f mTrrii^rs ot ^boiit from HO'' to 11</'' C, or in a msj'tHrG o{ 
absolute aUokol and anhffdi'vus eihef [equal purU] or, finaUr/, in 
ahsohite alfohol vlo/if may be employed. In tho latter the prep- 
arations alirjidd ri'iuiiiiL for at ]vnst Imlf an fjuiir, or, butter, one 
himr. Formol, a miiiurtf of dO-|jt.-r-oeiit. fürmaldehyd in mciJtj/l 
|w*>fnlj nbiiUül nud vatiir, "Mixc*" in one niinuti^ 

Unw |iurt of Coniiül ih fiiiL iIJIuUsI ^villl 10 i^aitu of watur, ■.TtiL 
of IhiB mixture» ^£aln, 1 part lit di?ubrd Wkth 10 pariA by ToUimp of 
aloohol. tfl thU volution Hip diird hlooil prrpnmtioni arc fmiHIPoily 
"flsrt^d" in on? iiuniiU. Th«y fun ■uW^fjUcnily bi« i4ul»jodtt<t] to zncml 
0tüiniu[£ rvHj;(-ntfl wiLbouL nltvmtiun of rillu'r llip t'jiiu or fuiiiiJObUioji of 
thp rlc^mmliL. Thr prnlnplu'in at v/A\ ut thn hrmn^floh^n I« trnnifomipd 
intn nn influEubtr cLiid Aird ponddi'^n, And tbc pnipcrliM nf (br tfdl« for 
Uit! rttT|ilMii^ Hijil lulviUiüu i>f hLiiiii^ Hii< wbiillj pirxfi^iidi 




STAlNlNd or: pRiEri BLODD fRß PA RATION 5.' 

1- Slaln with 0.1- to O.flpflT-PPnt. walrry «)imif>ii of »»lo upon 
vhkh thft ca^fT'glftifl pr«r>iinitiOR «hattld float for lrf>tn Ivn to tvflnty 
minutcifl. Wath in nmlrr, dry, and JiTib^d in xflol^CknAd« li&lNim. BLkin 
Injr frt jfTpally liu-ttponl hy hi^nting thp «otullon, Alonhnlir «MulJon ol 
MiiD {O-'iti 1o O'A por wntj utalni tho prepan-llona U trom one half lo 
one juinnlr. The rtnü UooJ'tT^lii Art »tnirti'il a brijiht- imiü utiif<>im rtd- 
Tli«< pmlnpiaun nf Ihf f-nlnrlv«» (vMlfJ rikrpiLhHfM 1h uT\]y ^}\f;ht}y 
tingfid. Tho cosmophilic ^analen (wMch u«) A]>]ir?ara* intpoi^ly aUincd 
mliiuto tphciuk'*- 

?. FllAJfi with Khrtifli** h'mnTovylin'PDKln dolullnn inr fnom twHv« 
t« tfrentj four bcnm (PlmU IX, Vlg, lAj, Tho »AliitioD üv pr«piiT*d «■ 

Diatill pd iritn, 

Oljfflrin of«4plil00a 

HffmaCciyliii . .■•■■»■■■ia*t «*■<>•■•-■>■ I 4-0 (o G,0 

Qtadat acclk ai-id 20.0 

Alum tn cxcon. 

Tho frMh fvlulitrn »liould fltanJ For frum ri>ur Ut %ik H«i^k« in ihr 
tun: Lhen atirxit 1 prr crnt. of iv^tlti h« a<1dr<l, Afl^r Iw^nly-four hour«' 
■lAJaiug (wltk-ti Ifl bcit done 1& • elcnsod dl^h cipaicd to «nnligltt) iknd 
tlii>:i}ii)t1i ttuhlijii|j ijj nn\trT. ilivinif. sud intinddiiii; in ImIxuil, Üiir wd 
hU»m1^4Virfiiiv*lit>i Aj>|VAr i(tTan''lH>rrj' nnl {now nnd llirn wiTh a al1|rtit 
tin^G <if oranjE^^; tliP nudci, when prcwsti d«tp bincki ibe cell body 
af Dl« ItiUMJrylj'« a liutit and Dnir nut-li-l a dark Ul«c: llic titalnopUl Je 
irrannJM inipn^^y rtti; and lli* <m«ll l^^mplirif'yt* TtnHfi ii«im.LTy blarlc- 
inh— ■ flliadi* 1ii:bt«r thim tliooe of th« «t^tlirrKTtc*» thcLr protoptasm 
acarrrlj ting^L 

3, Üiniii with EbrUch* ttl-acid «Olntlon (FUt« IX, Fi^. 14^, whiob 
la mado as folloT« — 

nUlJlh<d waUr 100.0 

Ofimir O ,.,,.x...., ....,,,. laß.O 

AH(T fm^lo^Iti r.A.0 

DUliLJcd vaI^ KiOJ) 

Alnüluta aln-hul JOO.O 

Mf-thfl'RTVWn . ]'AM> 

Bintilio«! watpr IÜO,0 

AUolulo tl(«b«l - • . 100^0 

Oiyotf^ loan 

Tb«C an lo W pnidiiallx mixrd «ith f«oh othvr. l'he miituiv etn 
b* naMl ODi> tUcT lon^E BUmlinji (one or two wi4bfr*-BRCKMiaJ> Tht 

< QrftbkfS f lala^ laadt In Lripil«» an U* bwL 



prTpBniti<i]tt «JT« Üo»lcd, ««cording to Klirlkh, tor otAf two hüIXuUb— 
in tfar »ullinr'H uiijiiion. füi l<> vijflil iitijiut«* wuiild ff Wtt«r^ — upijn thi; 
»nliilJfin. TUi>y «r* Ihfm «n>thr*(1 in pIpnTv nf M'jilfr, «Irinl, And iml^Mi*«) 
in xylol -^wlMim, Tlic f^qHhroj'ytQB tn atAinv^ yellow, thoir auolclgitcfi 
iali blue. Tlip Qiajüiitv oj Kie lcuw*c>ti?« fchow fine, vlukt DciJiri'|j|iLlk 
pnru)p4 ftnil & ^nwni^ih'bUi» niiiluii«, Th* «a«iiin|ilill]r jCfsniiW tf» 

TIiLh inrlliW of »lainiiig i» liiililj rvcamnipiiilpif fur the mplilUy 
Vllh vbk'h U «kn Id i?AfiE|Eir<[«iL Xh» flno flilTvrrttliiirifin, hawtfvitr, can' 
not alttftys b« brotigbt oul with a aolution prrpartd ^Fordintf to th« 
nbort formula. Appufcnity, Ihr cllacovrrcr of thi* nUinlug wUiui» biii 
hbrnuir oltoQ hnd huc'li 0V|>i'r»«rKVF. (af lli« fontniU ^iwn «b«vd, uihlah 
the milliur ubUiiivi] tlurd'tj^ Irum Wn collvi£Uv» Clirlioh» diffen grFiitlj 
from nihm piibtUhcd by hlin. 

C KhrUuh'ji Iri arid ftolullan hiu hoaa mAJIflcd by AruttAon &nd 
rUilip aa tulluu«:^ 

fialuntod wnlrry «olulion« at onngn O cxtn. add nibia «xtro. 
and cryvtAlllKcd uivlliyl un-iMi jim fir*! fin-parrt!. After üuMt vo[ulioak 
hjiv« clmivü by M'^itii^tilnUnjin th« (ioLri|xmiljijn in a« fulTvvri;'^ 

Ui-flnpi» nalHflon Irü P- pIö». 

Adid rubin >4>lu1ii->n --- - , 6fl " 

DiFfliJIcd wnwt lOti " 

Aioohoi ... an " 

Tbvn »ddi— 

Mclbyl g-pfpn mnullun ... ...,.., C"; c. «nifc 

Pinjilltrl vHlvr tiO *■ 

Alcuhol IÜ " 

Tbc mixtum itumt ■trnid lor Ipom on« to iva vivfkt. 

One drop of tbii Bolulion In a l*Hri dish of wat<r Buffic« dUtii 
1c *Uin lb* firr>|^nniU»ii in twrnily four hour«, Iti-fura LmlirrJJlng, 
prvpantJonH nro imih|i<>c1 in vtalor, brJoHy in alwolilto aTcohol« olHr#d IJti 
itiiKaiium-oU, Aud jmbcdded in :tylol-Ca]]iida. idlnarrL. 

The Blifl*li?a of oolor cßiTi^tpfjrnä lo thatvy ahif^iJt »tnlnBd With t.ri- 
ueiA. liivdcr highly pmiflo^ tbia stain- The niithur, bowirvar, boliovM 
KbrLii^hV tri-acul F^olntioii la uiucb lUpriiur 

&. ^turning witli ChenzInslcy-PI^hTT Bolullon:-^ 

C'uTU'dilrattd wtftvry «uJution <■! lucihyl«!« 

1>tiiF „,...>....,...........< ^.. ......... 40 jEratnSk 

O^A'prr'CVtnt {preptriM] in TO* alc-ohol) eoaln 

tohilion , .. , an " 

tJiBiilttJ ^TiikT ^t " 

fitniii thr prvfi^'n^ion (»f ivvniy-tvttr hciuri, U iii^e«ary, \n ihv 
Inoiibnlor. Tlip hnirr/l niiTiiifin ^InTn« ttk riU-m mimilpfi. but not «d dcd1< 
mUily. The red bJgoü-otiU ore ata,ined itoeln nA-. the «UHLnü^hiUe fnin- 
iilc^ l^jfbt foil; tlic nuclei. bUic (IIaLc IX, Pig, 14), 



iSUinlng nmmdwljr wtlh alcoholic »olulion of nMin ftnd cuv- 
«ntraUd wmttry »oluUon of inclliylcm fcluc aIr« gl^w «harp plotoTM- 
Ft>r rULiiitiTe. alauiJu;; ivt ifitu twu to Utii-c uijnulc« In bf«W OJ(-p«v 
ocnl- olfohi^llff tclution Af ro<.in und tTi« S4ine tf<nglh ft tlnto vltb & 
wttirtttcd tvutcry »olutioP of mctbylcno blue. 

EThr lollovdn^ mdhod win b« found xiwiuX tot Utnty «xamln«ilonfti^ 
By (niranit ti a pip«ttfip dTop upon th« provintitlT ni«d 1wf»or| aleobal] 
•lictimcli A »mall cjKjfljitily ftl. - 

^almitt«d jtHiliulJt «'rlTilkin of m^a 

10 («iri4. 

«od Jk«af over » frao alcohol or llnaiiu^ri iinmt imUl t^por bHu*: wash 
in i^aUr ai«i! »tain fvt Imlf * ihSquIc ffilh OoW I-Cfllpr niutliylniu bluo 
toliitiim: wii>)i in wHli-r. dry tTujroii|,'h1y (4Imoi'1ifqi [luptr mid Htme}^ 
and «»Riino in (>i<rj»vr-»il wilb V,, oil immnniiun Utt>. without <N>vor ^Ipm. 
ThU ou'llwhJ cull !■: ua«| ia cxamiiiLnK Uood roici>jBcopi(Älly for any 
^hanpa. Ta avntd »virvlALVing with iha mciliyii-nf blue solution, it in 
ftdvE«abla to «nminc the prppnratioti, Jntt after lb* blue hai be«a 
vubed off and while 11 U ilUl vci. with a '/» objpütivr. In n »rll- 
klainod M|m<tmi'n ehi> rwd oarpUiU'lM abuuld b# pula pinlc or llgbt rwE, 
and the vr^tc-ntrpuecle nudei vcr7 pale bine. If the rr^I t^orpuAdn« havo 
a purpUib or auiMh/it hue, the t>!uc dye hai actvd too long or too Iti' 
IvBMly. Ill Ihm caae icataüi with *Oiin »nd proooed ai befOTT, allowing 
tb« btuo to rcmnifL ■ nhnrtcf time on the ifprrinim. fwmeticnu llui hhiv 
Hill oiTntflln no lEuder hov iiiuph caic In ubfcn'mt. TliU i.aii be uvi-r^ 
romc bv diludik^ tbo Li^Ellcr lolutioa vrltli ono tidtf rl> ttulL or murr i4 
■tnU-t, If Ibe wl»lr-f'jrj"U»clif nii'-M oie tn?t T<Uinrd nfUr tlwr Uinr nbuvu 
mf'niioTinl, rptlnin vlth IFi^ b)ur unlit the niiHcl lAk^ nn tin* paWihie 
lingr. WbcTi the li^^t culorinf; of both corpiiict« it attaJnvtl tat can 
tndJIjr be wrJi by rmiiiinjinr wilU a Vi objnjU*« ■* iilm^p di»trrilir-tt. 
iry off til* waUr and vvamin*. With a Ultl^ rare, j[Ond miilt4 can b« 

Tita malartal OTftntim ran alio he dmon«trm1«d by tbU i]irlh'>i1. 
It appaara blu« witbio the pink »Ulucd bodfu ot Xha nd blood «or]kU«' 
fl»** Th* nudei of thfl tthilc Mr>("t3-ii(>r|iU"<W< an ba» abi-ady l»c*n nid, 
are aUo italned 1-hir otui th« e<HlnnphLf(* grarulfm, uitbln llu< protop1a«ni 
uf tha vhilo corpatel», bright red. 

My aitoelatr. Dr. U. K- CHne, hu dcvlBrtJ a tcry alniple knd *i- 
ffollent Ti]«thod of nUiciii^ applioabU foi ordinary blood exaTrlEUtiunt 
141 wbacb dilTeiTTiUal tUinlniE of th« leucvrylf KnnuIcA £a not ctwDliul. 
It !■ aa fnllowt^ 

The bloi^d ia «prrad in Ibe oidinair maoneir tipon a tTid# aiul 
alloirrd to dry In ibe aLr- The prepaTatloD la Ih^n irntty Anrfrd ,nol 
mada botf J about ttt iDcb« abart a frt« gaii or at^boL flame, and ubcvL 
009l«d U placed lor Ivo Qjinuln fin mctliyl iiPQtti) aleobot conlaininR IX'> 



p«r Mni of «otin, Waeli In mnnlng v*i«r and *1a.fa for two mmutca In 
GObnwV hrmolüxyUn. wliLfh I» mjiilff Ml folTnwn:-* 

L ll^rnitoiflm ?r]?tlalt I griLni. 

Al^h«i (olb^l) ,.....rT---T-- ^ ^- ">■*' 

ÜimilM ^'AU>r 20U n. om«. 

Hiiit in wii(<ir balli iiirtJ? thftklurn oryMnln ore dipsolvpj, 
WKi^n 1 und II mv ■li'ntiliti], nÜK Üie Iwii «ahtllonii ami Ipt aUind 
in Ofwi«, wlrtfl-nioulhe<l t>ottlp foT Irom right lo 1*ti *l%y^*] Ih^a flltcr> 
FiliiLllyr ü* a ^treKTvativt. add 3f or 3 nnall lump« of fgiitn umphor. Uh 
full ntriiglU. 

"iijfc -^-flWMiö tujf/^ce. 

(Flg. as.— CopliLad StainJng Ditili.] 

AfUr «lAininff irHli th)A eo^utMO» VAqh La rufinin; vatcr, dry ia 
Ikm«. ■Uli f^Htnitit! i^lthuut CüVcr-glou.pUdng ih« Imincniun oil dlfrctl; 
upcm Iho profiamtion, 

WUli tlüti im^thiiü Ihv kiic-iwyU nu[-]ci ulaSn a d^q» blue nml jirr 
verj ilixf.inrt tinrl *hjir[i: Ihi* n-d ccllfi nrp rolnrM > dark pink or ligbr 
red {icc IMalo IX. I<^g- LA). In diffpftnlinl rounlt in Iciioocjtoaifi tli? 
Qtrtluid U itll llmt i-an Lc JuiteiL The maWUl or-^ambni ii «Iso weJl 


H IA convenient ta keep tho coiLd and hematüXyUu talutionü In 
itaU-iijüiitli boltlvi )iiiMiii|^ a1x>ut Ftiiir uuutTA, In Llil» wnj' \\\v pFtTpHriHl 
ftliiir-B cnii I« pUi'cd upiij^lit In lli? ufifinh ntirl pr<H<lpitat'4 )tn> avoidi^d. 
Tl>c Copland slainine ili&h (Fif, 8^^) iq niurh bHt^^r o^Jopkd to iMa pur 
püiw. Tlip fitilixtiuiit liuld tlidr sliijviiig pro|j<T(ioa for inontU*, — ßnooKTi,] 

Bc»i<Jf^ l^hrlih'li'fl tri-ft<?id i^^luUou, tiiö author would rccom- 
ruenJ ChcnÄitJskj-PU^bu stüiniug mixturo for the prflctitioii>»r'e 




QBe in prof^Tonpfl lo nil oihctf ; it is Adapted for tho cxominatiwi 
of eon^titutionji) blood sfToctions ae well as for the d^t^ctloo of 
Ihtt vuriou* |iatii>;ftnt nrnirring in tlip Llor.ul. 

II«i*hntan'i Vodlfififttloft of EomftooTiky'i fltftU for Uolftrl«! and 
OtiKf Blitod-AlniL' — TliJH mrlhfn] ifi nr ntvjr of ■jTplJciArJiiu und r^iiirr* 
■u liiiu xiiuv unit »kill in it« mnriipufiitiou that it tn»f ■dranUgvouil; 
tre fiii|>toyrd for oidinAnr bloixl ilumiJijf tti pii:fcrviiL-c lu any |>foc*<larL' 
now 111 it^it. It gEvt» «Kiv3li-nt ri'MilEn sku t%lLh 'uriit^Hi" iirj-imntlrhii^ 
from b^riv-BiarT'iw. Ilio hplihir. livar, Rmi "t'atifvr" jtLi(>*<, Burl^rM tt*in 
by (hit tnHhcd Willi ^rAt cti*liii''tiimk No previout fixatioQ U nccn- 
Mry, beiuiU« the nlulnin^ »oluilun llu» Hbd »lalni «I Ihr lainr tlma. 

Mcdldiul DiEihj^lirnv Uiic lUrllbltr) LO 

DiHlllli^l MAlrr lOO.d 

Sodihiin ombonAtv , .^ r - , IJ.5 

Itf«t In a fmralTln i>T*n fnr twplvfi lioiiiit, nuil tli#ii alJn« in «tanil 
at room t^inpvrbtitrv for tfO iljijii Iriffor« uvr. 

Ki»idn. »vira R A. |Gr(]|ik-ri . 1,0 

DM^lIcd vatar IWO.O 

Ki|UmI vnliinip« of ^nlullnni A and B arv inlnpd In a lurR^ open 
vi>'*r1 finil iilti^iffcJ to Mund for fiviD tlx to tv«|ve houn, »lirring from 
liuii? tu tkiiii' vt'tth a ^Iah tuiI. Tlie almodant flovcuknt |iiiM'1|ii(al« wliiuli 
fornia U r^llpcinl on a rtlt»-r amf ihnroiiglily vaxh^l wfth «lUtillwl watrr 
otitil tb« flltrmU U Doh>r]p« nr palo bin«, llio intolublv midu4 U now 
artfully vulln^Lrd. diied. und [KiwUrrtii, The iwH'dcr tJiuii oUalntd haa 
a |[Ta#tti*-Ei. rn^lilhc lual^n* mil oantaln« tjip noMtt st^ln^ng ln^tri|ii>iil 
l^mvnt jn UamnrAwky'i »tain. 

Ihawh-v O.IA jctA.m v( thv jiowJi^r In 100 milric i<fiiUiTii-Lp>9 of melhyl 
aJwhol |M«rck'> "lor arkniy«»"} and prwrrr in ^la» tiop|KTod bollk 
antU uitrd. Tliv mIuIioq do^a not drldriumf« iviUi OfiC. 

Italnlnt. — Füidb lare nimie id Ibr onjjuary niiy and alloTPtt tn Of7 
tn Iha ak' TItfl thinnar amd mora unifunnry thtf blood ij iiunircd. tbo 
brtiR Ihm mult will be, Hirr« ^J 4 ttroi» uf (lie «Lain arv alLirt*«! to 
art itfT abtiitt half a miimir and ibrn tuW tUf aimmiit it-''., fmin to 
K dropvj of dulilM wnttrr i« aibltvl an4 n11o*i'?d to mu vrith th« dy«> 
Aflvr frum flvc t« («n minute*. afrordinjE (n the thlckneaa of llw «incar 
and tb» rbnrafler of tlie nbn, vaib In diiikllal vair-r. aittnefutt a far 
##i>fM bf mfrr In frmai'ii cm Ihc prtparotioa for one minuU- iJr^ in Uip 
air and raamin« Ju uil viUi '/.j imniT^Jon 1f»pt. AllowiiiK th(^ atbinal 
pF«j«fa1EnTi In hv artr^d Tipon by Vie dlilitkd vhIat for a niinnf* afUr 
»laininif "inlnuiTt« tbt «<t«iiüng, ramnvot tha nniaitia nf ib« drpotlt, 
•nd (hancn tlir lint of Ihv irrythrDCjt** from ^mniali blue to a iraaa- 
pftraml ftnk." 

IMUab iMWt Jvtna^ j4«fi<i.icf », |«*^ y*^ m. 



Acoordipg (o Lcialiin&a, tlu appcartint« of lAf ttlwd films et4iiiiod 
t^ tliU iDtfthod %n tu fnlliiWM: — 

UXD BUKifi-conpuBCl-ICs- — PaI« jiink i>r j^rovniah tit tlng«; mrÜ* 

rubf-rtd color» Mvitb bliaiply iL^ünui rtiHLrgiim. Kxtrftnudi-Ar protoplatm, 
i^lurk-iA, Kijic cotUtophiJi^ üti&iiuJpe, tvi- 

Mo»r>MiCLKAlH.-^Niu*Ipi» ritiy-red, with «lr«n'*ljr nljurp. clv.if 
outtiDcB. Kxtrumdeiir prolopla^io, palo rau-dc-^'^f or bluff, i>?i<«»iotiAlly 
m]iu>vjji^ ■ fvw rod ^nrmli». 

L\UPPTGC¥TX<^, — Tii« »Knie aa tiiononmOrArt, VEWpL tJiHt, l>i# nneM 
Are, an (L nilo, luoro doQpl^ ataincd, 

CoAiuiC'Ciui-Tiui Euai.^üi-jiiLEB^ — ffuvTruH» nibj-rod, bul dijL lO 
(IvcistiEy fatuinM, Grantilin, p«re \nnk 

HAfiOi-mMW---CraM]rüd virry Ji^riB^ly atnini^d, nf a, dnr^i purplish 
blaolc UnL Nudcutf, red, Uiit u&uall/ uiom ur Itea mufikHl tj jj[iunuloi 
oTsitf ing lt. 

tiM; cxtrnmitlcar E>Ditki>n, kthj. 

LUorjD-Pi.A'L-tä. — Docp ruby^ red. vriXh »pik^ niargiiu. frocjucnlTy 
•hijvrihu P pjitc'bluE pcrtplietitl kujl^i surrounding [bi; K'd i.TiiItM'- 

blu^ but» by prolonging tbo perKd ol etaitiirig afiit tijlji«t^iipiilfy de- 
cglorin^ ^illi Ah«i>Ujlci Hk^liul. iiuiity InlcrvAtiii^; liilTi'H'iici^ fim> bv 
tiofi^ H'il Fl dilTrrfnt or^ni^niA, by uhioU §lTU('1ura1 dvtaiilH nti* hnntghl 
out not gcnoKiIly ob&crvcd by otUor atnining mctbod«. 

Mai.ahtaI' r.vnAHiT&p. — Tho body of tbc pnrMitc aloina blue t,n'l 
iU pbromaiin nihy^md i in Ih« cnst of tlie terti:at |>urHhit« Sflif^lFnAr'« 
ilotA an well mnrkcd in tbc coDUiining red blood cor['»qol«. 

Tbia melliud Is ütiimrlur to ihüt of Jenaer. Jbiuciar'n lolulioTi booh 
IriBAb ita qfjiining praptfrÜa«, tipü «ven vb«n fresh the ntaulu arc nut 
alnajfi sali^fiftory, Wright'» nnd Goldbum** fllain* olTpr tio ad- 
\nnlagra ovrt Ihe melbcjd fieri^ deKrltwd, i?xcopt. pt-rlinpu. in tltf saving 
cf liintj. We hiive not spaof> to mora thon ral«r to tb«a^ aUtii»,— 

(A) <ieneral SumniBry. 

Ai cüiiiprtivil willi wliat waa oblaiueil bj earlier atm3y of 
frftih blood pn'pttrations, our koowleflge of the changes occurrmg 
in tbc rcti nad yrlüte blood CL^lb io dif4^0E<^ has bocn greiitiy 
Qxtcnded by the app]ii?ation of unalyticTfll Gtfiiniag mothoclB. 
WhpTii>vpr pofttihie, cvtrj cX!iraiiiati<*B of the blnod should be c"n- 
dm^t^'t upon frwb as wdl as upon hardeoed and etaiued prt-p- 

TliK llUKtD IN lllWKASH 


The* fallowing rfx^vrntimj« linve iliiui fur tMv»« rwogclied: — 

I. In the Red CclU. 
1. In fresh |m»p;inLli(in* ihr rr'fi i'iAl% iK»t iufraigentlj ehow 
dcciddl ohan^a of fonn, wliidi, at Quincke*» fiuggi^tiuu» aco 
daaeod under ihe icrm poikilocytotU (iro«ü*t =^ vnriegnlcd) 
(Fig, 93), The erythrocyte aro drawn out inl*> pear- or flufik- 
thttpe; <r are proiidod with a long pedidclike pn>|j>Ti£ation ; or 
th«y appear ani'iK wallet-, or posthnrn- iliflpoit; or resemble a 
CTOM or trtnr. While »ome are estremdj smiill^ other* appoir to 
be imtisiinllj^ large, and SQiinetimes ahon a wavy, firrmt<?i] uontotir. 

Fig. U,— PoilcnccytHlB. 

All» etm tbi? Mu»tta»t, «WkbiBtB Bho» dbUnct vmhüiaiiiont 
They arc witltout doubt to Ic lotikin} upon ax scgnii^utttlioii t)udiM 
<Wjvi>d from olcl <'rTthron'(» by proccMcs of cönrfriction. { In 
aocordtuice uitli tliifi vicnr, Khrlich designate« th^m aa "»cbifilo- 
«yt» (ffjp^r^ ^ cMt, from «x^acu = to doavd]). Hnjxym 
a!on(t fOTutiil^rt tTn'm trHüfliliDTi form» of liis li*-rnaTob!a^ts (BiiTO- 
lerofl blood-pUt««) lo t>luoil-celk» nlUiivu^b hi* hm\ iH-ii-r ut^wjrved 
theiT actual tranaformatioii into ■ colored blood-corpuücl«. 

Ai 1wikilo«jrln«a ia romporKitply mont frpqiiwitJy unnriBlod vHh 
prolound dhnhllitkMi b th* number of nd blooi <orpu*(l<t. \t mftj. a« 
tama olmcrveii hai^ «u^tgotnl, piHwiblj- Ijc a «nurfTatlva preoMi lor 
incrv«<^n^ Ui» rviflrfttOTj iiiriaat of the blovd^offHUo!«!. 



2. Furtliennor«, tJie app«ArsiDoe of unolcated red biood- 
corpuKl«! I» dw^rvirp of atteDUon. 'Phopd occur in two forra*: 
aa normoblfixfi, w)\tt'h are smull, DiicWtetJ^ ool">r»ri bodies lli« 
Mjw iif n nufHinl rotl l»Uioil'i'ijr]HWi-l'^; um3 «a mftjitlu' or ifl{tanio- 
hhjtU — tliiil if^ nucU'iLtii) rrjtli rockten, which nn' from iJirw? t« 
ßv« liiues larger thuji ordinarir red blood-ircll« (Plates VIU anil 
IX, Kißö. l;; to ItlJ. 

Tho audoi of (he nomioUoAt«, whioh are not infroqueiitly 
o1»ft«rvi><I to l* Btjcmeatiiiit, trc ^^iiorally eontratly local^J^ 
HdfrK'limrft Iiiriiihrmlly. Thv^ iirr rhunicli^rij^t-d liv Ihr i[i< 
tc-r*ity with which thf^y utiun; th« nurlri of tb<? mcgntnWBjitH 
nrc »toincij »omcwhat polor, but alwn}« deeper tlinii the nuclei 
of tho whilo Mood -corpii sei ofl. 

On KlnLnin^ wiib Immn-Iov^lfti «rixiii t.lio nnHrl A|i|i<'Ar an limno- 
^■KOiji or cnfli'wlj' ^ATiiilur, iiiiifonnty bln^'k oUjrrtx imd jfDnfmtlj, 
y nicjtt a ahflr|il/ Ji-flncJ onnlouL. Wtlli tW Irlicid ntB^n tlioy &ppt4r 
■M *^*fT^ pMni»h-tifuft or (Inrk pc«aciifkblii* bnillM in »harp <:i)ntnut 
with tlM7d1ov4tnüifld htrutiin <if IW tif\\ blunU relit. WitUrjLiriiieiiiAhy'i 
«liib Uicj Jirc «iUthi^uished \>y a dnik'bluc or blackish-Muc color. 

Kaic«pt in the nRvbora, uuclcatt^ti red tilooj-cürpuacle» ara 
noTf^r m<^l vilh in rtornwii bliwd. 'j^htry nrc of fr&iücnt onciir- 
rnnco, howi'vöf, ia pnUiolßjjicftlly altprod bl™x3, oftpi^oially in pur- 
Jiicioiie aiieniin find leiikemin. Thry äri* If** nflon oliw^ivod in 
severe üüiiIj* nuerniaFi uftcr b»; nf llriod ami in c1kli)ro»ie. 

Dodic7 \t\y Hcfciirly rtwmbliiig in t^olor llie atulTieil midei of 
nonnoblAAts Are often found fri^ without itny inclosing ntrnma. 
Thin phcrncnifnon rtnd the fctt that the pLTiphorally lorfttod 
nnclpi of th« uormohlii^ts ^m^rtinii's: idiow only n CTnall area of 
contact with the »ll-body sjn^ak in favor of the vi^w that tho 
nuclei of the normo^laet^ may be eitrud^d. 

Inr Ai h*i boliflvov tboar nuofti ngnin Inko ott prütnpliitin ( *} It in 4lif- 
frrrnt *rlb tlir mnj^hliUitii^ whlcli alwQjB cuntrtlo cnxly »'»tf nuclcUB. 
h'hl(i1i» AH bit Hlrcnily Wi'ti iiU'iitluiii'ilH nLiimH Ii^hh iiiliin-Hy iiiul ih Hiiid 
tioi to Ih p«1riiiU*<l. The noritiobla^l« oi-ciir In Ih« nonn^l Imm^-Enarrnv; 
of mSnlU. tlic nti^g&la blasts oal}' in tliat of Iho ombryo. Tkiai litems t» 
ii]dk»te UiJtL llw ttpp««trafiL^c of Üiir IhLici Ir Hip liluuiL or pittit'TjU mark* 
& *'»ver»ion to tlio «RibfyonlG " hI«1«, 'I'heir exoEubiva Kpi^Mntnc« tlwAy« 
]iuiAt« to Mvric pcmkiuu* fomiA of nni-miA. 

TIllü B1.00D IN I>LS£AS& 


3. Tho ocfTurrODoe of ahnttrtiuiUtj lar^e, n^nnu^itaUd cryüi- 
nKftm n ol Üie j^realoet diai^ioätic valuo. Thcae are 4f«ie- 
tiat«d a« »iffdU-^ttfits, or jrfonf bhod*i:orpusdtt. TItev niv from 
lü lo H /i in iti»% «ml fthoit n vrty vnrinlili^ hirnn^'tciliit; iimUnil. 
Tlinr iJUximtic wgnifirain^ id iK-micitm* forms t>( amriin bw 
bOMi cmjihn^i/tii wpccioily by Laachc, with vhoFe view* Ihc 
ftüthor ia ^tirt^ly in accord, in rare iurtanoc«, and tbcn only 
Bpariugl^r, Üicee «bnormflüy Uvpfi reJ blooO-coIla ans übAön-ftd in 
severe ehiort^ü. 

4, Of Inn Hij^iiilimiuv i» tfu? ncciirtvncv nf vnry fiifiHl], Tiiiiti^ 
bwlki from 2 I4) A |t Urg<\ rcM-inbtiog ihe blood -jilatcfi, wliidi, 
bocauh' of their dietinct hcmoglobia conteuL aru U> bt Jolcr- 
protixl a« c-r>lk^rocyti?s, althouj^b thcy arc not uinbiiicnl«d. 'I'hi^dus 
ar« called dwarf hhcd^orpwtci^, or microcyfar- According to 
Gram, tliejr ure tiowly formed red bktfw1-<H*|[*, ainoe IhcA^ most fre- 
quently fM^iir flhrtlly after wvere acute loesof blood (Pluio IX, 

Ä. Not infr^rnicntly tlf w-called aaciiiJc or polycbroniatc- 
philic dtgeneratioQ of tbf* red blrKid-diika ii mrt with. Ttii« ii^ 
manifMtcd on »tauiiDj; ifUh codiultviuatoxjlin or <!oeiji'Xncth7- 
lene blue b\ tli« ab«i>nc<t of bornogniicous hr>moglob]D ataitting 
and the [ipppnmnn? nf n "wiwlnvl-niit" Tiolet shade of color, 
brrjiimr lh*i dcjEipDiiraUtc dioiigv»of the Mroma favor action of Uil* 
nuclear dych 

It ]■ (|Uit« |iral]it1i1fr Ibal llip qiiwllon hrr» 1« i^n« rhf dvnlh nf A]x\cr 
fonD*> aIVU th« ■Ainc «tain Lug phpnontcnoD i» toirullnii» bUo obtn^nl 
In lttff«affd carpUKi» (riatL- IX. tV 1^^ «iK mliitb um> ju>t1y be »jr 
AidHTMl u jAiing or «iiEjv«<<!tfrt fi>rnvt of ilio ml hlnvl^wiqiti «Hm. Hm«. 
h««**»r. Ui* wr*rily M the poll««iii^ ffittum of ilhnv point* W II* 
pcrakioui chaidtlür of i}xi? dir<4iij1u □!?!>■. tikt tipinv^lint ot uMHi La Oi« 
raallnUAtlin 4f Oio di^i^^nfrallnn f'» llir frr^h (■K^ni^ntM mlrmlikiv*! fr&ni 
th* boov-miurciw. It «ffjxim to um pii>l>nMi' llmt Ih« ^JolyrkL-DiTNil^pMlin 
of Om bb>od^?ciii*ii»rb-* hhtMi|<i ikM in' iirphiilf-Tnt at ■ 'Ir^^Ofnllnn, iliNt 
III«* fi»niuli*n« arr nThoT lo (■* rAnkrd upon ■■ «lonk^DtA in An ««rlf 
•teff« of dcvelofTiirrit and t1i»l (htir itppfianuiv U (<# b» inlrrprrU^I «4 
>a Fiprtminii at lurn^d i*|{viiiKrHliuii, The »tjtlcnKint-^ af T, ^. Knur], ivhn 
Miv Ihv*« qit»ai|iu«»bl4 forinmliiiiiA in MuhrTrinir lil^otl» n^iui to miArai 
tU* vitWi «Qd, Hfondlj, 1 K<i\M vdd that poljr«hraiD«l4p1iUfc blo«J< 
voffiudM arr» irry fitquFiitlj' DicL v^tli in nulitUl uwmiji. uhit'h »liniij" 
\n r*f«nti« lo ^«trnr^kon of IniJivtitiiil «ylfiroryl«« AlUalc^ hjr par« 
•itci« in vhlch, hmATOCTT llio ^odtloa U QOt ouv of a DdA vbJcJi lojarco 



ICO - 


iJJ blood «orpuwlcfi aA\kc. Thoie cij llif ocyU» whkb c^iiitnln « p^ra^ll« 
u>d h*vfl nlri^udy been laort or Lou d*'troy«d--4.ff-, trb nndcigolng «Ic- 
£CQfinttion — arc partihTutarljr nmrknl \*j p*1f ntAiniiiff. 

fl. i^llJl Ir™ iimb^rMUmd nrr tlie atsJniriw alumliifan fi ivd U 1- 

wlU wliirh InbHirh rfMi^ntM ■■ "tlippUd" und nrt chttrn-'tpnTnl by UiP 
apponnci} of very jtuuicrou*, dmscly brr*nj(r<i blu^r puiii^U oo lUininf; 
with UH-tUylvaD lilu* miittifv». T\wy ^la aot ItifmiumLlj/ U-itniX ia 
■nami« ilii« to vmriou* rfttiHit«, I'onlniry ia I'lthiij Ui«y %n in nri whj 
DiBiiocJiit<^ with malAtiiil parnritCL 

n. in the Leucocyte». 

I^ng Sßo ^faT SchullM, Vlnrlmw, Krl», Am! *thcr* dffirribMl dlf. 
fprenl formfl ol Ic^oooylcj'. The prMy morpWcgJo fflinrtt'^trr^, Ihrir 
iliffciFPQtä ük BiAP. the more or ]»b course giuDulaUou, mid lUi? TLriubla 
vliap« nT i'i0 niiolrnii otfoinl a hiiali for cllETDr«ni.iBlton. In ri^gjird 10 
orif^in, »Ivct, ccH-tiTi not-i'mn Und bt<li «intorlaiiLt:^!^ tc»r rMmiidc» (k^'carJ 
In^ ta Vii^hnw. the EtaaW niouonudi^iLttd furmn iro dtriv«4 ttvia the 
lymi-ii'glcindfl. Vie 'trgo raononueloAtn] 1ri>ra tb« aplABQ. 

A& A rcsuLt of Ehtlicha fluaiytic r<WMJrcliM by eUinin^ at 
npplied tn the BtinJy of tlie leiiCocjU«, the foUowing Jiaa to a cer- 
tain degree been e^tftblisbet) : — 

Aside from tliu diiroreniiution into smnll m\(\ krgi? nion^- 
Ducleated, and line and coarsely granniar miiltinxicleated cells 
nccordiiig to the nnmbcr of ruclei and sht of th? coll» the 
niicrochemic dilforüncofi ol the ^anulfttio&d permit the follow- 
ing EitbJivjfeionfit — 

I, Eosinophilio celJa (Piute T\, Fig. 13, i). 

In frvflh^ uTistainei] prp|inrwli[ins Lhrar? nm be recognized by 
the strongly refrnclive, conrae gntnidation of the contraciilc pro- 
tnplnem (Fig, 71, e). Since, however, they may bo mistaken 
fot basophilic cclla, vhJch m\\ later be doäL^rlbed, they can be 
pOBltiväly identified oidy in elaincd preparations, 

Th» efteinnplulic a-ffninufe* aru fliorBfrprli'oil by thsi» p*fluli!ir 
■fflnify fur thr *m.-"1 miitio dyca. Thfty Inkn up the dyp «-ith «Jitmo» 
iejt4ln»K. Wilton tiaincit uilh üdsin Uu^y npiiVAr U9 brlj;1il-n.'d «plierulct 
AlUng Iha body of II;« co\l. to v.-hich thry aivc the Hpiiociniicc of a alruw- 
trrry. Edhih. aiirnnliji» and ni^ro^in Btaiii thi? fTtonultm m cunccntrutUil 
frlyt^rrin nolution (aftfr a nuiiilKEr <if liouihk ; (liirinuicin, »mniuiiiiim 
pUrat«p iind oiuDg« «lain llipm imiji in imf'^y wJiitton. 

Tin* BiiMpkion rraJity nrouped in cT£Qadnfl1i'>n of fc«h upeclmttnii 
that th*n« griimili\ rtmH&i fi! fiit ii dlKprovpd by ibrlr r*sUloiife ta Mr* 
Ac;tion of abfTilulv Dkc^bcl, DtluT, And i-nrbciTt b'i"id|iiiicj, IfuHhonnofi*» 



ihfy ftrv «olubl* m vrfttfr and gl7ccrii;i> ftad ^n not ibunr^ bj obhiic »aiiL 
rin«1ij. the tjcvi that tlipj pro Jroplcta of ItcinuglobJo oaiiDot t» mtcn 
tainM, itncc it hai t>of-n thown th*C on itülnrnff dry Uood prtpnmtiont 
witit A $ per c<nt. »oluiion of CArbolJc ftHd HUunUfd with c<»kn «n«! un« 
monium |Mcral« tfa« r?d ihraiü^loUiiit bloT>J<vl]fl tin- «l&inril |iu,it! yv\\vw_ 
and tho «oiiooiphi I it? grannln bright Tcd. 

The eoiinophilic cpIIh of norinai blood arc nlwaya the «ise of 
the oriliiiarjr (multinucWk^J) kitooc^tea, and wlicn viewed upon 
;i «arm stage mnnif^Bt acUrtt aiucboid inoYeraoitd. The numone 
ratio to the rcnuininf; leucocyt<« vari«e l>ctwccTi xridt timiU 
in difftmit porfoct^y hoalthj lAdividTnilE u well m fn nno nii<1 
tho mi» p^raoD at dilT^TADt ümvB. Whether iht^ origin of Utn 
üoftiüopjiilic edU S« in the böne-iiiarxHw (Ehrlich) or not is jtl 
to bp cl(ri{W, The poiitiojjhitic ctU* fmiiid in tho böne-miUTuw 
art, for the mont part, vury diJTcK^t from tho« occurring ia tlic 
rin?uljitin^ blood ckf hoallhy porfonci, not nnlv m ftixc, but nUo in 
tbc form of thn nudru«. On tht oth^f hand, ^/radual dtvalop^^ 
rnent of finftj/ (franular cdU intü cccrsflt/ granular (i.<*,, #OMi>- 
l>tiüic) ctJli OM triil at dii-iiwn of eosiiwphitic £*IU CUti tinfiuj*. 
tiowiUif hf^ <ihx/rrKd in iJm bloods 

It U nut incrraga m ih^ tiamher of fm/nrifd) tosinophilU 
€^U, hui M« oecarrtncc ef such eoeinopkÄlic forms as ars numer^ 
ctiä in tho ^tjne-marraui and luuaUy absent from th$ Hood which 
a of <hiff ditigriJitiic important:^. TbcBe wUI r^c^ivo *pec4il 
cacAirWalioD tn fhu il^criptinn nf the rndings in leukemio btood. 

TliQ »tAlemrnb in ivgard 1o dimiuutiou or increnM' oT the 
eoelnophilic c^Us in the blood dcmonttmtc» thfit thi» phtnomo* 
non ia of quit« irrcciilar occurrence-. It Bccm» ccrtnin, howovor, 
thftt in eof«r« &ueinia and moet tcuto infcctioua diseaeGg tUo 
sunbor of (nomml) li^Min^phili« <^elU is iii^U 

2. ITentropliilic oelU (l*in(<r IX, Vigs. U and Ifl). 

Tb<MR ^ninulfst nhirli nmiinir n cliamct^riBttc* violet hnfl 
'vlKia Etaincd wHb the tri-ncid mixture arc dcfigoatcd ncoarding'j 
to Ehrlich as nttitrophilo (<-) j^rAnulntioruL 

'Hi« IduoDc^lffl ^th noutrophihc granut«« tiniAlJy »how 
pteulEnrly «haped oacloar figoi« in the form of an S, V, F, M, 
«tajomcnvmldtilinct nuclei Tliey constitute bj fur thcRn'nii^ 
nuRiW of muHnmHcnted leucocyt» pivAfnt in thi> hinod, and 
Mve Tithout much doubt derived from tho ntoDon^clc^tcd coIIa. 



According to Ehrlich, itll paS'CetU iPAüLfc^t the chftrftcbTi«ttc 

violet KnuiuJntion» (soc eosinophile cell» in gonorrh<]ft. page 47), 
While th9 ooHi^ophilic aud basophilic granulf&, which will 
nttt Iw tiiai*iii<Ti«J, v/rr\* ciha^rvt*^ hy F.hrlicli in fl]l aniTiiaU, Ihe 
Mc-iUropliilJc graiki^IcR, tlie uri^-rn af wlticli E» ta hv i^oii^^ht in tli« 
bonf!-mjirrow nrd tplrcrt, flp|H*^if io occur 'tniy in nmn, 

3. Bftfropbitio (Uaatccll) Grftnules (Khrlicfi* y- and £- 
gramilationfl) nre docply filuiritnl wilh hatrit: anilin dyvs, «monj; 
others with a coaa»otrolecl walorj' »lolutttui of mt-thylcTUo blue, 
whiich ift a]l»wt*<l Lo uol for from fivn to tfT miaul«^^ 

EhrUch i^v«f the foUowiof TufajuU tor «tainiiii; Hut mut-CDtb 


Wotff 100 .- Piiw. 

HHlurxIdil uliAnliitn nli-ohoHa BolulioTi oi 

SMla flO " 

To Ibv vhxr io)uiUtn ohtiiiiif'tl «Itj^r itnrnliiiir oi'i: inhlf^J From 10 
to l-nA njbir^ rmiliiTiL'ti^rh nf j^luclnl oretlc A(-hL A^M« Troni liMi'lniri, titf 
«olulinn blhiurt fmly nm&i^ctUe lri>d^» tvhil« piie^cfiMii flrc< bnrnk^' fin|fod, 

Tbc toaopliillc |;r&Du!4!d art usually doI bo donarly arrnrijs^d. In tliit 
pmtnpljiMm Ai» in IIiq rlrsl-nameil granitlaliimH: tlie ^-^lAiniln »[iprrmr'h 
in BLJ^ til« ooiiinophiliq grimtilvi; thu iiiier are ilut^»Lml im J ^rnnii' 
Intiun*. .\m X rulr, ihtt gmnuU oi the bdividUftl velli «re not of uuifurm 

Becent invefiligatiora h&v& shown that occa^Joi^al bAJ^ophilic 

collft can he fornul even in perfi'ctlj healthy individusilj*. Th»i 
autlior frfltiut-Tjlly iwet the:» lu ^jrrjB riuftihcrs Jii the «puhun of 
Ä*tbniatic» (st^e page 20S). According to Ehrlic}!, they are 
doriYcH from tho lisL^d oonaoc^tivc-tie^uo coUe, niid purtly also 
{rom tho boii^-imtTrinf. 

Aa to tho percentage of the dilTorcnt forms of loiioocytc* 
oocurriog in normtii hlnod, \h** f*<lli>«ing lin« hp<?n ileti-rHiined: — 

Atnoijfc' einin!*n-aU?il leucocytes tht^re will uaiially be found 
about 25 per ccut. of email mouonuclfjated cell», — lymphocytte,- 
while the rcitjnining 7'i per eont, ut» muUinuclu^itod ecUe ■ 
Inrjjer bvh?. Of these, nhout fmtn 2 lo 4 p<*r cclL are co&itiopln] 
and haroly Vi p<^ ^^^ ^^^ basophil«. All other mnltinudeAtedl 
fnrmE «how TiMifrophllic gmnnle^- 

Elirlich haa repeatedly vory strongly emphasized ihftt '^ 
single cell nc/crr cootainÄ two kind» of granulationsp" Accori-j 



ing to 111? jiuLlic^'» «a})cri«iice, this sUtoiuenl muAt be accepted 
villi üinitnliortä {otx 'MA-uk^miA**). At adj tim« one CA& con- 
viiLi^ hicDM'lf tliat, for exiiinplc', t\xQ «II« ol jj^onorrhoal piu 
(Hlirliob'« pnradtgntn) trhc*n »tAiiicd »imply wtüi oo«in ofU^D 
thnw llic «mo anv gnumlaiiou« n* on «tnining vlth tri-nclcl. 
Ocinse<]iientlj, tht Author fAnnotai^oori] tfl llie iipiitr^iiiliiliogrsfi* 
uUlioiu the hiffh degree of rigiLiCoince uliich J^lirlich and liU 
pnpila have nKtigiiecl to tbem. It le diffcwnt. however, vJth tho 
fxtsinophilic pTonolG«. Thoro is flcaroc]5 a JouM that ve havo 
h^iv lo cl«a1 with a v^ry remarlcabla »pGcifli- ruction. Tito sUo 
an^ inUaist^-ly refruclivo character of Uw ontlaiiwd gmmtleB, 
but eApi?oUlly the mpid atit] iiiK<iiMT xtnining v^ilh add miilin 
»lutioDfl, KTTt aharply to dislmpnish them. However, ccrULii 
c^lla arc eororrtitm« met irith which, id addition to enroll, scarcely 
vifrihifrj faintly \'wgt>A gmitiilw, foalain ntKitiMnonablc cobif^ 
<*biin<ip>ii]ic granulation?. Th*?*^ cells may jiiät]j' be lookeil upon 
aa tntDHifional fnnna. Max Sohullre long Ago rtrev atfi^ttlion 
(o tbe fact (Hat lrAD»i1triTi twin Heic bi ccmnwly grnnulnr telb 
can bt^ ob*crvccl vpfni the warm ivUigc lii-rc, however, it iRwt 
be flwumcd that cvlla crsntamin^ fine — t.o., ntuttophiUc— granu- 
latioaii ftl«^ oontatn (^ofirophtlic grAmtln. 

Of vhat »lirniAtftnc« mc tlici« ^■siiUUi>Qif At llic prttcul tim? 
It i4 (mpAtBihlf (A iin«ivpr IhiA itri#4iLnn wifh my d^^tn^ af i«rtftinty- 
KhHKb <Hji»idm tlic jcritniirrfl ^impljr » w^polion praduvla of the crlXm 
AltEdaa coosldvi* Uicm in» elementary «i^nbm» {bbbf«jU1 whkh, 
bjr Usdr LggirgBtlon, (orm the cdH» niicl«iu, and prot^platin, wrtd plAjr 
■n actirr uid rprj Important rtJe ip Uib hf# <>1 th« r«]l- !□ nuppori of lii> 
throrr AUman ciUn lbs oWrnilioni tjpua Ihv nb»or[ition autl wrtMlon 
ni lai. rh«r o^wj^ntinn» hnvi? thflfltn f haf ihv *' hioHatT«" ifTDilitaliir 
hn^iiip loaJi'il *ltli fit, fcnd iln^n mn bo dpFni>riftr»t^ wiih f«mc nciil 
■« (IrilivtP, U^^y <ir tilHi<kUh i'iii|^'h nr Muik iflubultH. H U trr/ iiroTwUtf 
Ihflt* for »nubpl*, Ih« !■( i« tAkvn up 1^- th# j^rmmiLt« in vjTublc iorm 
Asd tnuifonnol by lyathnii Into Dculml fat- Trats of nfudy wUJ br 
nrMftury tor a «olntloji of the iTnblpm. For the prvwnt, bow*-ri>r, thp 
tbHoua kindk of K^nuUHoiu utA/ Tw roganlod u pouaiuinjc a hHjüii 
dcfnc of BvmdoUo impoiianr« in «linical ilin^noHi. 

(B> In Special Affections. 

Hflving nkHchH in a grneral way in th<f pr^iooa BOCtiOD 
th<^ mothoda of PvaraiJiiifion and lh<^ altrraftrktiH ti) ho ohWTT«4 
ill i}w bloiid. ve will dow dcKribe the »pocial luicroouipic faaturtM 



to bo Men iii individtinl dii^coM:«. To «im|>]ify rnfttt<>r( tho 
dotcriplLon of tho romAining chnrftctorietics of the blood will b*i 
inHuiind hvtv. 

rite AncmlA«. 
Tliwe may be diviil^i! into tlie fuUowing ("roupfl; — 

iiiinplf lirifiiiki^' dnrmin. limpid BPoandary an«miB. 

1. In oUoroeis, or fimple prunary anemia^ tlic blood is ofti*n 
Iiuerosco|»it4]lly df^tinofly jinJor; ihn bomo^-lobin roducej to 50, 
40,iindpv<?n ISpciro-nt.; amHlK' *p"«jfic grUTity not rnwly pixv- 
Douiicrdlj n^i^Hct^J, — ou mi n^rmgi», 1.040, Ai a ruU-^ the nwin- 
bcT of GryÜirocyt<« lA normal and Lho form is uauoJIy unaltered. 
Tlie vhiic blooil'CcJb arc not incr^^ ; dow und tlicn the ratio 
of cofiiüophUcB ig increo«^, 

Stvtra cjw.« of ebloroEi^, bcwovcr, numifL^tt miiny deviaiion«. 
The rmrnl>pr nf red blood^isl« mny fnll 1*1 from 3.Ä tn 2.4 miU 
lioiii^ lli<T hein'.'ijiobin coTiient to 30 or 15 per cent. ( t), and i>n>* 
»equently the specific ffra^^is to from 1»033 to l.OSd, Cbief of 
ull, howovt*r» tJie rod blood-iörpuBclH* prcflont euch chan^^ in 
form ar- luliy lo justify mh in üpcüking of int&iuo pM'ihf^ioJSts 
(Pig. S3}. lU occarrvüvo in ohlorosU is often dUputod; tliG 
"viirirgat^d*' fortn* iirti Knid to be jirtiducE-d ju n r<*ült if 
"evapiisiUiin,'' t> which chUimtic hloi-nl is wxm di^JK>ft^^d, Thi^ 
author would oppose tbo acceptance of tliis objection, — wbich 
of ilÄL*lf coucedcfl an alteration of tlio blood,— because poikilo- 
C)'tocia u mot tvilh m friuli blood drawu uudor vxi^Iumud of 
air as w«ll u In dried prfpamtionfl. ]t »liould be rcincm* 
Wrwl, bowi'v*T, llmt Ihi« plirTLciinrmjn tjytmlhj ouuup* only in tlio 
früvrrcwt forms of rhTorosU, in which ii ti'-iulciii*y bj tlimnibrnJn 
esiet« and diuiferoufl accidents — embolutn of the pulmonary 
artery and tbe like— may occur Cooacquently ita occuiToncc 
must be inlorpi'i-lod as a warnin^ of the Böce*fcity for a Rxiai'diMi 
progüosiu. In btal one iiittüiict' tliü oulhor m&t witli rumoroun 
"vnriegatpd" forms in a tji^i' nf dilnnBiH in wbidi tli« p'lv^rril 
Fubjective i»id nhjec^tive eoTwlitü'n wjw in rn way Ernvi^ly diti- 
tuibed. Gräber and Gram snw poiltiloc>'tn»is rebtiyely fre- 
quently, and thoy, aa wril aa Lfioche, found that the dininotcr of 
the crythrocytee vos not larely rp(lucod> On ievaral ooüjwjoü* 



Üwmillior tlw» lin« fcJiincJ i]i]tli?ii1ci1 rwl bloofl^wiriniwlw in severe 
ohlonwiA; <|uilr rrrN|i[riiiIy n taw jdnutrniaWy Lir^* piuiuLide^Uii 
red bltHid-cU* arc nicl with, 

3. Ill simple «ecoaduy accniiu the ftlfcrtiHi^n» in the blood 
an, aa & rule, dependent upon (he naturo and duration of thrj 
primnry AtTection (phthisis, carcinfuna, fvphilis, chrooic aephrt- 
tifi> mnlAria, eto,) . Th^^rv ia ulniuät aIwliv's a more or 1m8 inteiu^o 
ififRiniiiirm in ihr numhtir of tht iryihrvfT/icit und a ctttrttpand- 
ing rciludioQ in Ihe amount of hcmo^lnbin. 'flic minihrr nf 
Ieu«evti< in not rpdiicrd; on Uio contrary, thcj arc oftai fi-t/ 
conf^idorablj iikcrcnft^i. 

ITftunlly the form of the red btood-rorpuAclea is noaltorcd; 
there ar^ do Tarin1i(ic& in «lie worthy of inenlioD. Nov and 
\hesx, boiA'over, Oixided p'tkiW^lwim aiid the ou^n^iKie of 
nucloatcd n^ blood-c«I1s nrc ot^erre<3. Tf in rtucli com» lb« 
Bumbcr of trythroc}i06 is tctj gr*«lly i^fliit^i. it i* a cjviofttiou 
whclboT Üio (liii^oeis of itmplo stwondary juiLimia lüiould nnt bc> 
rejccta). In tbtvc doubtful cjii;t« tho mimprio ralto of the l^acn- 
Cjka BB wcU as the &iM*ric» nf riorWlcd r^d rrlls (iTLsont in uf 
importimc^ If the former are increaainl and Iht? Utter pre* 
dominat ing in the Bisc cOTTOftpondicg 1o that of normal red blood- 
ccdb^ ibiin tl^o existenoe of a aecrädai^ form la usually to be 

Trnn»iflon into tJio chronte pcrnidou» form U ran», btit 
it ijn<]u(vTi<>nAbly ncri^ni. 

5. Prosreuive pcmioiova anemia (Plate IX, Fi^. 13). 

Since W»^, vh^n Bii'rrrj'^r gavo a mnetf^riy dc0Cn|>liOD of 
fhia dieea«?, tbo «Uu^no^m of tbia peculiar atTection k generally 
made vltbont gr^i dinJeuUr. Tli« int^oae pileoeat of tb^ 
«■^tcfua? xkiri and miicon^ iik4<riil>rin«i% inereMj^lLg weakiiesi, gas- 
tric dijdurboiic««» cutnutvLu uid ndiiul hemorrha^"', fcter. vie., 
1» addition to i\ve llood-ftnilinK^ usually n^ndtT the d]A;cn^>* 
ccrtnin. But oven far the oixptriL*Q«.-<l ob£4>rvcr vim hojt mm:ii a 
few dozrn crtto« cmfimiod al necro|wiy, it ii nßt rarely diflictilt to 
di^tinfftiith bHvfvn »n etifnUal pTvi^nTUftivc p<>mi<*ionfi anemia 
and a form driiendcnt iijion a mali^Aiit nc^jibtfin or other htJ- 
0U8 diltaaCt Jf a tnnli^atit growth exist« a BtjlutJr>Q of Uio 
pToblem ia of little avai] ; it ia otbcrviee when the Ihrratcning 
UMüni« ia df'E>enden( rijion viflo^ral parisites (]»tl)noccpbntuat 


(oohyloftoiniun» otc.) or uypbitia, nacc hcn: ei rurc c^a bo 
obtained after TOtQovoJ of the uoiüc. UnfcrtuiuLtGly, our prcwot 
mMlioJs of blooO t'iHmitiufioii du not Htiilicu to oo&blo OD4 in 
(loubliul i-attnt txj imikr' UitH ijiijxtrl.jiiiL lüffm^Eiliiil ^ingnoiiM fmm 
Uic Uovil-fiiiiliti^. PditiU wdiüij" of AtU'iition in tili» connc^ 
tioD are fiiwn in tlic following: — 

AiiJüLijf CLtndibtiUi'y c&uiM, rtiwnUvl hiriBll Li^iuuriUjtiji-i (aterlnc 
mfüTTiaU). |p4t alli>ri u «Ln^Tf prcifiiiu» li^motrlm^p. üy*jH>|tUi- dUliirb- 
■nao*, inl^lJtin] [>iirA*it(»H, iirannnnoy, and piirtiitir.aoni llimlfy, cliTUiiii^ 

In oidditicai to uYcrc Jejccicrativ? chnnii^cA in tho livi^fi htmrt, &nd. 
kidaByt, and Oiti vi-ry rrirrly jiL»'iit Ifiiiihluiumlluii Lit tJu^ fjiUy iiiHmiw 

rvcüfnl^pd bj Quin-^kr, nmnFl^' a !ai£c iopotitJon of iron in tht livcr 
ami moif or l^-w Jnicn^r Mj/mr^tü/tr^n {plffmmr lnf*rcl*| In rlip livcr, 
■{lEi^tm, tinif kidncjrt ( Kid i bunt, Uuntvr, Kirch- Hi r-^oMulU )- ThiF lillnr 
plirnuiiitiiH pomt iv ku-aL dr^truclion vF it^ liltiud-TionJUBden, 
III tiinj' i>p |nTt^<.»tv<4J own infru i^Aitin on «aimhyillon ol the blood. 

Blood'indin^. — ^Ttjc blood in nnrmn.! in color er ):1rlkiii^1y 
palp, btit ft'>mi'linii'K (äarki^r ihav nnmal, Üki? u"*'!ik roir<v\ or 
evüu tat colored. It h often tvrjr tliui ; äo Üiat it dut'ä not sjiread 
into II tliin iujer aod flrj upon a cover-glnM ao wd!. 

Tlie nufHlKT of eryihroLyiu ie alwa;^* Uiminislicd, often to 
un aat^niftliinA? Jo^-av?, Figure« of fixjiu 40Ü/J0Ü to 8üO,OÜO are 
by uo müuiw rui^. Quincke <iouuIi-h1 m ouo oaac only H3,000 in 
ji <?ul>ic in3MiirM?l*>r, und tjio iiülhor himRC-lf fitüiid 375,000 lut the 
iiiifiimuTii kiniiL Oti ilie ullier Jtimil, iUt< miinlH-r t\t U}uuir^Lt% 
ri'Tiiaiii" iiormnl> rtii incmnsc Hcing very rare. 

Tlie tülul Iwiijoyinbiri cimtcnt js n^ductJ to l-"3 ur wen 18 per 
<'L-nt.T but Umt vf tliE^ irnlividuju corpusclt^ä ia rot; indued, it in 
nut raroiy incruiisod in tho latt(!r, tt» ia at onco (i|)p[irt.*i)t by coin- 
parJHon of llic r^'ui'os giving in pcrttailiige thü diminution in tho 
nimlmr of fryliirrK-yli-s and }ieirMtg1(»liti, For t*%jimpli% the nnni- 
lM»r of red bliW-<^rpiBc]i^B nmy Li? n& Inw fi» IG pi-r tont., wliib 
llic Uemoginbin content is only aa low as 30 per cent 

Micrascopio cxaminatioa g^ntrully sbows an eitormous 
päikiiocytosii |»cc pago loT), dijfHt ti^ndrncy to the foniULtion 
of roiUcanXr frecju^nt microcytee änd strikingly numorouA megn- 



locjrtM, and u»uallj, alao, i^udcaU-tJ rrd blotnl-cvdlv Vctj fre- 
quoBtly the cdlä uiv ii^bodde^ in & pate, boniofp^ccus (alSu- 
mio?) Uy^Tf eücL &» ia otiierwiflc not obtscn^ in ftUincd dried 
btood prvpamlLun«. 

1a thii nicTOSOopic diaguoüi» oi jictuiciau« laemii ihn autlior 
consider« liie ni;ecAtivt ticrtirrttic4 of ahnormailif larys rvd blooiU 
coqnucles of cbitif jnjiinrtniici.-. 

A point ol iuipurUmi^ in IIjc ililTervutid dtngmiaiH UtHui^tai 
Mvootial ancinla äud t!iat form socond.iry to o iDJÜignant n^o* 
pUsm Ü tiial, ia Uic Jutttr, Iho EniiltmucJcAted kucocrtf^ arc 
in tfa^ majoriti/ of inKltincM« ii)cro.a(4H3, ;vhilc in tho former tJiey 
are ntJiv-r diiiiiiiiKiK-d. 'Hit-ro nn> ptt^ption^, however 

Aiiii oliKii viiltfT-1y nT^tnt. If tbU ii Imnni to bo tl*c ml«, it might oiTfr 
ivn «tplmiAlIoji t^i thr conttAQl mduovd temUaCjf of fftc bfvoJ of frfT< 
pfffoä« uiimiia fa rfHiffjjfnfr. In ft mpl4ly pTO g T*MU'tf ly]>ic n««« in wtilnA 
AltrntinD nu itirtHr-l to Ihiq piu-tionUr point« Lh« author did net imir« 
the imprvisluii lli«t th« bluudplalcA aitc »UlktDjflj illntliiiPhEir<t- lluw- 
mr. »• oouniLng of vhc Wood pin ti*i onnnol ho ilan» wic^ uTiy (lpgr*v o* 
riii<txH^AHf tlio rautl4 oblB&iivil Ilctv inual be hucd mora oi les« U|k04l 
tfriijiialnl tftliim. 

Yvt «Minlif <li7 ftn-pAml lofii, hhrlii'h'a tri icid and eaün und 
moibflciio blue Bottitiuiib ar« nvomnicditul lu prtf«micc to itll olhfin, 

I. In the prnpamllnn« iiTnlnM for from lU la Hght iiilnuleii wlrh 
tho iri-tKlil floLulion thtt n-J bluuil cvEIk up|ivitr diirk yvllo«, tl« nu<Oul 
of tbo nurk'AT'^ nii (>]|pi Kiii'H or i^nrmk-lilu**. TIw IrkH'^JCjl*», diivfly 
pnlfiiur1»r, harr ■ dlMiiirt. vmlpt- jfraiittlnli-tn. Tlif itfitii]r|ilillM are. 
On ftn n^^cr*^, It to I -I >h in ew- JvotMr^l Iiiq;c» mononmOcat'd l«ivi> 
4:>i>« ¥ii\h LiiH|iJt«ti<riiHlr](», ili'iiH'ly urutnifiHl uriiUfpliiLtr |[raniilM »Imi 
occur, vliitr i^llicm «hi^w a pnUi protopliAni. Tli«- iiiicli>i nf thi* Tfiu'ticyl^* 
ftre pale blufr. Mi^njr red bTood r^ll« or« pftlcj otiion »bow » fiij«4 rrd- 
dl»h blite tÜiCG, 

B- (tn ilfllnitiff ulth AulftJhnAVt'JfjfJfili, prafffftUy fur from Iwnlj 
to tvBDlT-fotir liDUr«, IlkT ml blai^d «Ibilu arr «trawlMtrry r**!« wilh a 
■llgttl «luilin^f of oranp*, anit 1h« uuctrl are blucklih. Mrt^nlucytv« Htid 
mv^lobUuilt up to IB-A >> in tiu tould b« obAenvd b^ Iho fiUthor. The 
ItOflOcTl««* ifhieh an Ktdocn and tbrn i>D\y «lijcLtl^ i»crra*»d, «boir 
upon a hriRlit IJlaL.'-cvltirvvJ budj ilark EiljirxijTiiTnl niiclt-i, »hii-1i. t^^tr- 
cUlljr to til« larg« nonom]i?tvAt«d i?^l>, prpvpnt a di«liiiM MicpLilatcd tinw- 
tuft, tJifl Ewbt *|j*'^» in hlilch niiy be bitcrpn^lcd a> vamiulc^ at Alt- 
nun'« iiuilrar ifvutiula. 'i'kt iiwtii of tht tiiuiphwt/tfM ait itmch ttaftn, 
CppfiMtckimff thr fkn^if of coUw of lAr nommhifttt au^M,' ■» fk«f vkf* 
the pr^toptattfic jfriif-ftriv »A'/if ü UMif^rvt nad filfti^frr^ <*hr fl mmg 



Tuthrocf/tc nurJc4. In inany ri<tl hloud-corpuvcltF u jnom or lea* ^■ 
tjnotty bUilht'Wd ton« of oolar ol Iha >i'lida <uM-Zj<:>ily j^bq ha msu. 
CU«Ds:ilnBk>'> »lain ftino ^ivtii gooJ ntulU- 

IVuclcfitcd r«d blood-corpaiolvi, oft^n of uduahhII/ Ur^ 
mBt occur ciihcT ia ftuiaU or in large numbc», and are but larcly 
abSGDt (k^ V*^ li^S). According to the author'« cxpcriuiiciv 
atiotiuc <lo|?L"!ioratton i» mro. The btluivior of üjc tKmnoph\lcä is 
wholly tindiaructorutk' ; flimimjtion lu: w<*El *iü >ili0;hl iutroii*e 
iiiny bu obsiTVP*! ; [■f»mjil<*tr Jilisriirt? Hjiiio-flin lo Im' m vr*ry iinfiuor- 
nble prttgrtcffiU^ sign. 

Nuduilccl iT'i! blood-ccll» may wrur in all »evpro'Hncniinü- 
EhrJich ii£crii»:s ao important role to Ihfir «äc; according to 
bim, the prcscnc« of »t>rmf>blafite pcrrniU a more favonibto projc- 
ncfiU, nace tlipy are to bo iiitorfirn'tod uf an iadicjttioa ol on 
jner^oflod produdlon of normal olt'im^uU from tbi? bone-mairnw. 
Til« proinUL-rii jjjirt pluyi'cl by the bone-iniirrow in the fonnn- 
tiou (jf bbod lijifl Wh pwiiivi'ly <!HoniiiiiLyl by XcHiHam] nml 
HiÄTOKcr:», in i»«vcrc anrmiiiR thrre is found a mon; or ]i^ 
ftdvnnrH trnnüforniiiHon of the Tt'Il'^w, fat bonc-mtirrow into red 
bfi no-marrow. In Uiis way an inc^rfl^Hf«! rflgenorntion of Ibo moro 
readily df^troypd red b1ood-c<?lIfl is w'^nrod, From tbie tIpw 
of lliii <{Ui'^tioh II mi:^M br> aNftiiiriM thnt the aWno^ of mitlmt^d 
n-d Mwid-flell» is an indit^atiun o£ ibe uunott tirrtnf-r nf Ihp sig- 
nifjoint tnin^fnrmntitfn inlo red nirtrmw, Thip, hQWf'ver, is 
not in bftrnic»n/ with fa^U, Tha mtthof ropcitvU^ found the 
mit^i advanced r'u'Iartiorphomg r^f Ih« hmi€'miirr'?\r intn a niii- 
ftfrm. rei!. ^tlatiuffUA ^ifus in msi*s in li'hich the mt^st carfifut 
fj'amhuitian vf blutut jrrejNirtitü'jiir aht/vrt] vtrl a »imjJf nurifatrd 
rtid hhodT-'Tfnisd^. The diat^iiotis of pi.'rüii'ionB anemia wa*» 
h'w€vür, mufio by the other biood-flndiBf» and cocropftv. 

An Txtiemoly riiu ftccarrencc — ultcatt In Ocnnonj— ^ the prewroe 
of fiaßfltatti in Ih'- hlfkfkcl nf pfrnliliitit nriL-TnU, A»'fftriTlnir tu ihc ron- 

wuuld >cein UielC nL'Uicly luotilc iiifuBortLL— jiornvtim^i wlili, Hprnriimc« 
wlLhanl, flogfllu — Dc^?at!rmnlly n]>prnr In the blood, Wlitlhnr Ibpj hnv« 
&ny MioTopi^ HigniflflAn^ or not U quctttloimblQ, cv<m Ihoujii \W\r n]rna»t 
mn^Iunl otTurrriii'V \n t*•vl'tJ^ «'hm^a 'fb^i-i^iil Vj KU'b» in ^diii'li ilihI 
PntifLie poifiti to immnJiiilr lihaoil ii;ri''i'Miin, 



In thr bl'iLu! nndliij^ In (hTHioliMii HtinriiH ji^tclu» A i'tiArArT<TljiT.1(^ pk' 
lu». Wh«tlivr tliit d<igva?ralioa if atwuyt prii^di^ nr whHlivr »«vvn 
dUUirt«occs »f tbc p1a«aui prcwdc the dc{«Dei«tlon of the cotviisciiUr 
r-lcnipnU U il^l ah opi<n qiiK«Tlon- Ar all cvonit. ili« pc^tlbint^- Ihnc thv 
prucvu may occur under tho lAtl«r cirEiiiiuiiEHnrtM fnqnoE, occunJ^rkg lo 
Uia ftBVttlcliCfl od AVoulilfidjcv and othi-riv be {liL<iiiri1. 

Tll# obHTVflllon of A ffv TAU« cf pCTTiicioiiH tncHila In vhleh a 
priiQA|-]r onUounomb or, conErary lo tho U4»a] finding*. An cnonDOua 
tuiMrfActiDEi uf Ih« »pl»rn ptt-ctd^ llic vrt«!« irvavml dinlurb«uc«» 1«id« 
to lilt prcBUiTiplicn tbnt divo^p of l>oth "bloodfnttniiiir'* orgiiiA dIaj 
f iro riAt to tliu dtivdoiiruGiit of ftnuinv pcm&daui aeiciuU, Uut «tca In 
th«» ISBMA, vhfplip bn'AUitr ot thrir «xtiviiiG iari1>\ piccliid« svarrEil can- 
«lutioru» thcT* i« Ufking ihn clear inhi^fit inln thv ri>iii<k>n nf thp fiAlh'i' 

fit nU nncmic Hulijccto tlie blooil'fmilings nrc Bubjcct to 
greater ranntions than in hoütli. At a rule, tlicreforv, n din^' 
nosit dioul^ ftt^f b« hA^o^ upon n «ingl« bloctl «XAtninfitkiti. Tbl« 
ifi fi^wdally tme of tb« number of l«iicocjtr« tD vrbich w« hfti«, 
to & certiUn ijegroe, nscribei) an iniporUnt Me, in tbe J i (Toren Üfi- 
tmn of Um onlinar; Mwnj&r? and penuc]t>ua fi>nu. Kv^n in 
tbc letter« however, von Ki>on]eii occ4aioiiall> obeenrtf<J an iuteotfe 
Itncocytofie of rery bncf iluralion^ acooapaaied by tmprovoinent 
ui otb«r iv&pocU. 

Lpukcmla [LriicocythrmU?. 

In compari^ou witb tho blood dUt^asuf already oonBid«T»d 
tbi* dU>?uo«is of d<'veI**TK'd leukt'miu 5s ueuuUy thöt^ readily and 
dnßnitrly iiisidf.. Vitv «ifU'U it xin^'li? glami^ JtiUi Ui*- Miiorir«M[>e 
ftnSIc« to nrodcr absolutely crrt^iu & prc5uniplU-c dw^odi« bttvüil 
iipoD other ftigii». Ca*o§ occur, howtrrr. in whi^h *uch u m^er- 
90Ukl e:iAznination ia inadoquat« ttvd wliich demand nto<t caMh) 
microtccplc «tady. In euch iiiAinnc«« \t \9 nooc^Miy not onlj to 
eount the r^ nnd white btoorlHy>rpusoW, but it Ja for many 
renwiim ik?iir:ii)lr. if cut abaolutrlj ctt«clia1, niao to «Inlu and 
Rtudy drird blood- prcpaTattoiitT. 

The ehnnrteriatio fcattii« ot leukemic bloed U a pennanent, 
mon or irta inWtVMi iacreaa« in tb« number of leucocjt«t. II 
>iaa already hfvn «lati^ tbal iUa nnmiAl ratio boturwn Iho rvd 
and ixkbirlMS blood '<<»rpiiiu'li^ xürim Xwlvtva t to Af^O and 1 to 
l(K)0, and n rat» of 1 to 4üt> oWrvod in frrqm^Dtly ru^tcJ 


HiCBoecorY and cBBjnsritv- 

(^oimts moide in the interrAlc of diction should itroufc atten* 
tlon. In Icukfrnniii thn ratio i» eo altered thot in many car-c* f mm 
8 lo 10 or ?0 r<Td to I ooIorT^i^ corpiii^cb ocoiir; iii(l4«cl, A ratio 
«r t Ijj 2 Hiiil i*v*ni of 1 lo 1 Krs bepn descrilod bj reliable aLitlion- 
inv. Fleischer and PoiiKoidt iotiiiil a ratio qI even ],I5 white to 
l.OS rrd and S^reiweu of 1,T0 while to 1.17D reJ Mood-ty-lk 

'J'h.j* nlTcr-Uuii of Uli tijLKfll WM fljT^t Jr^f^riWJ Uy Viit^lnw In 1!^^ 
A« A iui[HirLi1i- ili-ii-riH^, iirul tint (liii|fnohtirit]<'i1 in t't'^ living 4ii1ijiir't- iiy 
Vo^r^l m IMO. [n the majority ol Ih^Iüdccii it ultndif the male vex 
lwtv«p Ütö xad 40 yturs of itfic. Aqjoiije ll^n cauwh uie ihciiUi/iil-J cluxruic 
iuli^i^iitma dltiQniioi, *.\\c!t at h^pbihH afiil mk]«r1ft; ft)«o chronic DiitvnlU, 
afmholIi'Tn, and «uiMniilly iTuinniLlJo innuooceai Thv diimliun of Urn 
dlAmac 1« Ktiicrklty fruni uitc to l40 yian; It lümL'tUnL-i nmi a icry 
rftpSd ooEivio In fioni *infml ctayi lo a f^rw «Bi»kfl, The pietur* tn PIrtp 
IX. Ily, IB, wft* tnkdr fnjm HUdi & f^am: ubth^rvt'i! ty Iho AUtU^r lii 1l40i- 
TJic {ijLlJviiU ^t< ynrs uM, naid lliut »bout tlirH muiittii pivijiiUA to «um- 
lug ander CUT can ho had anllorpd from iQv«nil tirvottf atta<:k« ol Uiorrtlüo; 
Im uoiittEiurdp hi^wirvcr, Ut ix^rEuriii tliii m^uo^jn dtitin« uf a IrUni mriti 
until fwii iirtil Pii^-hnlf week»* Ir^fivip liW di'iiOi, Thi- <'»i"i' wji» unr (»f 
ftlrnotL jniro lympJiatiü lorm.^Bll tho lymph gin ti da nhnwcd hyporf Jm^n j 
Ilia fi|.HU-t.'fL vju ul ilurmHl *irfi luid llic houe iilarrifW u'phtIj' uUrTcd. A 
{inriiii« 111 riMiiAilHMit iT]t»>n>«t wuA nu ^ttnnxlvf 'bnijjh^iTnainju /Af maffujj 
in Ihv hrirrt. In o rapidly fatal oäap <i( primary *afOofria of thp thymin 
Vtfü JaWli otHroetl ihc [mthuWKic fcftluri-» peciilUr tu lymiilialjo 
IpnhHinU, Hhil Ih« dnihor nbhi>rvrid lhi> flomp iilKririniriniL In » mAn. aßi-il 
AD ycjhrp> wIkj dJo'l from iti uuurmouit curomuniA of th«t htujTiiLcihi Thtf 
author üotd nut IvHciV) bow^vor, tliAt it Ib v»tt(.i.'l lo d^i^j^iJy hiic^i irnsr* 
» "loukcinUi" 

^imn llarn a nnnUHir of Mmilar CHfm liatn \tfrn lU-ArrilH-J tiy A- 
rmnki'l mid <dTii.'ni: Tilt* ttiilh4>r liimwtf hn« ri'puiipd ffiiir rH.'i^iiiiiil ub' 
»(«rTalionu m ^^hi'^h tliPiiitMine tr?l>nlt i'lmrn* »(Jj^^bTimj Ihr \tri^vnin' af nfi 
a^'iiLe infccliaUH dlat-itau; tb« flftli tüöc wüa icvn Ly tiim in October, IflUU, 

A jMwitivu dUgaosia of leakcmm is posaiblc only by micro- 
ficopic viamiristioi] of the blooiL Tlir dmiie of hlood uitlidmwn 
«ometiiucfi appear uomtal. but nft^üer pntc ivd» tliln mi^at-jtiicv 
color, more eoldom chocolate colored. In prnnoHnccd caw» tlic 
liret fik»ce givoe thQ JtnprPHMon of a coüflidemble jnoreaae of the 
i^ülorkfiä corpuBclw- Thf laltrr uleo niiiDifG*t great variatloiiB. 
More or Isn^ d^nhh^i] diFTi'it-tiv^a in ttl^e iind üt|ii=*i' mrvrphalogic^ 
devidtiona nrr ttvn. In addiliuu to btiidU arid minliuni-sizcd leii- 
i?iJcylirH sliijwing ft ilclit:ufc groiiulatioit. niHfiy ^^^I]s with diatinctj 
highly ti^Cractive, cour^ groutilutiona ütc günr^mlly found. 



The rt4 Litood-cells art paler tiiAn iuuaU axid not rarely of 
vonobb eize. Blood-pbtca ar< ti^iually moro nujiioious thoD 
rormflL Accv'^HJ»;* lo iiuiiu-roüti ciulhonli««, vilh whotn tlie 
autboragrwe-fl^rr^t'/'racficr ü'i/f utmUti infflce to Uiaj?no4licnle, 
fa; careful examEueUmi of llu» //AtJ^ blooil aliiüe, 1h« |>articulAr 
foflm (if ]eak(^nii& occortüiig 04 Ihf? pariiripnlion of tlitr fvpW-d. 
boiic-mftrr<>w, or Ijmphatio glandular ayeUiu pTtpondtr<\tcs. Jf 
tba«c colorliw coipu^dcs, which arc abi>ut a« Icr^ a# & iKirmaL 
cryÜirocjH «^f» <^ljii?fly incroiw^f!, it may eafdy be cooclii'Irfl 
thai (fie yhndüiar ^sfem ii priiidpally invoK'otl (?Ialo IX. 
Fig, Ifi) — *• iyvifJxutir form"; on the olhor hainK if Ihe largo 
odk appear iu tli« m^ijurity. n phHicipnttoii of tbc? boue-marrci» 
and apl»u mu^t be thmi^ht c-f (PIoic IX, 1*^^ 11, 15» and IG) 
— " fagnlogtinoiii iind sphnic forms''; aad the tpkcn »hould be 
miflpcctcd wti<.'i: iIjito Ap|xur in m'ory fiold of Xht» microecopcr A 
birgif tiiimbrr (fmm 3 tr> ^ nnl mnni) of cf*Ilfl fllW wiih strongly 
ri'frnctiTc, *p]irroid granuli?«, wfnle inrolveinent of tlie bone- 
marrow is rc-DJfrod prob^le e*peciaUy by llw pnewnce of krffe 
mononud'iaUd IcncocytM. 

Hoveior. an inRi^^Ut into the diffcront feature« praiait«<l by 
the ku4^oyiM and the ratio of th<:- ctndl, ni^iunn-rijuMl, osd 
iibuornially liLrgc Ui vnch olh^r i% ihwiMit iiiily by mpjirtf; of 
gLiin^ii ririfd pirfGrntvms irSirh alto rcwnl (he atnictun? of th* 
nucleated rod bh^oJ-corpueclcs, vhich arc almost never abneaL 

v«t<i> or alocLclic wlation uf tuiia «nd f:t>ju-rri1riitc>il ftqucttUB «oluUua 
of nwihykne bli« whlct U nwJ lifiiftL 'nn> w^i/'i-y •ftliiUftn <ij ivMin 
ihoulii a(*t fur frix« 'iiitit Iv t*ii minutv« «Tid Uiv nEvulibUc for thr«« 
niinutc« fwt pBc« 1531> 

Skmtlar pIcrtiirM krc oUaiiihI Ljr ttpatlng for from tAPnl]r X^ thirty 
minuU* wltli lintti^i Hk'.-uxiiiiiy t^lulian, l( (hi» -UinifiK iK^utinn \* 
■llitvrd tn 94-1 (in tivfiilj-fnur butir» in a. «jittTi rcK>Di ur uvir a ttcir. 
*rry in»tniftivp rc^i^U nn? cMiiin«! Fr.iÄtiophilp unci bkuphil« grair^jfe* 
pre wpII »hown, M art alao the nuclei ol the rtJ bleoj «ll«. Hw picture« 
thu* u'ltniitrd arv ilj»lliitfiiiiiUnl fniLu tUü"!' »Ibim^ iiifiiillj- liy Uie itluiqirr 
ooptmir of Ihf imlivMiLPl o*}]*. 

2^ Slain wilL iTKrIieh's tri brlJ »lution for from Jiro Id #^if mJiiHfr« 
■PfMOHt heruft;4£r. Aci-oriLiifl tu Iha author'« exticiic(i<i\ tivu niJauuV 
Mmininjf li«rti|j tlngrit Uir *o«lnnfi1illle franult^ ikJul Ih* i»fut^iithi\m rw^l 
at aJ], aftrr four inimiUit tHt fitniur xrt di-tiiKtlv Alainrd. iiaJ ih^ 
lalUt Juni vl«it>lF^ aftrr «it ididuIw & vrrjr ^Tiiiq> |>L-lur( la otfUlnfd^ 





ThJ« iw«l» bmuTlfuIly tU# propflTtlon at rrü to wliiU Mil*, pnJ flUo 
%hü r&llo cf Lhe varjou* foruin of llir Ull^r lo I'A^h ollinr, «n vll n* llic 
j:iiulnUil rr^ 1>UlijiJ-l-«1Ibi Ihv uvulpjptiillc uniJiuUn gf the (lulj'iiij^rlwir 
And lar^ mniinnnMivr ^Ib^ Atid thv votinnjihllici j^AniiJr« (Plutv IX, 
V\g§. U ana IS). 

a. for JornoitdfntJnii nf niftit-oelli iibiiTÜiti; with t^ani-^ntralAt 
y/Alrrj tfilutivn of mplh;U>n» bliiu (f<>r friufi i^n tc fl(t#«n niirmrd«] lA 

4^ Slulning wiriL KhiUi^h't ronln «nd Ur^iimtoij hn »cluUgn for fTüin 
twenty to twfintyfoi^r liour« {l^alo l\, h'ig K) givt-^ cxtraW^ni and 
hiKhlj' instnirtiro pirintr». Tlic cnillmr» of ^11 thr drmrnU fttr rrry 
ilLEiLlncL nncj Ihr ptolnlDf uf the vaHoiLi wUi and nuclrl Id i]i/Trtriil trjiii-v 
ot color la iLipfi a* oun ■oArvul}' bo approachod h)' any othor mcthoUi 
Til« niii'lru- Huiiri*» Jill* |MLi LJi:ula[Ij ddicAt« muri rtcM Odliio^L ('itfHVJaJI/ 
»h« chrnmniiri Ti>(j(-iiliim In llic nuil*-! <^f Uif Hr^r iMoiiinuj('lca.r rtllH. 
Tho Haimng of the imlividuat bToodccll» hcin nlrvnd; he^n comiidtfrfcL 

»nlumlM vtitli cnxin oniL aniin-iiilnin pirnit« aliuiih iJiv red hl'>t>4l-wr« 
|tu&i^lc9 >'cI]ow aiid (he rosiuo^iLilio j^rnnutu JntcuM^lj' ltd» Fiuuf Ia IUha 
fnml'hi'iJ thni thr InMrr nrr- in no vny ronn^Iod nllh lipnioglohLn^ 

Staiiiirii; of Fresh Blond Pre pa rations.— It h nwiisiomilly 
ilc'hinibltj ^1 sUin llje freah blood jii*t tülirn fmm Üit? puiicmL 
If S or 3 tlrop? of a OhI* to 0,&-pLT-crnt. watcrj solution of «win 
fire placed at one cd^ of the covcr-g!ä« And raado to floiv Lcncath 
tlio Liltor ly flWrption with a pioco of filt<?r-pajKT plnood at ÜiO 
opposite oJge, tho red blood-collti will \>q seen to E(ä«Diiie a. distinct 
>&l1ow [Yilnr; the Aldining of the oo^inDpliIlii- gTiLDul« is t^pocially 
pn>jiiii»'rit., mill (jfd'ii inU'itT^i-. If smirm dihilv im'tlfjlont blue 
joluiion i* rrkw allowed to flow U-ncnth the covi^r-glaw in the 
«uiic mannor, Ih*? dye will hcrrc and there be quickly tÄkeo tp 
hy othi^r gnnulrw. rt»i different occtiMons thu author obsen^erl 
setffal friW* of fframtladons tri on« cell in sufk proparntiom. 
This i> emphasized hrrt' Ijpctiiih* Ehrlich <lriiiw »iich «n ooput^ 
ri'Mi'« ill tms*. ci-n (in (3r/ pre|>.iraLmnn). Kii'ilf-r lui* fonnd timi- 
kr pKturt-a m dry pi-tparalions in nrut<? l*t)r:ocyb>sia excited 
by InjvctlriD of hnctc^ruU cxtrncte coutiiiniug protcifi; he desi^ 
nat<^cl siii'h i^HIft "amphophiUc" [V^^ ^= h^^th : ^tXixv, to love]» 

Biii^oatiG DifllcuUiw- — Tlie riiiigim^ia of developed J&ii- 
Ki^miji IK Jitniln quit«? rn^ly niiil with crrlainty» Cams at« occn- 
sioDally n^et with, however, in which n ^u^picloa of the cxi^Uini* 
of kulir[(iU is nroiiflcd ly ü ^rics of clinical flytii[)ioiiiA, nitliough 



«larninnlEfln of frech and many itaincä pfvpumtirn4s Hih 1o 
roiidnit Uir;dfjigni«iii. IttMirli liuitiuirtiv n^|i(»M c^irr^ful euuiiU 
of the blood-Gorpiuclce must bo made 'Id acfonipLiab thU gm- 
oiilly required tnoro skill than in ttainJDj:, n^idc from the fnct 
tlut Uio coiintijij^ of tho white blood -co qiti^ Irs is attoodod by 
gn>atar orore ihaii is tbG case with tho red cL>l]e ; if a fiuccwfifutly 
stained preparation h eidiiiinM^ a qtiili» aLvuralv e^tiiimlion nf 
the ralio of w!iil« Ui n'd l*«?!!» la jjoAHiMt?, In litis t*aü ji great 
m&ny niicroftcopc £eld» mua^t be counbei] vrlth the aid of the 
ocular mioromclcr — at Icnfit twciro hundred. This cnn very 
rMdiljr be *ion<L In this way tht numeric rotio of tho digtrent 
forms of I*ucf>ct/tes cnn also be detcnninod st the aim« tira& 

Thi? diagnot^ij^ vkoiiM he ^G^ally 4im{>litietl if it was posaible 
to rccojiiiia^ & i^tfiuiLi" tji>e of tell an i?hariurh?rifltjo of U-ukfrnia, 
Shortly after tJie discovery of tho toainophiU txlh and th« obscr* 
vntion of tlttir iLbundact oci^rrvnoc m lirtikctni;!, it was hcliovcd 
thst IIlc -tppojirLtncc of thvco cells could bo accepted oe ah itnpor- 
liint dijignrwtic f**alnn>, YcsT« of rM«srcli bare rMtiicUd the 
viltM fkf this symptom. It has hfen shown that eot^tnophile celln 
uiay filto occur in Lli'^^t utjiribt.-n in the blood Lindvr Ttinny utbor 
dicunintanccR: e.g., in Mthmntic» [and recently in tnchinoei»!- 
LikcwieCf tho AtuuinpUnn tlint tho mii«t-ccll9 nre cb^rvcd only 
in kukomia hiut hLtn (HtprorfifL On the olhcr hand, Ehflirh 
considt^n the Inrgc mononufiear neuifvfhitic celle (myeJocaitu;) 
to be of impoHfiut significance in the dio^eeis of loitkeinU^ oepc- 
cially when uwciated with the pr«wnc« of eoaüiophile cells anil 
nucleated rtd blood-cells. I^ong before hins, bowercr, Bberth and 
otbcn drew att^'ntion td tJio »trtktn^ charactcrinticv of the large 
monounetmir Icuoocytoa. E\^cn in uTifttained prc-pnTn1i'>nfi,'— 
under certain drcum^tnncc« only itfirr addition of acotic acid, — 
bat much moi^ clumcUn'iMic in »tain^d preparalionsv eapecially 
in eostn-heni.iloxytin. tho careful observer wIU sui^ leunxjte^ 
whidi arc Dcvcr or b^it rery raicly prcwnt in iicinnal blorM3. 
Tht*e mn hrge ctUs tnort ihan Iwi^&wsito 9fcn ordiaarii f^'er- 
lim hlocfd'^orptiuU ichieh utuüllj poü««« but ono excoodingly 
Uj^ nncltii«. W'Htrd more friv|t:ently <<ceAnt ricallj than con- 
triLlly, occup>in(; the ;:rcalcr poriinn of UiocoU-hodj, and usually 
in crcKcnt furnr. 'tlit nucleus is >onicUm<s lobulatcd or vallet- 
formcd; more lardy polymorphocf, 'J'bo nuclei etaincd with 




hcnastoiylin fhovr almost throughout ft öerul^ipt^J rpUculuni, iha e(r«clurc9 of which are diitmctly Plnintd. sho^'ing tbft 
lighter protoplasm in tho Bpac« bctwoou. XL F. Jklütlcr tMvr- 
iiiiüeii bcj'onJ <]iio^[ion tW ocpurrt-iice fif inJirt^^t divin-on in lhft»ft 
ci»lK Sin«* tlw¥P i'j'IIb, vh'ivh niso ocriir i« ^A* n^rrmtt bi?nis 
wcrrov't an? ntH uitli in great autnljrr» in Ii^ulfnn^ boni^rNtirroH'-, 
it i« not ßioiiiÄ *">> f^r t'> regard thc*c lar^T iimnonuclear cclla as 
"hninMniinvw cclla"* [mjolocytrj:], and to ftF<aumc timt in Ion- 
kimiin thoy nre waHio^ ih^aw into the blood ^MopIct, Xcumanti, 
nn^ oth^re). (Sw Plat<* TX, Fig. 14, d, Jind IS, c.) Liko the 
lioIjTiucleur l(ȟi.'0r_vte9^ t)n? rnyolofj'les liwn* n (lktiH<?tlv f^raiiular 
|jroti>iilaarii arouni3 Ihe niideuji, mid Iht^rr «ru nlsn Uirue vanctiei: 
iiL"utrf>philo. Iinntjphilt', aiid mwinophilc myplocrl«». 

The qiittiti<:in nn:»*'« wln-ihcr thn f»crurrrntic of these "mnr- 
row-oHln" in the blood in dfuhtfiil caepf niaj' be accepted ns 
Ali«oliitf>1y divisive in the dingnnsiB of lenkpnito. The an^hr>r 
believrti thai, with rertiiin ri-^triction», lliis qiic^ilon may be 
ausweml jifTirmatlTelv. A ^in^U' couflittiug ohirt'rvutiüu must 
natuntll,v roMtnct tlic v«hn? of tJiio aiam. The aatJior iuw already 
TofcrK*! \t> a viLH'-tlmt »f a \-ory p^tlc woman uil<!cti^d with 
Tiok'Ht paina in Hut bon». Id thi» inätuüco nluiOAt «very Seid 
of thi* mirrofimiw* *lu»wi'd Kin^h: "mÄrrow*üella," whlth iifm- and 
tWü prw(?n(nl pvm fftint Ttnitfopliilic grnniilAtion, Th^^rf: wiia 
also <!ecidö] poikilocytosii. Ncvcrthclr^, the lepid and p<^nDft- 
Tii.^t cure foüowin;: proper care and the ueo of iron nnd nr^oic 
TorcCfl Uie cooduBioQ that th« case was &no of vbloroeia gratis 
ccmibint^d with anoniia. 

Tlii'n'fnn'^ iiriUn-r Un? iiirrfi^sed 0{7<rmTe]irp of eosinnphilic 
crlU nor thr ftpjif^rjinrc of a moderate number of ao-cnUed 
inarrow-cclU can be intoTprd^M^ ns ab-^iltthltf ikcisive in tho <ling- 
iioftiß of leukemia. On tho othnr Imnd, howa^^er, tha aburttfitnt 
eccurranca of ihm& lartfä morjonwlvotcd crlh, irhich si^ldom,, if 
fv^, occur in normal hhod. mminnprl Willi .^f-nidpfl i^crense in 
(he niitulcr tif nosinüpliÜe iL'lIfJ, J6 of the ffrvalfAl jsir^niftcante for 
Bueh ft tliignoxiji. That tb« niarrow-e^lla [mjeloc>tca] may 
oIm) contain eosinophilic ^nnulci ha» n1n.!U(]_v b(?cn slated; thia 
type appenrft thus far to hnve been observed only in bidtemio 
blood. [Thoy are anid to ni*^ur ot:i:uBioj3ultj in the blood oi pcr- 
oieious anemia. — BiinoKs.] 

•niK BIjOOU in DIRRA^R. 


Kinnllv, the moUU phtm*nnifiui of th« Imicocytm «Wnc 
»filial ci>iuid^ration. Nürmally the muIlüiucTealcd Icucocjrtc» 
are diflim^iflicd from the niononuclcalc^d by Uicir actitc inotil- 
Uj- The earoc motilJty la obacrvod in X\t^ ordiimry mulUnaQl^ 
nted ecttinophile o&lla. On the ctlier hand, Iho "martow-colU" 
[myi*Iiv*ytM] mniiiri^l no molilitv up(m tht* ttjirm «toj^. 

A <iuHo ran» uinnifi-^lfttinn in leukt^mic bloo*! in the presence 
of i»i>lated Charcot crj/staU. The tiaihrn lin« ncTcr observed 
lh«ic CTT^tnl* in l!io unalkred hlood, but he hu #een them **t- 
erol timce in large numbera id freshly drAwn blood alter thti 

Fig. 44.— Acute Luukvuib 
JT, ir&dHUd 1*4 Uo444or|mvl*. 

tddition nf wnltrv fnlutioiiä of vtmn nuJ iwdfij-lene blue. Thte 
plicnomrnnn hn« no ilijignoetic significiincc. \a a ruler ^^ 'i^ 
found in titoompi>t€<i leukemic blood, thouich tticy mciy apponr In 
the aboenoe of euch a ch&n^ 

In »»-{»Il^d acuta laafcania large niiRih^r« of mon^nntiwM 
IcQeocft» are chiefly met with. Af»er *ij p»>rsoniil ohtfrrations 
of th\% kind il App(<Hi9 to llie Author to be ivroug (o cuJiaidt-r 4PJ 
«pecial fnnlurcT ax diamctcriatic. In PLile IX, Pig. 16^ nte given 
the Sndmp in two C4w« nhidi wi;re climoallj Tcry «miUr; in 
one the Email mouonuclmrT in tlio other the modiuin-fiicd and 
Latga mononuoloar cclU cbic>fly arc incraued. It ia injportant to 



note that in lU caaca the mjltinuflieaUHl leuwoyto* arc dimin- 
ished EU Duinben The auUior »ouM laj emphaaia upon tho fact 
that in his lajit obsermlK^ti Iha lympboc^vti:« almoat exehuively 
wtin- Lucci-jiHt^l, ulthciiigh tnormtnm tumrfnciion of ihf. liver nml 
itphcft ü\ihU:i\ in niMitiou in tltc inknM; ^nnvrnl ^w^l)ulg ttt UiV 
Ljrinphdlic iz^amh {^cc Fig. 84)- 

WhflÜKrr ÜJC pnthnio^c coiulition doeignalpd a« acuto lou- 
kcmifl >hoii!<l be fcptMo<! n6 fin ficut« form of this dieosfie apiwars 
to thft niiÜKir vürj qu^'t^Ifanahla 

The «üuau oF the altcratlocH En the l)1ooi1 in loukcmia luive aoi y-H 

OUA» ol thfi Itlorid, with ratDTilvil tlUmtfiffntinn ol the Riurv »iiiOvnt 
Iciii-ofytc« (If^trit)» or >ii'b«tbtr Ihc blood- farm inj; qt^aeib thrniKlT» 
liBVc boxiuie ppinitAhlc Aud arc na laiifji^r rApabLe of irrnvi-ntlii^ Ibo 
promnluro cwnpa oJ unrtp« cori>u»eular cEuintrHt« (Viti-'ho«}, u »LUL 
unnolvcdi iVibnji» b'.itb vioire am cr>rr70i) •nd tb« procrif Li <raa m 
whiL'h tbcre |i hy[iPL'pliisiii nzid iilinotinB.I permcnbillty ol thn UonJ- 
fontLing: oT^nt as well a« a diminLilicd il»Uuctf<>n ■>{ IclicücjU« in Lha 
cinuliitiiLi: blijvr], Jt Jh carlain. boMWor, ihitl « vprj- ii-Uvu fvnuatiofL 
of iipIIb b^ üivinioTi cnii In? dti^rnnl En tSu^i* li>cntioiiv in which blood« 
foriDBtloa o<?uorB lliiuowiro) — a fact nhidi miljtatci agp.\nvt L^wit'« 
tluir^Ej^. Likirwibir. in ulruirnl i^vitry cmmi of li-ukruiiii ibrr« lh Ui tin foiiiitl 
t mnrr» or 1^<« itilvJiTin^il hypi-rpliiHm oi t)irf ttiive bloofl'fiirmiii^ orgKnir 
tho iplncn, tbc lympUnlia glanJ^ and the honc-iuaiTCrw. Tbc lalUr U 
l|[t'iiU> lüUriKET, |pvi(iculuil/ ill Uii^ loi^K tulikt!ftr buucn ami xlfiiiuru, bul 
■lull in th« hb> mid viTlvWiK, Ar^OKliTig t^^ N^iimdTiTL, to ^hom wr- Hin 
<^bicfl/ indcbtf^d for our bnowkil^ of the subject» tbc trtnrrovr appean 
ciihiT fnu<Uk<i (putc huh-'mMi^ or ot a mote hoiiig^L'nE.-gkLB rupln-uiy-rrd 
color niLil ol jjyoiU or lympbndonoiil lorm, Aq a ritio, tho varlDtlua oE 
Iviikcmi* mtt with nrr^ miioi ty^pf* in whirb nTl blond forming urgmos 
pTTJient alUrtllona. the intPDüity of tbc pHthukit^i? proct» vurylng In 
dlfft^ront looaMticA, onä p1ucA sbowlng Jou ndvaiictd, another iitleiuoly 
piui^i-iuiii'a cban^n«. T];c <|iirAtiuii «ji Io which «luan ts tnoet AfFrcF^ 
eon ^i-ncrally be rlTidr-d by lb« blouil-nJidln^« 

TLm OUO of Lcubo And ITlctKhcr» alitch PLt nfroropFy Bhowod Ipn- 
lihuiU'iiniil HiHii^i-A til Uju biific-manüw, but no altfiAliom in tbc MpTct-u 
auri ßhiml*^ ix imiinlly f|iiorj^il In »Lipjiort, of Ijlwlt'a tb^iiry. Thin rib' 
■orvnlion» however, by no nn'onw ulfrm n flriri Im^iK fur hi« tlmi^ryi for 
k iliii;« uot exjiliiui why In Ibis cast: a d'ttft/^iiUni, of tbo Icucocyt*» 
iU?«iimu]*itftl in Ihfl WoihI dirt not oe.tii In ihp jiplocn and gldndi 
phcm* million vbidb, uoi-urdinj^ lo IJl^sil, (klwu^u <kvlii-v »rerjudart^jf in 
IcukcEiiliL, T}iiit imJuUurj a1lFiiilv.>ii» mny bo rntifdy bbFii-nt frvpQ In 
ItakciiiLia of iDttmo degr?« bw b«n demcnitrKUd by KlpUrhcr and 




• V 

In coDDCcfion wilU leukemia wc will briafly c^n^i'^cr Ihosc 
almormd autc« wbtdi mtty gitc lise to oonfusion wiUi it Aeidc 
fiom certain ^row, palptblo phenomcDE rc^^mliling leukomia, 
tt-Ui«)i will latfrr bi^ rligfriL^^st^iIr h tr»ni<i1ory increaai» of leucocvtes 
c»pannl)j iiTtmu<*( Kti^^irinn. Thn CBmbrr itml kiiirl of Üioaü i^Ia 
matt, tlicn, dreirlr tlie qiiralion. 

In hucocytcsis there Li obberrei! a more or kn« d«c:<Icd. 

ly tr)insiiorij. incriotic of i/tc cQhrttM corptjacU4 normaiin 
\i in ihe bl^oil^ Tlii: iiiciviu;^^ in Mlddm oE hijjh d<*^o<>. 
althnugh vrm Jiü:«cTi hjui dtrttrriljci^ in childmn a Lt^ucocytMii 
with n mtio of I I» 12, [^Hi« IcHnjpvtra *p-l<!om run higlipr Üinu 
90,000 per cubic millimeter, thniigb m raK iiixtaiiccs tlie nuiii' 
bcr waj fiicC4>d 100,000.— BfiOOKB.] 

The coiL^itioiu ander which Eciic«c>ia«ft rnnv mcxif &rc 
partly cf a phyeiolnj^ic, pnrtly of a pathologic, naluro. 

L PbysicJogic Fonn, 

Uuriüic tlic* prrit^i [>^ diyMiion th«n) Reacrallj oo^üru a 4U- 
ÜDCt iuc7rvab<? in ihn nuiiLbcr of eolorlc« dements. Aet^ordin^ 
to tlie unnninnjiiH opinion of Lkuntrrouft inviTisiigHtuiy, hiiwi-vitr, 
this phcQomfmOD i« niiilhffr inrarinhly nljiwnri nor alwn3v of 
the earae degree of intcofity in the mttic indiviOuni. 

In beflHhy subjccl« the tDovoM in the number of leucocytca 
nfluUy bcfririft chortly after oatiti^. After from tikroo to four 
boon it attaina iba iDftamom, vhich «xeooda hj 3000 tho nnia- 
b» (SOOO) naually cnntainod in 1 cnbic millim&ter of blood. 
Tlie nlio (if []ioDr>Ducleat anil poljnut-tear cella geuvraüy renvalu 

Digeetion leucocjlons ia more pronouDC^ in healUiy inji- 
viduala tJian in difiCAWid flubjecl», e«i)»iAUy auch Aa sufTer from 
4iceetiTe diatvrt^ancea. In tj^^trio dnfcr cE\ivcial\j pb^^ioloj^i« 
biuvxr)-<o*i0 htu froquuntly been found to be nb«ent, while it b 
Niid ia hv catii\ani}y Gbwnnl in giulHo uIctt. Fnrthi^ m«^rrfi 
and obwrTfttion in tlii» dirnvlion nn^ highly lo Ir dn<Hiri^, Tlii*re 
Appears to be üttle doubt but (hat digoHon lcucocyt4>»iH attniiu a 
mach ^Jiter d^^^rec of intonfitr in children than in acli-ilEa. And 
that, to a certain extent, it ninK purdbl with the (»roteicliopply. 




Tliis fact may, perhaps, oHor au ejiplAnatioa for the occuf- 
rence of tJitt«li«u leucotjtcei*; it ie qmte poteible i!iat the 
loucwryl« ar« ttimulatud by Ihe produde of protvid mclaboUfim, 
apcdally by peptone. 

Hii-oij^Ii fi|rtirETi]rRU mmilii lijr Fiilil n|>i>n tUig* il^i'iivi^l nf fo<Hl 
fi^r cifihti'i^Ti fcjr>ttr4 in «tnlcr to mvuhI virrir ftiim i^mdiiAl mbvtn'lion ol 
food nlkll |>]t in Ihc jntpftinci It wort found that, aa ■ rulp, a itJitia^b 
ti^nrofjloiia o<'t'iini^d rmly uttof the ■diiilnlAinilLcm r>f ufbufuin'/lil kUb- 
dUii(?vt_ li l4finii ühv hour ftlLel fttodlng and roKL^htfd tJiu uiixrmuin in 
Ütrvr b<iurfi »t tljc UbMt. 

l'h.yaiolüjjic loutMJCYtowfl w iiL«» otiwrvt^d during prr^nan^, 
c&pcoiatfy in the second half of llio p<'rjod of gO'-tation, Pri- 
mipara manifest it regularly, while multipara nflor exo^ptioBfl, 
Idnng ngo VinOmw flfinnnstrotfi] H groving inrrpase nf th? leuw^ 
vyi^t Lu pn?<^tLJiiit, »LiiiR'a fitini iiiUiitlL tci iiioiilli, uud attrjbutttl 
Uic phcof«m:ii'>ii io pn'»:,'T»-*tJve eAprtnjfioii of ihe iit^Tiiii? lympli- 
viWpI^, and iHort- u<1ivü in<>t<iL<>liFim nrd hYporplaik of Ükj 
injfumal and himbnr lyriiplmlio ;cUndtr. Can-fikl (^untv tnnde 
liT RiedtT tip<wi thirtv-f)iip gravida, wh<i hnd f;iptpd fnr from four- 
tirn 1*1 *htf'r^Ti IvJiir^, showrd dnidrd vnriiilijing in iht» Unro- 
t^lö*, ill twuuly riiE^'^iEi^ fj't'iu 10,000 lo lö.OOi), and ail avi-rage 
mcrcHde of the ounikr to about 13.000 per cubic ruiUiincter. 
About onftbird of all tlio loucoeylc« belonged t* the mono- 
imül**»r forms, 

Fiiinlly, (s^rjstnnt and oftnn prnpouuocvl Ipuww-vlfusis otwiin 
in tlir vi'\t-hr,'Mi. Acccirrlirij,' to Hn^vriTi, Itii-ilrr, wnd nfbi^r*, lb« 
Luiabcr of colorlow Ml* ejccrd* thai normnliy pn>cnt in adults 
from twofold to thrrcfold. The hi^h***t number« occur in the 
iiret three or fonr dn^> nftcT bJHb; a diminution then occiim 
vMeh Bomctiinoe coutiniup^ unUl th« Dunilii^r approachf« that 
obMTv<<d 'm i\\e aduH. IT^LiAlly. hovp'ever, £ I'njnd rirti? wMn rvap- 
prwrs, Hml KVLm in tli« tliiid and fouitli wei-lui Ibe uumbär reftchai 
an aTiioiLot 50 ptT cent, in *xcf^** of normal. IIjc increoae 
alToct« the mononuclear oa vlHI o« the polynuolenr forms — 
usually the farmer and ^pwinllv the wnnll mononDcleiir A 
P«ro«pllb]^ iceri'n^ of the (>oKliiopEii[f? MIe ie also geiwralty 

Furlhi*rtnart^, there ia observed in tlie ne»)j(jm an nii^i4^n* 
tatiou in the number of et^throcyttiA, iüttu of ti-hick am tOU 




,. finil IL mora qt Iwf do^idMl incroa* in Ihc ttmonnt 
nn (nWut from ü:» to 3U pfir oont). In »ddition, 
poikilocytis and miciwyte* are not infmijupntlj- m<^ iritb. 

A piiffidnit «xplanAlion for thli vc^ry iriniirlLfiblc «rrrintidn U diU 
iBcklnfl- The ttcl that tin-- puikiTjit i>F ti-ü «ad üliKc bluucl-crU» and Unf 
«imiUTtl cl hiqnajclohin um r^iKiiilnrubly int'rv&ifti randtfiM 1t prtThnbTa 
Ihal, in iH« ncnWm, thr-ro t» a (■I'lirrnl ir^'t^r|irAilij4*tion intfTiJi<il Ici 
•UgmriJt tht! pourn of rc^Mancr af llu! yoaiij- brJne JUflt llbrrHird from 
th* iMltmul ür^üfc»iii, «nd lo ten* *■ a rowri-o fnnd nliu'U in ciflda 
necttt<ikrXp pfrfiflpjs b/ Ihn *udd*-iilj allrrttt ffiH*lilwn» c( life Kiid Uui 
«onvilAiit and r«laUr«ly «ijrnlAt'ant Lot« uf wiiliftii. 

S. PftTholog:i« Form. 

Palhiik'^^ic li'uoiioyUwift Is of regular occorrcnce Jn pJrroHic 
cavIiM'Ut diAturbaüccM, atUsT itevurv low of blooi), uud nUorÜjr 
^fi>rv death [Agnnal leucocjrtcmU]. 

In tlio firgt-müntioncri onM« tho blood pT»Dnt0 more or l(«a 
dJGtinetly tlic f«iilur«« of tirfdrcinia; the Jntlor nppcant moro 
rpfldily »fter low ot Mofid w'/rfn d «Hm&rr of nf^V, rothrr then 
v.'ht'n aintjie Iflr^iT. hfmorriiaijfs harr orrumvL Wilh the <Hviir- 
rencv of ever/ bj/dronnia there ia an iüL-reaaeJ Ijuiph-^upidy 
[Cohnhcim, licbtbcim). wliich l<4da to a risa in Üie number 
of Ieuw<!ytc« in tho blood. ScnJUnf; of tfie l^-mphAlic jc^i^di 
pUyt an iuEigni Scant, if any, rölc. Clironif? hydremic li^ucocj- 
ImJa muT vMry within wMf* limil»- Jnrrt*r»iu* ninounting to front 
S«\<V>il to iKi.OOO iM'r cubic iriilliiin'li-r huvf: b^vii iiInrtTvci!. The 
|uui tho dilfprr-nL forn^E of leucocyte* play in tlic tDcrcoEe vanc«. 
SoTnt^Limc« Uio iiioiir>nuclciir, tomctimcs the polyuaclcar aro 
dividtiiiy locTOOB^« 2'iio latter vccuircnM appton io bs Vtü 
ruU in aireinomatcva ateheric* 

TW mti>4« ft( t«ralnnl leafoaftotU j Iciicurytfdiii «f tht* motibumll 
Ifl not cEt-Ar- ru^AJbly Vti: U\\ 'n\ tlir« bloiril |>TT-Mij|[r. {irrNApt bIh (Iw 
artion of mlAbi Uixic (irAdurtJi. plny o r>Mc in lU produMit^n. AL nny 
rate, itit iKTurrvuco U «DquertLonAblci »nd lo thl» »ourt« tAmo may b« 
AUtibdtrd tbc inirtmiM' in tbv tJuuilKr of trik^'ncjln imLk^tl toitunl Ihe 
rmd of U1* ifi many vt*p* at [u-rnMnui «nKHiiii. In ubic^ti 4 lvl]l^^pfrll■ 

The occantn« of an often enormoa« iii^rr4tK in tie number 
^ leucocyte» in a serio« of acute diseaae«, Mp^Jally of an in- 
foctiotu naturcj u not quit« m unifonn oa tindcr Ute alvov^ 



montlCDt^d coüfSitiont. Tbls form i& deeigDJitcfl as inflammaUry 

lenoooyto»!», tlio naluro of wtich h« been etUicnlly sinJii>J only 
witliin the. UM ilirwilt*. Our knuwlc^cl^ rif thtr siilijecL hn»r hnw- 
f*Tpr, born ui iar atlvanrrd liifit Ihr oM^nrrrnfR or nhMnci? o£ 
inflnmniniory loiicocyt'MiiE is now atccpi^^d at & differential did^^ 
noetic and pr^^gnoei-ic ei^. At tho prceort ümc tho folloviitg 
may, in a aw^asuro, be «cc(^pled aa proved ; — 

Tlie Mgbpgt degrre of inrtammatfiry lencocytosls Is observ&i 
ill acaU Icbar pucmaoniA; iite mcrt-Jt« i»[^"iji>v Iil-rt wiliriu a ft^w 
Jioun» aflur Uio cJiill. nipidl^ reaches the hpiglit of from ÜO.OÖO 
to 30»000, or cTcn GO.iXlO» cdla per cubic miliincicr. fall» very 
dcjcidf^dly after tircnlj-four hour;, but rt'timina more or Iok* above 
tho nornial until Ibc cmU, and ialh ;till farther only wifii the 
dwlinn of tmnpprnl.iin', Hgjim renrhing Uip nnrmnl niimlwr fl 
few daye later. (Refora the crisis the polvnucU'iirs tonatitutc 
ÖÜ per cent, of tbe total number of l-jucocytee. On tbe eve of 
the crifiiB thc^y riao to 80 per cent., faUing to 71 per cent, after 
doforvMti'neu, nnd to 57 p&r cent, on the duj's foüowinff 
(T^-rnddr). At Mtt tmn? Llitre is filspTvisl nn ini-rease in tlic 
tnmilx^r f^f lymplnH-y|j*): nnd i"tjiHiut>()Jiilt», thu inlt« varying from 
3 to Ci or even 7 per cent. (Ttitck). In oues In whJoli poly- 
nt.icle<^ata perfti&lß after defervescence, tJie tcrminatJon of tb« Jis- 
caae eliould, according to Kogor, bo coa&jd(>rod incomploto ; if tb6 
polyntivloft» iücrouac, Buppuratl^n of the cxiidalo «hould be 
fi-ared, — BirooKS.] 

In fnsfjn rfidinif fatally ihi\ mrrr/rtrt, \f prrjinil at all, vt 
imüjtiifitMnt A datinilc parallelism bpU-con the de-in^cc of leu- 
cocyio^iif ami t!i** Incnl find gtmor^il jmtholo^ic phcuomciia has 
not yet been poi=it:voly dolcrminetj. Tho incrc^o affect« to a 
prcpoiidc'inLmg J<?grco tl^e mu/^'nneloated fonna ; and vhxlo tho 
eosrnopliile eelU an usunHy ?j]itii'nt, lire lymphnrytffe may l»e pven 
rt^Iat ivi'l)' ^l(n^ini^lln^^, A po*il-apjrPiml rpi^)peHJ-;irH'J'üf |L»m-<H'y- 
{om, fttvoniimnied by alight ri*it* cf tcmpt'ratiirc, is often the 
drst iiign of a be^'inmög cinpyemn. 

In e<nntrnst to tln.-^ r(?mitrkah]ü roault^ tbo nsonrches of 
niimerot]» authors (Hnlla, \on LimhiH'V, von Jukweh, and others) 
liave iri^de it pmh.ildn tlint in hjph'nd fct'er nn iun^inimsitofy 
lem^rh-yloaia is not only aha^nt. Imt a tlimlnntjon of the leucocytw 
(tt> from 6000 to ISOO per cubic miUimcttr) [Icucopcnia] is the 





it oi'turs ID aJl eUg« of t^hoid tarter and diuppam only od 

An evplauatjcm of this ^hmomenon la dlfljcuU in vkv of 
the iavt that itiiolmcr d^^gnatco the protein oi th« typhoid 
ImcIUus tf ixroo^ly chemotactie. [Wlül« in tbe begiimhkg of 
tir-pLold tht'rt Ik u n^diifljuu Lc tlic number of kuctx?)k*i {W illet, 
fttit-mitt, Cliauii-Jii««"), ^hc ynUauiiviti'% am more liuiinTuyi 
Uuui uonsal; — TO to 90 per cent.» — Uic Ijmphocytn* iinj ditniii- 
»hcd, And the Doainophilc* almoct cntircljr ab«cnt. The numb(?r 
of Leucocyte« b alwAye eubnormoj in the socond eUg^i ihtt num* 
tier of iDononiJclofln» purticnlArly tho l^Tnphoe^in. rtMA vhilo 
tlie Dunibor of polynticWn decline« by 3(iddi>u tii]h. During 
crniitt!«^<euciä the |»olynudeaTS ore not nmileilljr luc^reabti), ttia 
lyinpluxytcs are iucnNUM^d. ciud the Urge moitocuclctin ooiMtJtute 
£Ü to 30 per cent, of Hit total number of leucocyte» (Kof-or). 
Tho approach of convnlciLC<'nco it^ taid to be unnounc^-d by on 
itier^A^ m tl^o TiTimlH>r nf rfminnphilts. A EiiiMt^n au^it^^ntntion 
in {he numlier of polyiiiu^lfjir li»upiy:ytt'& \*> iDdii-ÄlI^r of Koms 
iuflumiuntury complicatton (piicramania, etc.). — Hqooj^] 

In addil^on la typhoid. innoTntiiiLlciry louoooyl«!* U aiarttt In 
ncodCf HnJ lutrrttiior inenintiiti^. CoiilrikdicUiEy iiAlcMfiraB aic inii^e 
In connfflinn M\ih niTiiiulinti. vim !-HiiT»*rk uri^l Tii-k cUnnlnu imvur 
t» h\vo «(41 Iciiroi^ytofti«. ivhifc Hip'lfr fivind it to bo «linn«t pr>n>taiiL 
[Amnrdintf U» Uogcr. «»iljiUiia Ia nlicndcj by a kuijoejl^iiia »hkh (ipT' 
tniu Iviiff »fu^r tho fall nf ihi^ iiiin]wriii)r*- Tlio piitj midf«» nra 
tijgklly Jorr*««4d al Ih« 1w|riimin}{ nml tiofiinta tnura nuniPKiUM ■■ th« 
ilUrAw |rru|ire««u, KcitKlitlkolT aUt« thmt m ImcwyU vuuiii of trvm 
lOjOO lo SQOM U ronnd In nitld iMv». ^jyxl Ut 30;000 in f^ttm at mod- 
tnlt ■ofrity, ai>d nbov# 30<l00 an fT*v« vftiu*. Tti« palyniu^Ivitn ooa- 
•Utiito B& to 9fl |vr ceat^ vf tha tciUl numbvr. Id nirnjTD cam of 
nodtnl» vrtrtiy tlw «wihopliJM pro^rMlv*ly InrvMH up let Iba 
afcafc4 or IliirJ Wfck luinM^num. 8 to 10 prr true,), ■ii4 Xhu* jiraJ^nlly 
rduni to Dnrmnl.— Bt^xnt»,] In pcHlonil|«i pirurllli. nntl lubctitiUr 
movUigHl« lh« nombrr of louoMrytM U n«(ul|f fouhil tu W vHliin 
pbT>«olocii; liinitji or riitti«r JtoilnI*bo^ wliUn in pHnary wtcrtSititit >a 

Uor« or Jhb iHtdtd bimaM of th« IfVcorylM U abo oUrtvl In 
Mif^b, ptxtfierni frier, rryttf«!*», ttntU jtrtkuW^ rhtumMtimi, JijihtUtf io, 
rwnrrMit Uvtt. and iMtttMrnj^itU. (AmrdlBf to {.nairtvoM««« «»4 
R#y» In orTviptl** in ■48ltJl «ho f«v«Vfr tlw ii«|yB»rlron «ndrrifn a 
dbalnutioii u&ul tt<*irtwy u itnH i ihad, Hwinf Ifc« Nbrfl* prflrnl Iha 


MIf'Ri")StOPY AND caiKlliUSTRr« 

RKMLonvd^fr'* 'Uf »of niJinif'At mui'h viiHdti»ri» biit tbrt tin non*idei 

^JLtüUtiitlh cf Uie k»*H?cn;jl*4 follow a r^^or-c lutltw, nl"i nti in^Tiinp* in 
llick nitmlitr ia w«l tu bc « criUiU »igii uf tmr^ Tlip i-udi^iopliili-i »re 
UBiitEly nTi4<-nt lEurlrijJ llii' MtlIi» |i4<n'Nl, Imt rtfljipi'At n1 iiit> Ihm? kit 
di^lcfvvu^nrv- In tHldl (mw Ijjptirli'iioorytd'in ilIwujh nc't-i'tU \'2J}0'} 
u»il U c|iflrak.'1riiAvil by a pdlpiurtvuMi rvaching or ric^viljns 0* per 
»TiL (HngPTJ^ Tlin ]hnr*Uli^iirr or fiiiUltii reLoni of palj^nrl«»» during 
(DnTa1n»ii{«c Iniliciilet ifuoiifii-nc« cf * rdiipoi; — BnooKd^] KuKbor- 
niurv. iiuay «dtliufs Iihtv «nHvil AltmlJuu lu ■ prujruuurvd leuoui^ j Liiiin 
BVil porrictiltrlj- a H^fiJli^r] innTrnv rf the wHinophil? ?fIIi ff^lrr l/M 
iuicrii<iu of tulcy^utin, iBittWlü). [Aotuidinu tu JlAyoai, En ctronio 
LulirnuliixiH llii' Ii'Ifi i^'Vli'-couliE ti-ili^li(<H fr'iiii lO,n4K) In IfO-ODO- M'livn 

iliT luufuc^vlFfl iDAy ci(roftr.ii>nAl]jf run üb Ikk^li At 31>,000 lKcii>tcrj. Avlilc 
from wtnifi|ilnp-*t>ujjh, ihff cilolo^rj dl irhU-h i» unknown, wjujonxrimiifj 
IH uiiually otHur Villi m pro1'>j«iun iiirwE^Liiiii^ During ik |mri>xym of 
ittdfrrrtaf frrfr in inrrra-p iu tlio rumliür of Ijniphth'ytc» flrrt dcciim 
and ü kiwer uupnrnffillcn In Ihi« niimlwr of r^AinnplitliH ami Idj-^ 
aiotiDnucltiAr«; llf(r«i to t'ontf ininuld Inter tlio oiimUrr of lyniplio- 
(tlvp Lhi-rr<ipt''< jmlI Icr-r- iiKHicniiu'li-itrv utr* riifr- llim« is «mitvlr aaf 
rhfiDj^v in tfip nuinbrr of pnljnurloitM. Mniii>riiic-lpo*u i« 4L«n (ili«prvi>t 
in rFirfo/a. Tiic niinihcr of Icucaojlc^ ncioa vurl« Irom 10.CH)0 tu S^.^JJ^L 
Alt1iuu^|j Irunjcyliihih in ^iiüal'h! nt Hit uii1«i-l. j( i> |ni(lu-i)])t(l> iiiiirkfti 
■ L fiti* litiip of Ti^ti'ijluriitn nml ri'iiminii >T(iitihniir^', qlt|iliilj iliminnihcil, 
or incrrsk^CHl drjriiig pti4(u]uli<>ii In Khv licniorrlm^icr forni k i> lu* 
pfiiTiiiiiniT(l, 1ml b M-!lilum ftUwiu tLtoucij. In UUifian Itrui-w^iuniii 

A |K>iiit of din^rwtir importiinw it th© fact that iJie reiulU 
üiTTft far olitnin^d may bp nilvnnlfigiviiialy pmplojcd in thoiu not 
iult«quent iiiMlaDtH» iu wLitL it Jh ilL>iriiilL' to tiiaki- a tliftt n'ltlinl 
dlflgDMiB bctwv«u croupous jiBtfunionia uud typlokL fever, on tho 
Dii<- li^nf^, ojkI purulent and tulicrcular monin^^iti», on the other. 
In tX)ßsa insUnciÄ a uoruml or Bubnorrnal leuoocvto-pi>unt vill 
dwifl*' tho diagnosis in rnmrnf tvpboitl fi'vi-r oru Uibcriiiljtr priv- 
p« AA n^itist cmupiMJ» piunirmmiM jituS purulmt mi^ningiHA. 
rur>ft:lmiaün htis recently c^licd iittmtiirni to the fact that the 
dcmf>nfilration of a l^ucofjloei* in pcntvphlilis (aj>j>eiidiciÜd] 
is of tJio hi^li»t diai»»a^tic fijirniHrflnrv, Jf tho number of lou- 
cooHn* m« Q\y<y\a 'i'Zfi^(^ during the pourfip cf thJa flffpflioDj tiila 
ia nil Jilmnst unftiiltii;^ ^ign of abseo^-fornL^lion. 1 mined intt>1y 
hftrr «]ir>ritMnc>niis tir upt* iHllve Ginptyin«* of tlic nW'*"*« tlir^ U^ticn* 
cytwifi dii^jippc-^rs. After uuiiiomua iuM^ttj^ationa in i\\\i con« 





Upflni cnried out id m; clinic I can fulK cimflnn CüJfdxnuaD^ 


lb ordtT to ohUin ah Inilglit Intn tht^ naTum of InflaniTnuinr? 
ItüDOcytub oxpprinidrttfttion hitri liwn rwHtd to, Van Liuibfotc mw 
Inlvnv* ]«urocjtD»ii «fl«r ifijix-tjoii of cullam of b«>'UtUH «epT'dallj' 
tTiOM! of ■taphyliMwmui : Bint And ^firyrr mentkon tlio oceunvnni of 
«CDddvnblo tjipnsu In tho loufocytot »flor the n^nt^Mmtiun of Mhc- 
ictti oil*L TuliI dfU'i ppii-iUi rUr- T\it ^.rlm'niiLiorL» uf Biiclinrr Hiiil 
a(h#Tt TViiiftfr 11 fiffilkalilf tlml if it nnl llii« /i>r^ {if»'i>mpo«i1irm) ptn<|' 
Uivta of Ihc ^iL<'t-'rw, Imt L'hi^flr or rüdmirelj' th«r prnMfw [ftlbinniii 
■nbdAncal vhivh, Bcoordiiiu to Vlt^illti't uicdKid, |jruduou «j ralli'J 
yvtfriRi r/lrnKjfftrf«-— 11ml ii, mn udmttinn n1 tho l^uontjin- The Uut 
ll)«l »ftr? #Ätti7<4tirir (xf flip Hpfr«», ■« vHI an in tlic ol>oi« oxpcrimcuW 
BUVlr«l4fd m) btcKxI-optl« and 4 coioiiJL'nible IcLicitfyloi]« nr» L>bhcrVL'i], 
ifxdka aonunrhat In Uvor of Uih viuw IhvT an ImlMirt atl^un im BX*>ti^ 
itt|M>n tluT '* bluod-f^rmini;" oripui*. &» thi« ■* H m^y, iht jnrr«nc of 
Imtnrcytn la the Muud roiild aliio be pmüucvd liy tlic FDttmiicr of Wan- 
dertag oollc Qt <u iho rvmlt of impid ?«]l'<livttkoTi witJitn Uiu blood rlmn 
■ein fLfiwil). Tlic Artt bypolbvili would Ifc cujiliaij Lir l>hfUirhV 
theory, t^ntv. mvurdinjf tn blrn, only niononiiH^kU*(l ipLIh aru nupplic«! 
to thA bloodi thfr p>flt rnnjitnly of the cciloHru »Ik found in ncuU 
IcuciKytosts hiv Liiii|UL-*tUrij[iUy <it Uta poljauHrtu laiiitj. lluwi'ivr» 
WA knnw ihAl th« irjk»>fikntmU(m of monoaupliutr Irlo jtfJjrnitiilrnr r^ll* 
Uk*« p^nv< [jiiiTv mpidly. 

Tbv fatt thai tbc trrmiaattoii of tboM dUtom in wlilt^b IbllACQ- 
malory Icii^nryto«!« oooiirv nt nM t* fav^rnMr wbrn thr I^Uj^ncTim nrc 
(on)ddi>rahly intr'Uu-d uuJ untnwtnblit wbi'n tlii'y >ro dimininhi'd *a/^- 
fints tliAl Ihift |>iijcr^ i^ a Hi]uLai7 our, A ■«tWutoty »ptaniillün of 
■ncuto IntlAoiirintory ^ucorytcwlt U «Ü11 Urlclvi^ 

Tlie blood of loucocyloftifi, irhen obwnwd upon the Tr*nii 
öbJect-aU^f re\*iilft active moUlU^ of the lmi«ocyta, which an> 
chicfiy of the polj-noel^ap lypo. On the other tumd, Ur^? mon^ 
tiiielear gramiUtei! f^ells tbe oLirurrenw of whit-U iii gn^ni mim- 
brn i», in n nn^umrt«, ctumctrriHlic of Irukt-mliip hvk tlMngnittivA 
by almost complete nkiH'ncc of lunc^boit] movcmcxita. 

P «f>iidci l^iik t ml«. 

Tlio groM, pttlpnblf) oliAngf« vhioh iir« to b^ obMTted In 
flih äi?^?fira lint infnf]Lrrnilv firr^nit a nlnl^ing memblance to 
tlie f^aturefl of genuine Ic-ukcmiA. It i« hen MpedaUy tbat 
mic'rMCOptc examination of tbc bl«M| is xtTf ofleo of dccidcil 
diajrooAtic eignifie^noe» Although tboro b ofloo coiuJdcraUtt 




hfparplABLn of numeroo^j nonca^j^ting IvTtiph-gbnda and not 
nntly n cnnsirlrrable enlargeitK^nt of the »ptei?]i ard If^ndcrnttfl 
of the boDea, uiicroecopic eiaiutuatiua of the liloud prc^nU at 
first eillicT no üeviÄtioE from the ai>rmal or, later, & rvduotion 
of tho CTrytiircH:>tee to from l^OU^OO») to a,00ü/JOO, act-oftLng 
to the degree ot äoeuUa, vitU but 01Ü3* a slight incrooifi of tho 
eoIorl^^A eleinenta. Tlw luiiiiu^jl'jbiii tcmti-ül m rc'due*?!! in pro* 
jHirliou Ui the reilucliun of llic? huthIhu" ttt blocul-mrpuiirk-i. The? 
cBdnfTC corru»|wncl£r therefore, to the fiigns pre^nt in secorvddr}/ 

Now And then eweJiing cf the ^Innds and eplocn is ob^rveil 
in pnlitmtH in vrhrun ^nrnmütiort of the blood l^vod n dQ^t 
whf'tliiT iL^uki^iiiin or pri(>ihlo]i:nLkf'in}8 in jiri'si.'nt^ At first ^lAncn 
a coiibiJerullQ iLLi;R'iifie of the v^Iorl&ä celb b uoticed> An 
accuriite aoimt, however, abows, for ejcaiiiijle. a ratio cf only 
1 to lüij; if, in addition, uuctvutcd r«! oollfi and cclla resembling 
iiiyuktjtttt urc- !M.H<u iu ^tuiuad preporatiou», dUTerentiatioii ia 
diffteuli or even {m|MMKiLl& 

ParudoTf^ukciniii occura from tiro to tltrve times more frf^ut^ntJjr in 
mnH thsn |u wamc^n und int-y H]ipi'ut a.t any ane. 'I'lic pot^lhUkl^ of ^ta itF> 
vn|uj)T]ii>iiC inLu tru» Uukuniiii, as nianj' iiüCliüriLK^ii ot'ort, hut not bara 
fio«itiTf1j «JftTmitir-fl, Thfi vfrjr A|ii>rii|iriB,f«t iIiii^haI iiin " itfcu^-i\vH- 
k'*iniii" VB« rirxt Hvitlici] ic tti« •yrn[»Uitn-ron]pl4*K (flnst dfitci'ltv^d by 

H emogl obi nein I a, 
Tq thin i1iii><B>i^. vliii^h lio« h««n npriimliily i4liir1if*i1 only ilttriTifE Ihn 
loBt dc^uijfr, highly chann-tciisth) chcing» 4p[kear in the Uood tt'lJcki 
tiitJloaLr A luoiv «r ku con^McFAhlc dcbUucUuii i>f nd btuud i^rpuDclea. 
!l [k i)h»ci'viic1 nftdr pnUantng wliK clilorldt fnlfhtr»], nnphthof, pyro- 
IEaIIid nrU. U^dniuhltirliE niml, arxjUurcUd liydrojfun, lulpJioiiftlf |i1iDfi«c- 
ctJiiH urilifL^b^in E«i]flnmlid|, aiilijtyrin» frtJth imjiilitiio»i>, vr iu cun- 
TicM'ltQn wllh H^^Eit« nnd rhrcttlc InrnrltniDi dipfiitp-a (iC*irlalliiAH lypheH 
luvcr, hmUrU. «nd «yphllts) j aia-> lUUr pioluiigtil expoiturc to hJ^^ 
dr|-rw« ut Ui'tit Aiid vuld xiid nUft Imtivfuhiou »f hfiinml blurj«! iiilj 
muw, mtd, ßDAlly. it imy niviir iimfilnn^ounly n* Iht jn-tull^t] jmro^' 
yiniiaJ, ar irttt'r^nitt^nt, form» Kiip?k.'|ally prcdi^potciE iK^rfcine ara m.i^ 
lAckvi] hy thfl dl^i-HKii hUvt \ialoiit TiiUHC-LiEtkr tJftrilJcii liruly aftur pio- 
loii|(f<l marrlki«Bl or on mirlElfri nxpAiun» In roM. It hpf^tm wiE.h chill and 
great proBtritti-ja, iLiid li>ndii rupidly tn appnrvDity vx^vq conirtitutEoDiil 
dkitcirtunc« itnd iirunoum-tsl Hmtufffhiniirfit. l^rt piiirv ;SUJ). In Ui? 
iniijurity ol ii»i.lnnfo*, howpfyr, it ond» in inplJ rcro^cry, ariiil uf|«r ft 
tini« M nv^ Hltuc'k U pi-i.ri]iici^J by kiiiitlj^r cuu>c» 



TJ ibe hhotl olilHirii^l from eufb a piiiint bj tnrmis of « wel 
cap — or bctttr by uicana of a hjiiugt iwm a vein o( tlic aroi — 
i« alloircd lo remain qitietlj in a t«et-tvbi! f^ from ttreatjr 
to Ivootv-fntir hf>urft^— pn^fombly in th<> icü-cli«t,"tiio eoram 
«ill *hfjw a dütinct ruft^-r^J tn^^irAd of the oriiinarr light-ydlow 

Jn pcTfOHA «ttfr^ring from "paroij^inal li^niogloliiuuria" a 
pxjTciy local alteration of the Wood cau bo produce^. If tbo 
flc£«T of euch a patieat is comtncted acd iiancrtod for tiftt^on 
miDut« in Icod and tb4>Q in litki-vami vraUr^ the lonim aft4^r 
avparalioQ will *iiow t^a; rvibj*re(l »hnJi* fv*u m a tlim tapillnry 

Tl^cn am be no doubt that tbw cvildrainz «f the Mrum i* 
catükxl by tiic bcnrnj-tolin derived from U»c rrJ bloodn^qitiaele^ 

U icrMciipically there will b« found in tJi» frwhly drav.-?] 
blood (sUo in tlmt teotn tho confllridM Qn^r) a alif>it t«'nd?nc>^ 
of ÜIS erythrocyte* to lite formatioa of roukauv, a distinct 
poildlocytoftüt an^ more or Ic« uuiucroTu, T^ry palo or aitiwly 
deoolorcd <Jwk>: th« fo-coJIu«] (Ponßck'n) shatf^nt-Ji. Tbc lalt^T 
dewTTO capi>cial atl^Uon, bccomrc iht^y <lo doI ncvur in any 
other blood afr^iiöu. Tb*^' ßre^ ihoivfor*, to be intcrptvtod a< 
ft pwJUtc xign of biuar>j;li>i>rifr!rnk' rlinn^^ 

AcCfinlin^ to Poidi^lc'ii rocnrcbrv, poikili^ryfofil« may br 
entirely abscct, only tbcuc «luidov forms bctog piYwot. 11« hcmo- 
globiD having been eitractecl from ^e uiuilteti^ blood-didka. 

In mo^t clinical cas«« tfaa diui^ in lite blo^ u »o piD- 
DOanc^ that the flplrai and Utpt, wblc-h ordinarily «rrr« to take 
tip iliatntegratjou pmdada, become iusulfiduit, and thti «ixuM 
tft coi]Te)«d to die kiduc>a. In tUe liver Uie Hemoglobin fft 
coaterted into biliary ooloruif matter, vbich may appear in 
AbDormnUy lar^ quaiitily in tli« urine, unaeeoropanidd by 
hemofilobja. If the folalion of the hemoglobin ii Jtrj con* 
»iiU'rablr, fhfl iiunv. «tintaiim blnKl-tcirpnu-ln tfrtritux tut vrll an 
biliary oolorini: matter; hemoclobiaaria » prr>Tuoed. 

Viewed IhrnHüh the spcclrotc^pr, the ioparatcd niby-n?d 
blood-eortun abou« diatincl O-Hb nb«»rption batida, wUidi oatab< 
Hah the diagikotia. 

In not rar* instan«** of hemoglobinemla, particularly in 
tfaoae wbldj follow poi^min^ vritli cblorida and olh«r vubaUnefl^ 



tiw progranivo «olaüon of blood-^^ri^u^W induciid pronoi 
fMihWi^ffUbiMmia. MQtlionio>?lobir, wbit-h has iHvn aO(m-' 
ratdy studied by Hoj>pe*SeT!er,Kuoh,nnd Hiit^fuer, Ufi union of 
c)Xj^'i>n n'itli ihf i]Ti»d-(.Mlo]'iug mulij-T [lii-iii^jglubiu], in nliidi tlie 
fiaiiii-Hrnuuatof uAVK^'ii itiprrAc^lJhUtiu inui.^ti clmtTn-ombinalion. 
Tili« KuUtQiiee b i^fwcidly chnnurten^^d by n »troni; nboorp« 
tiou band in Uia ocuiU.t vf the r^cf portion of the i^pcc^trum (Klk- 
70). in ttifdition to vlitoh bnth 0-h4Tmf>|j;]ribin hpu>U may ^tiil 
In« prisa^rvi'il Tlint iiortion nf tlio sp^'cirnm ia thp rigM of thn 
hnni] pPTMrt in grpcii ifi iiannll} ruiiiph^Hy oWiin^ci The band 
ie fouQil m fn^h blorxl, luid in tlmt tliltileJ Nrith water, as \ri?'ll 
Ü0 in the tinni? nnd in lUc ei?ruin «<?paraUd in the voh]. lU 
occurrüncfi can bo r«cojfDi^>d f>veo vilh the uhL'i^J eye by tho 
irffptfl or chcciihto color of tho bfood, 

t& 16B7 Ih« Author *p<iclrc«copifiiIly dcmanelratH^d uclbciaDgJO' 

liiiie'ii^H rtvi'fi in t.liK rti'r»lntinsf Ulom] »I iLti huiuI veHWln {>r iLQiniftla 
(li'i^t p4>ii4niiiH] with h^'drochloric acid tali*. It in i|ui(« p'ohnbl? tlint 
la pronuunciil citiw> Ihc **Eike oliftorrAtloti cftn aleo be eiuxJv in rh«: huu^aQ 
Oftr. A«1c34t innn Um iriiiiit^UU dlnenoHtle vahip, uudi ii deU>ntiii)iiLiun 
U of di'<iidi>il «ri^nljflr intiTvHt^ nintm liilnkviB atAtpa llmt tW d^vvlup- 
mrnt of n]i:lb«no;;lDtiii is poisaible oikTy Cfffniffl to tho rircuUlin^ 
l>|ood PTi puiimptlnr ^vblch haa bct^n djüprcnird by MiLnliutict upon tli« 
Lbiuk of a fiii^ vfiri^n of oompHcHl^d ffipHrinidpti'. and vh&L-h pao bo 
I'jipidly mid i>PT>Uivr]y provnl prrvavoAia by vpn;i.tu"Ciii>y of Ibv divuUU 
tug blnod Df Ihw far. 

Vot climcAl puqtfuu« llif^ iQftthflmoiflDliio ■pcctrum Cftn euily «ud 
qul''klj Iw iLi'iijniihliaLrtl |r^' Hddjiii; « pu.'cu of poIjt^Muiii ti^i ru'ynjiid Ui h 
frvili ■'>liiE;i>n t^f Iilnod ITAiitUy an nKhmi>ticm bund «t ttiuit Mppt-am 
in th« rril i>f Ihc iipi*i?truiii| whilo th« &ilb banda boiruma iddiAUafft or 
dJ>tiLi4»rur nitiitd/, 

Curbon J^lono^id PoUonlnK* 

In iho diainio*ia of this form of poisoning the apcctroncopo 
pln^Tj n raucli more important t^U, Jd 5uch t-nwa oiy^n \ä 
displaopd from ila conibtMAtioD with hemoglobin and CO-homo* 
gbhin prodiio<»d, whSch \s ineapahle of tnVing up njcygcn. Tlui 
ai't^ri«! a& well a^ the venous blood then aeaiink» s bright cherry* 
red colL>r. 

MiemifefpicaUi/ there ft« no imwiuivocal chanfffS in tbo 
blo^ ; tiK' npfcifffscopf. however. K'venln ohiruels'rir.lie phondni- 
SDO wliidi prL^c-rit abaoiute ^rt^of Qf VO poixonin^. ^Vlul^ both 



Abf^orfitidn bnndp of ox^hcnu^flohin JyuijE botwc^on the Imf« X> 
and E at onro ctij^appoAr on ndilition of n diltLtc solution of ^'iiltoft 
ammonium sulpbiH, and nr^? r>*plfl(vd hj? a sih^Ii^ bamit imlinitivi- 
of (Icoxir^üi.^!, reiluci?c1 lioTn<^lobin, both aWrptioD bonds vüiblr 
in VO |ioi«oiiiiig. wliicK alw lie In follow nud ^ci?i], but ^m?^ 
vhat noarer ctt^^h othL-r, uxe imaltcrcd bj addition of amniontuiii 
hydraealplud (a&s Ki*, TD. a and t). In nU apotlroaoopio «äih- 
matious it it iuSxUMq t> coinpnr«.- Ihe blood to b? examined 
wiih rnniPrti Pjicrimfnu. T, Ihrrrfntp, nii-niinn xh^ fart tltul CO 
blood CAR at Any lime b« propar^ bj rII^wiii^ come ill urn inn E- 
iDg jfoa to dow ioto nonud li loud -solution throngh o brut Rla» 

CO pninfnang ia mont frc<|\ieDtk7 «luwd bj R>"** Til>i*niUKl from 
Inipirifwril)' i-uruliui'lod luftUii^ npii^ralui and futiiiir'», in iU'f maaii- 
fairUir* of "dW, Mnil «It'll Ivy iUuinkniitlnp gut. I^^pnr«, uiji^ir, iiuti mn- 
viileioiiii art Iti« niaiii »'j'mpLumM. nliu^K lUV davlty rcltiubtA to tb« 

MIcro-orKanlimn In the Blatid. 

As Tvgmivla bactma and para^ilw wf^Htring te t!»** 
circruluiiii^ UikkI, nil tluil i^ of ii]t|MirUiii.^e «U! be found in 
Section I. Here reference will be mukK' imly l*i tlie fflct Hut 
ÜIIU fur the fcUonJnj; inicn-oripuji-Hmrt lnui! bttii domon-irnttd 
in buman blood: The tpirilla of recurrent («»v-ir, the piu-cjeei 
and pn^ramooacci ; Frivdlinder"« diplobnctlltui piK'utuoai^, K- 
FrAnkvIV ^ii b^rilliifl uml othrr anm'^nihü- hAcilli (jirruindl 
obHrrvAtii^n in punperäl fever], letizi^'cnnf^, protcue (pemmnl 
ob)eria£ion), diphtheria Willip menin^ococcuB intracelUilaris 
(Weklmclbouin] (personal observation) ; tuborclc, kpttkriy. 
Inlander«, antliruc, tvphoid, parntypboid, juid ortlon bacilli, and 
alio material pl^^modia ani) the ^inbryod of Ölaria 3aDguiQL9^ 

Rare Blood-flnJin£B. 

tn llpemU ^mall dioplflis of fat b**« otx^btlcAallj been aveik. Th««« 
dtopleli liflr» brvn poiiU\*lr pmvml to b» fni by UittLr ftlflSfklaar with 
CMiilc Aind, thoir iirMift; rt-fntrliv» itk^ck, i>tp. 

Id nelUICalai whkh U «mi on'y o* b rri^ilt nf prrtin-i^rifl iim-'urin. 
nmU irmnnlcBi oimI Urr» llakt* d pl^fni^xi luay be DoUcnl in llio hluwl 
tJtbvi duiing or luiijf DlUf Utw «tUvk. 






pur fonuuk purpcinq; it U v^mHimm ntwanty to mnhe an 
ewimmiition U> lirtoniiinc wWtlicr wrUin r»'il skins found upon 
clotiiiD);, flooTf, wnlK etc, arc caused tj bloody and especially 
linnuu) blocMj. In m^t inetjuioc« Üii« quiKtion ctm be «l<ddcd 
hj micro^o^pie demonstration of etil) renuijilji^ btdOd-oor; 
or their coforiog nutter, 

JU a nü«i red blood-coipusdu can he rroogniuij i-nlj In ooiniiftf^ 
Uvtäj tnth blood^uinn- Fnuüi blood «dhartTig <a &n7 ct tK« atjov«- 
inuntifDcd i^rtkl«* r«n Tm IdcuiMGwl by hiiciply nKtiiitt?n>iij[ KmitJ imrtidM 
«rliicli fkiLTT 1>rvii ruTv^fully ncrupriJ cfT, ur thp bltrtnl-niuknl Aben, CftOq 
In a phjiliiliij^ti »Mil mtliitlrin iirirl wiit^hing d«THopniMi(* un/lrr iho 
TnlrroBfropc. Wbuk Lbft itoin» arv oLJcr, it t* mtrtaatj to vbuctbI« th« 
biwnl liiLiTH f<Jt wvi'fhl buiir^ ijj 30 irrr-tvut. (-aiiBlic tiulqi^li wUrliva VT 
in flufiriJtnn'« riO'Tittjalinn 'tf l'i<'m< % lliii-l TUiii ooniivti oit — 

CoTTvtlve «ulibiiiDl« ,.. .w< ..,•.*««•*•*■.■ ] p&rl 
Comncn «11(1 >> $ parU. 

Cnyfw>r1n Of «Adh 100 partflL 

of Lhe ftb»vc rcDficnt^, or a Bmitll qiinnltt; mcij be «ciapfd ofT wltb « 
aradl« and iiUrtil ti|iua & gUi* obJiJ^l-4]JJtf. Üicii 1 or 3 drupn <rf Ih« 
iboT« ■iL>li]1i^n>i a<hltii], KUit lb« gnulani Mpftintlon vf thiv coliornnt blood:^] 
dUkt U'aUbc-l ujulcr tlip nimro»pi>|»B. Tim (>b«wTiilk*n of lh< pföi-r*«rtvo 
ilnvdopmmt of t niuaber or ruunJed diskd uuL of ibe cirlulnully vdur^ 
pLous Q1BM ill oli)uv«|«dHUo. Ai ft nilif a dwolnion cnn bv wad« with tha 
i]LJuiiat(?4>|ic «nly b »(AriutOMhctbortbe nA blouiI<Tll(i«bHrTt«lvkrv burnan 
or mAiTtmnlUnr brcAnu thr«e ate ftlnnyii tionniiclmu^t. while i1i«ko of th« 
olbor vMi^bnUi (bird«, fl*b, frogi) arc nucteatnl On th« other hand, 
tbe qunfliüQ of the ptT<iTtLi'C of hunt«» \>\wd may niniiitin uniti-riJi-J, 
Awing to the gn?ai iHiiUHly in form oi Üv* thI hlnud-?HU of mui li> 
tboBO of certain d«rac>1Ic unimali. 

A dwJTiiou iiijnn llic; baiis of ctimparatlvc mcttturcuii^fil« uf Uiv rvd 
tl90d>MirpTiv|<^ii run Iw irindH only \j\ frvftti Moott. tini-i* r.hf Krl bfooJ- 
cell« of laiui (7.0 ft) nn> lutgirr tJian i\i-nit tf nLimiimU, ol wMob the 
«b^ {7 to T.4 ii], OK 10 £il. LJid Ibt borsL* I&.i4 ^1 h>tve the ^arvnt eryUi- 
rooyUft^ tn Ih« f»dc M old btoodiiAfTii. mfleantlmi In ao-por-cigiC. 
«juirtlc! poUL''h ■obitinn will be tnOHl likely to roadcr It poM<blo to 
mumre the dimri^ler of the «k^paralvd kv\U. Xuw und llivii, eirn alter 
ymn of drjing, dcridiH dilTci-i'iii^ii in «itp «rv itilJ qmc« diitloetly 
TOOOjca^vAU'! i fur GS»niplC| the difforcDc« id ihc diftmcur «I liuiiuui 


UooA-odli ud thoao ol Ae thccp [\Z «<). In aoob ihm«, howcvtT, U 1« 

noUkbln diff*ronot» 1p »i« cwur «von in nnrmil bloo'l. 

From thr ltnv»"< >> >« plntii Lvj>t diHkniU it> i% In Ibo mLcrtoeoplo 
MAintnAtimi eil i|imHnaAble b1r>v1 U* lilfiilifjr tli^^ riniimr« %h fmm Ihn 
liQiittD Bubjoot. Uiitbvnforv^mlifvrniE ibftl a laiolrj^io inHhtid humvMlj 
bc«D (puikl vrhlL;h, srou nTtrr yriui^ rruilild qb to ilct«ni>liic tlic orifLn cf 
Inm of blcNid: '^,, lo <llffpr«ntiiili> Iiliiiihu fiorii aiiinial IJood. Iliu 
priDcifiTo of ibo moiliod ia b««od upon lb* hwt ibat ■ «lAiutii^ ahiI pr«d|ilUi- 
tiou (predpitia kacIIqbI occutw \n a blood'ftnUticni ttliai ib« iMtcc » 
RiUril ntili h<iiTiiIifn>itfi i>i«iiin : i.r,, wHh vnini frt>tjv1n«l ttatü an Mdjnal 
whi«b h*i> prrvia(i>]y Tinti tri'at«L viith i\i" tnmv* kind of blMil. Jl* tho 
ptcnfJuiie iviiiiirin d|iivUkl tivbuktal nktFU he iiiu'tt rrlET. for 1b» iriiiiulifc vt 
the u*t, tf» tlit!< oti^iujil Utflmtitf* nti üip nnhj«!. 

KjQdltciiich'A fiJniofiition nnt \v inl^iitkft Ih« »porv« of «od* o! Uid 
luwrr fuiiifi (Dil]»tiuiL ^'^lOdTvinii) fui »rimll b1(j4^>ix1li jk nottljjr ol the 
inn«t rAtrliil E-i^nmilrrdtii^nH Aiirt^ from Pi*rlnm (ftli<r[k4(^o{tic i'hnrMTKr- 
btic* rcoogniublc hy tho pm^livcd nyt, thoK «porM *r« di«£JnpJlHhiMl 
ttoca b]wA-ixl\t hy llicJi giiuUi ic»bt*iicc to tJic olUod of «fid« bud 

In nfmoft i!r«T7 omo it i« adtiublo »Uo to employ ether tncihod» 

Tbe prpi^^DCP of bbod-coToting nintii^ in ilpmomtrit«! 
niuu^«üO|]icaJlj lij Üie proOutliott o/ LLe homiii ciy^tftla dbcOT- 
CTwI by Teidimann. Tt»c prowncc ^f ihos-s tlqicrnJ» upoD the 
foci that hümutin, o^n in miuutc blood-ätainsT coinbjn«» with 
Iiydrochlorio ociti Id form T*r^ yhamclürictic crj«üiU. Tohh- 
ißflim*« mrthrkcl im c.irrlH out w follott-B:— 

PUcc ft KDiaLl drop of pbyibUiglc a*)t «olution upcn a gLau ol>j««t- 
■Kdc «qU «i«|fctnt» by ^id (■' uriitl« hcaU Upon tbo dclicAt« irr^itiitüno 
lajcr (hin fnmipil ptHfv A «m«!! pottiAn of tbo «IHmI anJ AuMy paw 
4tnd blood- H ID pifif^ or minute fr^j^nH^rti of iho »lotnM fabric^ lad 
•OTfT vrlth ft covrrglam [ liilerpaalit|^' o bulrj- Kow add «anuflb pteri«! 
ftwtio fteiil «tinplM^ly to fUl Ih» «pa«* batv»n lh?i rov^rglk» and 
«Udc» ftrvl hemt for from tbrr«-f<]urUi« H> on« mintil« oi«r ft [BunAvn or 
m1inh<]|J Elaiup. unlli nfimrl« bubbln ftpprivr, Kmrw Uns lU'id. 1 dn>i) 
al ft üni4», ftA il #v«porat«i> unlll ft dcftctilo rod IriYttti colnr dn-^lop*. 
Aft «ooa u tbia u notvd, Ih« rnt^ninlnjc xaiüc a^U i* ft11tiwt<l vb(»lly t« 
«vapoTftto m >om^ dkrrltinf-F* ihriv«» th»^ nftmn. AlUiw B^1y>vrlu lo Aoa tn 
from thff fdgp cf tbo covf«t gU««, to oIht «nd pmwTV« iha apwimvn. 
[And tlirn TXuiiiiEiA wjtb V'g or V« lom nbm the deltrftU, «bftrft<t«rk^l^ 
brovoLfL fry^Tttn «if lik<i»ln wUl 1« wu, provided tbd tvoflioD flau Ukktn 
ptftcv. 1t U ftdritnbl« If^ n>jwai tbo i*at if ll» Jint trifti Si nn»BB<wfaL 
Cftr* fiiiiulJ bc tftkcn not lo bMt tbo tp«bnfii too *trcii^1j^^Biu>00D>.| 


wiL'Roscory and cukmiätk?. 

Erco TiUi Ih« iuiAtd«d eye, if blood ie prcvenU there wili he 
sen here and thoro under tho corcr^lufl bloody or liro>iniah- 
r«d dots and otrvskA. Mtfr thc^o Lav« boon located with tbo 
lov-pov^ obJ«nh« (•/■]. their finer Jc-taiU ere examüwd with 
a magitmcatFrin of 2S0 \q 400 (loe Flat« 1X^ Ti^. IT). 

Hciuiu or hjilrovhloratc of bematin cryslnl^ are Hglit- or 
änsk" bn>wu, rlinmbtc plnld or columns of very vnnnblo Icngtii 
and breadth. Ut^'/ui ion Ally wh^Utooidikc^ foniis of the same color 
Art alio m«l with. Tho »iiw rtf Ihe crystnia d^-p^nde to eoiuc 
rili-ut upon thn rijrthfM! (if |«i*pnrBti'Hi: thn mnrv slnwlj atttl 
csrcful); the ndd i* ftllnut^d lo riA|.KirAtr, (lio more frviiuoDtly 
largti pieces ]j( to 18 ^ in Icn^h will bo found. In every 
LDfitanc^i however, tho ^oaE>>t icTicty in SÜEO ttn bo »o^n, from 
Ihoec bflTcIy vjgiblt? up to the cac<aeuremeQtfl Just inontion^d. 
They occ\iT singly or \n masses, and ulien nssvtme tlie fonu of. 
St. Andrew's cnwi; very i>fU"a lliev lie i:ntoM.-ii u|htii i^Ai^h olhwr. 
They nrc iii^lublc iu w^tter^ ftlcohol^ and dhi^r, arc readily 
»olublc in cauMic polnnh, and are «olub!« witJi difficulty m Acide 
and fttnmonia. 

Th«iF demonRtrntion t» not nitainablo in erory infitancr; 
asidp frnm the fart, tlint, in ihr iih«'iiiw of niJH**ü'iit CJtt-p the 
cover-gU^ ia Liable to craclE. their foroialLoii may be hindcri^ 
or rvadtTftl impowible by the prwcnce of fat, rast, oi advanced 
ctidLn^ce in the bbod'<-otoriiLg matter. If fat u ttio dbtnrbin^ 
Eub^nce, it mimt bo oxtractoj with otli^r. 

The tpectraioopto demonstration of blood -coloring matter id 
of as f;nsjt xahiG in tlit* dia^unsis of old blood -sin ins iis i* tho 
detection of beiiin crytt^lsn As ba* frequently been statrd, the 
two abeorptioD bonds lying between tlic liuce D and E of the «oIai 
»pootrum make it at all tint« possible to tvcn^izo a »IntioQ 
of oxyhemoglobin. Both band» appear distinctly ^en when 
the tinging of the solution in »rnvply ponTRptihle, and thfv po<]- 
üv«l> provp tlie prt-M-iiLe tti li^nioglobin. To ^iian] against i-rror, 
nhich )& poa<ible only with th« eiruilar epcctrum of ammonium 
mrminaU, the fF>lIowiiis two U^ia iimy he oiiii>IoyiMl : 1, On 
addition of ydlor ammonium lulphid, the two flbKorption bandf 
of oxyhcmoglohtn disappear und a eingl«^ hmtid abvorption band 
peculiar to rprlnrrri hf^moglobfn IjiKps Ihoir pbuv; nn i;hal(ing 
Uie Hulutiou with oxygenated air tbc «in^lc band disappears ^i^d 



tlic twi> üUftorpt ii>D bands at oivkenioglnbln iii^ n.HU>i>M.1. 3, On 
ndtlitiou of A Uttlü ucttk urM Imlli ubNjritUou lijttiil« of oxjr- 
h^mo^Iobin (Jiäappcar. vliilc tlifr bimiUr hamh of ammoniTim 
c&rminato pewUi unulcenxl. It bath of tbi»<-* t-^U rueult pnci- 
tively, Incontrovortiblö pr<Jof timt llic «impi^cUcl nUiti ix>uULinoci 
tioiTioglirbiti h tthtAt\nvt] [w^e Ki;(^ ^0]. 

The iifTT4iiirT prFroqiii)lt«4 for HH^minff tbo ab0ivc-d«sct4bcd rpvc' 

»ijfTifirnt tn j'M*l h »jiipjy fcr>|iMi"n titim ntn* and i-tw-hnU fii tt^ft r-mli- 
mpUr* hijfh iti Bi) oHinmrr U"*t lube. Thp *lit of n pwkct "j-prlro^nnp* 
I» noi> [rU»d a^ntlmi the tat-lubv, uid Ujc BtKJPEtvt j^o^iibl« hifhl al- 
tanvd to jkKu throLigh iha loliition, 

II only iDiiiiil« IriLff* f>f blofwl nrv pimpnl, 1^ uiijmnAliun thould 
be mnJi? nith Ihc nikrvupwlrotcopv. wljich Ln Infl^rtiii kiittr the draw- 
lubo Ui i>ln« f>t tbc otnilir. Ilic bJood-itflin tniiHt thrn l4 dittolv^ kg 
a diminutive i^li» chamttfr bavtuir plana parfllkl vtaWi^ aui if Ibc hilii' 
tiua b lurUld U hii^itiU U- rli'Hicd by tliv mlditiuii vt ■ üilcq of amtUüuU 
\ty vrhioh th« filobiilln l4 i!)ii&i>]v«d). 

Ibe ipcGtram of mcthcmo^lobin, wbicb. in addition to i\w 
bfEDiia of oiyhomoyUbiü, ulw3 ^hjvls ouc in rf J, hn» alpcfwl.v bcca 
liiacuaäoj (pop* 13C»), It i« tc bo ospt^rinll.v borni.* in minci dur- 
ing inoilico-Uvtl iuvc^iH^ütioo» tlul ruL^ila^nioglübin biloßgs W» 
ÜMt fn?i|i]i^)t mitUmorpliiKiK phiMinmrjm iif ox^Ttrmn^Uihin, wbidi 
occur u the rtvLilL of Ibr* nctioEi of «unlighi rnii] mr. On aildt* 
tioa ^ ft «moll oinount of ycUow Ammonium snlphid or &ininoiit{| 
the €hftrftot«n«tic biind in rod di^nppoor«; on the otbor hAnd, 
ttltow ammonjiim «uJphid prodttc«« {he broA'j b^nd of r^^luccd 
hemoglobin inttt^id nf tli^ two h&mh of r>v vbewo^jlobin ; while 
on adilltiou nf ^□irituma both buiidK nul odIjt ^K'n<in1, but nnr 
tLiailt* nion? dJEttmct. 

In t!i<? cnw of very oM bloorl-tvTnninn wbich bar# been 
df<i^ni[M»ed by Üic artinn of bffbt uiiH air nn>t whiob nro iiMoJu^f« 
tfl KHtfrr, ftpi'otnwcopio dcmouttraUoD cf rtdnoed faem&tui may 
fttll iMtf! tn tbfi douirpd rramlL 

¥<v thU pufpoBo thft iii«p»(^l»d blMMLiuin i< tr*Bt#4l «lib a From 
10- lo äP-prt-tviit. ^uliilion uf poUulc or »odtc hir<lrftlr Ll^l^ikca) or 
latunW tolutJnn oJ pnUnhiiini c>biiH (R Mofiaann* until iltnhlv^J, 
Mtd Uk* »lution thu> dHaiomI UiTli«»r undiluTnl or dilutMl with wit<-r> 
l>Ur«tl in liodl of tic alll cpf th*' *p<iHrDwopr. If mluwd hcainlin i» 
pm«nl, liiitt* >p|H«n an abHirpLion Iwad cwmbling ibat of rsduevH 


hemoglobja, except that it ia displaced toward the yellow of the flpeo- 
tnim; its Hpecific nature U shown on addition of jeflow ammonium 
flulphid; wbile^ aa we are aware» the two oxyhemoglobin abBorption 
bands blrnd into one broad band, here — on the contrary — the üngLe 
broad band Beparaten into two parts, which are especially characterised 
by their Bitualion in the green of the spectrum. 

r. EXAmrNATioN of the sputum. 


Afr£onoKB of Iho rcftpimtory oTjrnnft am Dually accom- 
panif^rl hy etpcc^ontion. IJnctef «ippctoratioo \t included »11 
»ctclian dtfchftrgcd Llimugh the inr^utli b^ hawking anil cspo- 
cUHj bj ooufhiDg. Between cipodoration and cou^jlang Uiere 
Qxists* is n mie, an inimi^Tliatc rclAttve dependeoc« in tra for oA 
■OTore coTißtiing neually projuof» profuse, ond loe* frequent Aitd 
Enild coughing ^Itg^tr exj^ectoratioQ. There sra, howovor, mnny 
oiceplionfl to iJiis rule. 

Oougliiug IB often verj iDtrn&e, itill "notliiiig m lorjariii^il^" 
bccaiise littk, or only rerj tough, secretion i* present i or o;^p«* 
torntion is alight cvon in viol<^nt couf^hin^, becnuw (he pnli-^nta 
at oDi-s; *wallow the gmnl^r portion. The kttr^r ia tlio rule with 
children (up to tho liitb or eei^^th j^r), and oft^n th« caw in 
wpak dilpH/ or *irrionflly ill (tiphoid, pneumorria,. dolirloufl, tic.) 
pftticnta» Oil tlit otiier hand, large amcimU of Hpulum are aut 
iiifr«qiieat]j rdsH by flight oougliing or CTCn by Birople con* 
tnotilo mOTOmcote of the cb<i«t (bioüchohlonnorrlten, bron- 

The spiitiini is nRiuiliT of grrat st*mi*iotic »igniflciinci*, for it 
may Cunii^i infonnntinn in n^purd to tho pnthnlogTc pmcrt^si 
occurring wilhin the respiratory apparatus. It is clwir, hovrcTCr, 
that in addition to essential constitucnte the »putum will also 
oivntain a number of uniniporlänt «lemt?nts adijod to it dunns; 
transit through the alr-paaMgw. To the fr>rnier may be reforrej 
iueb eooittiluciild Lcloiiglng to tlie aDa1oiMi<.< iitru<:liireB and wliTt^i 
tnay be Üirown oil in innjuniriatitry oiid n^?croiic procestto; altno 
^nch n« occur ontj in dueooc an etJolofpc factor» or wquchü ^f 
an wpccUl dttK-^iJc. ^I'a tin* «ootid (rr^np hclon;: mjch ctrmcnfcs 
which, for oxnniplo, ^in ontrnnc^ to the Eputum fmn the oral 
cavity or nrr nddrd to it oiitHirl^ thii Imcly thmii^h thn ngrnry of 
uocloan nx«ptaGla»^-fepiUcap», etc 

For the proper judgmrtnt of the «xMn'ibf comiiiucnh of th^ 
$piättm an accurate) knowlodj^ of the anntorntc xtnicture of tbo 
n^pirntory tract 19 ahw>lutrly nrvi>^^ry. V^t thii ronton a 
•hort hifttclogic sketch will flfvt be ^«l-d, 

» [1113) 



cov^ml Willi lAiJirlUr«! vqkiAinoud L-pttlidJuiu. aiij tri ihi? piiri mpln' 
t^vin uitFi riliNlpJ «( Litcwit« Eho cmoniu mombrAD« 
of Ihr Ut^ni. truhtfUp &ti4 Urg«r brondu U covctvi! hf »tntiUrU rüiitAl 
cpllhvliuiii. »Kii'-Ii JH iiili-impU-il hy TTMH*iLn-N'H>n'tiriK i;i?MrtT<i*]U Only 
Ui(» p*i"fj»rirH' nirfiif^ of (^»«f rpjc^nUiv Ibo antctiot ■urfoc* «I th« 
ikTyt^Qoiil cnrtiliijrc» «nd the true vor«! corda ue co\«rt4 h^Ui UmcDalcd 
ujiiuirtou» q>Uhdiu[n- 

Tho cpithchum of the biont^hko.! mucaa* mcnibTunc \V\s- SA) 
Ui</iiuin> U'trw Imiirllu- uiiitl iji llii- Tiurt Ijuim-hi-:* i'iily a >i(i|f!ir Iiiyi4 uf 
HlUrnif i'iilthdlum i* iTPi^fEii, w^fiOi iiirrihtEiiiinl in ilw tH-^rinnm^ tyf Iho 
bronvliiol«, Tbc oilmlod i^pjlhuilruiat bovpicr» frodually poMcs over Ut<» 
an epltheHuiii cQiuposMl ol • jiiixluii; of cuUt anil Iai^^ iiudruicil «tjd 
nonniiolr-atcd crlla» whkrh cVfn In Iht* nH|^]iTiorhooi| nf tlLi* filvpuTAr Jiioi* 
ooimiut rbtfUv of tb« tftrga potjfifomal. fiat, tfi i-mlWd i^fitpiratttr/f i-piltm- 
titiiti. 1t linn li4-i'Ti r-fLiiMl b^y omlrrj<iliii:ic rrni'iii'li tb^tt tbc cpitbi^liuco 


ng. fti.^-CUliiilcd R[il1hptiiim (OlitniTir^l 1iy CAi«ftil ^rrA|iIiijf (if Mi* 
MtiooM}. X UO. 

j^HrliiiiHj tKv.if>mcM /tutUV'^t nnlj üfter rmpirrtLion >iiiHbiirbmocHliibli"hi;J. 
In lUlJtKirn diilürtn ctibJc L-ptlbtlium cinl/ Ut fuuml iii I)k- jilvruU. 

Htnootfi iTHnHf-pbmi ntxom^any tha brunr>h.Ul tulio dowo Eo tltt 
alnnUr dbiU and forn^ a ilfTffcaJci rSng fit the point nf oriffin of tht 
ohruti. Pi'hidi*- tb^^iii? (riu-i^'l'' illH-r* tlip f^'tft n^ tfif nhtvlttr dmtft tit Hrft 
in fifintif ftr>f-fi, tr/iicft arv ismtrtj^'i av lintiliir flttfrt /init ttiinf MHnvumt 
fftr afrraliia uf f*nh nlfciilw nnfl Ji'iir t/ifte trntt nut bt'an'Uffi trhith 
mii't'ftt't tht: itKnU: tilvrtilv*, Hu Vir immrtiUtIt tfiiitinilUti'i» 'tf ttfhttitPiV- 
ing rJ/i'ttf flber fitffo thü filirtihtr ttrpla a'fl furnird. The roHpirntofy 
|i(]|-Liifiin ol (hv lujii;* um' lIjvjiIciI by infnui^'tivi* Ljhi'ijp inU* Aiiiilt ami 
liiinith'4l- lohiilj««: in i[if*trT|iTml4r Elbritii« Hlrnins arf fminit btn^'k 

pfenu'iil aiid ]»iin»to (Drbon ffmniilcs vMdi bavc bcco dc^ioeittd tbcre b^ 
ruHiiitaUnn und Üi« lympU-vurmit, 

esaential pRrts of the expectoration oru-n tii^t iJocidi? the clmgno- 




(be DAkod oyi^y tomoUrrtot only br nid of the mtcTOKopP^ For 
i?vampli% Ü itirking «piitutn tnivnc} vilh tWrn^-IhrvniLln titica ut 
oiwtj r^vi-nU ihi^ r%ifi|i»ini> <tf pTilmonary gangiviiiv whiTr phviinnl 
phcnomrnn on the pHrl «f t)»r hingn uinj, l^vhaps ^c hnX 
tlijihih drvclop^'d; on llic ulli^r liaiifi, micro^cjpic ciatnioution 
of A j^Ain^d prvparatjan of the bpulnin may owuro a tlia^OBiB 
nf piilinriniLr^ lul>ori:ulo«iä at a ^oriud iu wbich perciLttion soil 
nii^oiill.ition will not jw^rmit a dia^Drxhi of this diw?A8i?. Sine« 
6ucb caaf^tt are by no imaiiiA of rtixz- itx-uTrvni^. mid Uil- «iputtnii 
prteeuU many otlitT |>vculiaritirv whidi, n$ will siiWc]m3itly he 
l«niod» diriX:t tlic ph>«tciaii to a cnrrcct diiignoeb, tbc ^Httc-ioiic 
jjgnilic^icc of tJiD «pcclorilion je not To be iiinb?rvttimotii!, 

Tbe a[>f>vLvtii4iitii'nEvl t^xiiinplr« Giitlli:? to tmUralc that thn 
macroxi'jtpic as u?fff 0* the mtfvoscfipic charafier 0/ ihts aputum 
fihouJd Kht conf^idiTfd during <-\AminatioD> Th? formi-r itrvcai» 
tiio fTo^ cou]p<feition of Uio sputum — the presence of mucuji, 
pufff or blood; its amount and form and it« odor and roactiMi; 
th^ otb<>r givpa the ewontial I'lemcTitary constitiieDts und iniij;- 
nific'jitit adiiiivlun^. 8(iinetiiiieH fbv innrninoipir fjiHTiiinAlftin 
i% (}( i^niiU^r tignidi'Htjrrf v^tmn'limi-K Iho. rnlrnmcdpic. N«>l uifr«?* 
qumtly the rcnult« of nucnMCfipic «-anminjitioTi rvadirr filler 
uxamirnition »u|>erE1uouii. Kxi-ry careful cjcanunation of the 
fqnitum »lioutd, tbrrvforc, b^gin with thorou;;h invivtigation of 
the mccrottnpif c/mrafk/i. 

.4 relicbU rjamitMÜtm ü jMwnhU only when thf cjj^^cfofo« 
fvm iit mceirfd iiHmistd tt^tih vihrr iitatter im ft dtan rcMf/. Tbc 
onlinnry giaw (putuin himblore arc prcfiTaMc to Ibp covcrcil 
porcelain ciipf, hraante they permit Tiipid ami Tva'ly obfctTa- 
tion of lb« (^luntity, color» and ttratincfltioa of llio (put;uiL In 
Rome innlance« it uiay b>- iTrv^Frablo Iu rcc^-ii« thi* i^pitlam in a 
gba« cvliniicr partlj filled with *ater in order ijuiokly to ilrler^ 
min^ Ihr form aiid ir"nv(ty — i.e.. the air content — of |bc irdi- 
riduaJ «{tut4, Ir ^ctionil, it is bu^t to iMTcurc llic «putum alono — 
vitlLC'ur tlio addition of vut^r Tlie pati«fita not cifiiifiu*^! to 
bet] r>p [ir>tiH' ulitmld b*> ailvtH*il to t-arry with Ib^m t!ia DiTtlweik-r 
»putuni fflfUH- 

Afl^ tlic cxp<>irC»ration hiu bc«n icapcctcfi in the »putum 
0am, it >« Dion? thc>rnu):bly oxotnincd by i9|irf>udin>; it upon n 
poKrialn pUt* oni^half of which i« bla«k«ni>J nitJ) a^pbait var- 

19$ MLCIl()fla>rV AXD aiEMIKTKY. 

abh. SiTiall i^u&ittiLJc» diilv uliould I« inkcn from th« «puUim 
gloUt AO Umt Üio f<crctitin iniiy be Pprcnd upon the pinto id ttic 
IhtnDOtft jxemtblti Uiy*^T. Kor cinrnmiiliaii tli« indivicliial nfniU 
should be drawn apiirt by two pri^jiaraTion ikhi^Ic« (vhiob, UTidi}r 
nrrUin cirpiiimLlnniv*, «bould nnt h^ mndei of mrljil) nnd Uiu 
tjfinniHpri>Hc mncrrjitcopic fwitiirr^, nuh-ii-qni-iilly Ut be iji^wnl»«!, 
carc-fullv scrutinized. Eiich poriton tliat li^ been examined ifl 
WBShod ofT and facli new portion cxamln^J in the «am« inanncr. 

Attention Shonld Qenerally be Birtcttd to the Following 

1. '\l\v quantity of Hpnluni- Tfii» vtirw wilbin wMft llmUg 
— from ucniMuuQl sput*t to one or motv liivTn in iH-entj-fiiur 
houTQ. The lirgcat nmounb nn: ot)Scrrrd in broDcliorrhca, pul- 
mofiHi}' abs<-c:6a und gnngrünc, ami in ruptured cmp^'cinn. In the 
Uttfr ctMLdition the amrxint cxptKtornlcd may amount to four or 
five lifprs. In si^vtrv hrrnnpi^fiisj alfio, the qimntity is not inftv- 
quentlj qnite Inrge. 

3. TIjo color, which i§ dcpondcut npon Üie admixture of 
mucuB. puü, blood, And »oruiUn 

Aeoordm;rly there la obfamod the imporUat division of llio 
expi'ttci ration into mucoid, jmnifent. »troiut, and bloody «pufa^ 
and — aL-ciirduig to i\\v naluro, nnd ndiitivi* proportion of udmi^- 
tuiT* — into mnvo-'pn''}Lhni or piindnnl'mtai^ind. mur.a-hafutir' 
rhaijü, etc.. FpiitA. The color of the »putnm ii* lighter nnd more 
tranepnrcnt the proatcr the c^ntrnt of muetiA or wnter, nnd the 
more opaque the more riohly c^'lhihr U »e, whnlh(>r the müjorily 
of cells present are red hlnod-corptiaflp* or piin-cplli, 

Tlw most comirLou fonne of eipcdoratjua are tlie follow- 
ing: — 

i'tmp^ft muotiid sputum — (puluio cmdmn of the onoientfr— 
ia of plairy or grayith white appearanoo aad st^iiKtimee ol liquid, 
fiometimte of u-nneioufi, consiBlonoe. According aH it ift raised 
easily or ntily uftur seven? coi^ghing iU nir conU'nt vrini.«- Tt 
occurs in et-erjt acnto catarrh of tiie npi>cr air-pasnagfa and an 
IronchUl attlima; also in chnmic jiJiso-plwir>'nfc<-aI i^nlnrrh^ in 
which» ho^vevcr, it le of tougher eonäistcucy and £ometini<£ irixod 
with dried wrobB. 

In the vtucft-ptifiil'^i fj.p«rtorfition—\he Bpntam coctum of 
till! nucieula — It umti ho dotcrnLincd nhcthcr it i» of homo- 




0BD6OUA character or wIiuLiicr it« composiiliau of niucitft aud pitü 
cao ht TtccgiuBtd at a i^Unr«- hy tliü groed ^-pumtion of Ui«0G 
ooiutitu^ntfi. Tbc Itnit, thc/roitiihJtf mi^cd, muco-purahnt, yel* 
lowbb-whitc tjmtumj in which thu miKouK ccniMit in in cxctsci, 
it obiwrv(>r1 during thr <lccl(no of eycry fiimplu cjiturrh of llie 
upptT n*^)imtOTy tmct; Uic other is pnco^inlrnxl in rmnj rnw» 
ol chronic broacJiitia and eepcciAlly iq pulmoDarr phthin». 
Hc-rc, however, the cio^m of pu» is iifunlly di^tindly nianjfcct; 
ooD^uentJ}' the sputum iä dwij;:njit«d aa purulent mucoid. 

Ulis occtkra In two forms, Ibe charaelcHfilk difTr^renons of 
«!i[ch depend upon whi>tfior ibe pus <>oiiWt'eb or liiiik« 1o the 
bottom aa ncparatt-v JMilateO, individual sputji. In tJic üni case 
thu frcih ^pfiioration prcwuta tlie g:roaa composition of puni- 
t " hailed/' yidloTT, or yi?ilowUh-grei'n epulA unci mucus ; ouly 
tur aomo tioto »ppnrjition oocunt; the pus sinks tn tl^o boltom 
and coaIcvci« to a mom nr Imt hnnin^n*TiiM>ii« tnni9, vhilf! tlu? 
mucno» lajiT Rimrntre ahoTe inio an «lnm*t i?olt»rh**4 «tratum, 
or obe the tbii^urr mucotia layer U imvcrstd by i^(-n#cr thread». 

Ulis type of Bputmn i« uioat frequently observed in bran- 
ebf&äta«ia and In brondioblennorrhoa, but alao oeeurA in tliOA» 
fonns of chronica pulmonary phtlilsie which are aaoix^ialed with 
f<?vi-rv {antral bruDchitia, etc 

Wliiln 111!» tjpf of pvfMtrnt tnwt»ü\ »piitum \% nol dicifnctcristlc of 
nny one Hiwilh prooiH*. thf <iha«<Ti ii I mn of iLf t4-i'iiiid ih (jf morir J^nrillc 
ihngno4l1o tJifnltWni^. Knim ntunpnt timw« "^h»« ^hnf-«*!' (iiuiniiiii jir) 
Bjrula li«(p tidrn look«! upuii n.« ah iinpnild til maiL^fcttalion of plithitäi. 

olworrcMl ulniont cxt'^UMVply in thi« iliiuu*. Tlt^ ainlinjrK Aim uiual <1U- 
tioct vlwu IJjv coutirntd \,t a »vity only ifl cxpcctotaUd «jaJ Iht 
f^lnrrli^t plifinnm^nft njf In *T«^yiiTk4*c-. Tbr tiiimmalar t]fiit& Are ofti^i 
of ifrvAl VfilurdP, m Ih^i fKini tn^ily i^tn: ha.ll to one lalilnpoonful 1# 
CKprTlnl t>j n ^iifflv cJ(|>DPtiii»t4vD; Ui«ir color in um^Uy JJHy yolluw or 
yfillovnih jj^'rn. 

Fujc puralcnt ycUow ipatnm i» moat frf^aimtly e:ipi'llct1 in 
piilMoiLtrv uIj-'ll*?! am\ perfomted empyetna, hut it olao occtim 
in Lir^n<:b'>bknuorriioa ] the pua oaoally eeparates into two layer« 
-—AB upper ti-^roua and a lower whclly purulent stratuni. 

Bloody expectoration otvur« In bri^bl-rci] niid »ot rarely 
Himrwhnt fr*itbj U-ttn, iti hi'moiHi'if.'«» from pulimi:inry cnvitin 
or from aortic an-^iirii^mB which liave rup4unxl iuto ilie trachea 



ct tk bronchiu, ortij mixed vrith miicua in the ow» «f foreign 

miiciiK or piiH ntv rogularly oIi^^ctte^ after 4ul)eid'^ncc of a iiyti^ 
phrhifcir lii^mnrrhjigp, Afore iinifonrly b]ood-«taEDi?<], purulout 
»puU occur in jilithbic Kl^J>t'tA uith rAcvi'-n:! innitration; on tiro 
oltK-r hancl. oeca&iojial fttrt-nkB tif blooJ iii4y lie hüxihI with ofOi' 
uary "nfl&O'pliartiip^fll Hputum'' from iht pliirvDTi, c^iis^ially 
M'lifm tiT>lyul pün>M-siiuT of tsiuK^itiig are pfvpcnt. Dirty Urovi 
i1»b-^L^l tputurti ciinoolorod bv dt*comjw)stlioii of the blood-ci^loring' 
mHlljT w olwrvi<<l in pnlniotiiirv gnngrt'in* Of more» fn^iimt 
o<nirr<"mT ilinn tlif liittpt U iho thnmu^hly inrtirporalfd ni' 
hcmitrrhaglc " ni$t-(oluTtd" rti\r'\^\n<tui sputum ahsentJ in 
mcnic pati^rtU. vhich is of pathog^nornonic intcrcet Whi 
rwjilutioa of tb^ inftaniination if ivInnJo'l, it M>]n{>tiiüCfl luauinf 
£ di^pp-ypllow or ^r[iiit'^f(fn color^ owing to the LnnuforruatfoB' 
of the L|ixj(3-ralor[üg inulliir. or it lOtuuj^'» In a SrowuiBJi tu 
prunf'jitlffi ctfUir wlien tht- dreafcl comp! icnt lor of (iiiilamm/i- 
torj) filpma IP fld<K*ü t> croupoua piifumom«, I'urc bloody or 
tcitnciouH ii]u<*oi(l »putum niixod with blood in ohfcxxtid in pul« 
inonnry infnrvtiou; it fmiuontty n^xt-mbli*« cxuctly tho »putum 
of piiLfUHMriir pn(ii<ntK- 

Not infrequently the »putura prc^'iil* a rtspbcify-ieli^ike 
Appearance in n<:^plnfiin? of thr hron<'hL nr lunt;-ti>fiuc. and the 
aan^ charutli*r of Pputiim w ocaieii>nnlly obflcri'cxl in h>titi.'na 
(K. WfltO^or). [In Mnivh, l!t<iS. I rivpivp*! a cvlindric piecre of 
liaBui*. 0,5 X 1-0 writinii^'^r. cxpttiimt^J by u iiiiil«-' [infi^^nt, 
fl|C«d AI yNiiT*, iilknTVfd iu lb*-- praelite of Dr, F, F. C. r)cHian*t, 
of Prtwnic. N. J. MicTfTrtopiu t^xAiniualiott fbown! tbr dMrac- 
tcristic histologic »tniolurp of mkuounrt^inuiaii (brüUk,''hi>r lud 
A dia^iwifi \t([r mndo iii^L'oniiEi^'ly. 'Htit «puttim bml a richly 
h<»morrbn^ic Hiararb-r. arid^ nltbon^^'li Ibc phvsic-nl signs sug- 
gntm] (jLiliMOoary tuU'ri-iiloniA, ri^prjiUtl rnicrrräi-opic pinjninn- 
liQiiB faiM io reveal any tnbirrdr bacilli, Abont two v^elca 
nftt-r r-xntniniiliou of the tif>«uc ccn^brnl mct4wta«ia occurred, fol- 
lowed by TiuJdtn d^ath throe niontha later, — fiROOKg.} 

Fnrcly *rrott* kputnm is a tranüpan^nt. wbJIi^h fluid, and ia 
chard otc-niwt bj tta higli idl>urTiiii i-onli>nt Os^in^' (o l]it> itifH» 
cuhj wiib wbu'h it in i-\|>'lM. h in riflea mii'rd with nlr in tlio 
fomi tif large or fine biibbb.'. It is rhicfly ol^en-ed in ordmary' 



piiTmoiury o^lonia, lew frct|U('utly in the *'ejpfftcrQiif»i albtiini- 
nviuf " following pflrat^enti?HU of the pleura, in vnlvnlar Wtrtn*, 
Knrl in tuEitor» n{ Uiv Lli<?<t-L^dt|E.y. Ill ijififjiiinuitortf pulmonary 
tJema it XA iiiorv or Icrv IrUKH^taiiiAU und tliou rueCitiiblcfl 
" pn Jilt'- juice" (wf iibove}, 

3, Tht» ten^cit; of the »put»m i« rJnrflii duf to ^dmirhirt of 
mi^n/jc- Tbl- «jiLtrijEii U (ii«iiÄlly ^itrpitnly ti-imdou« in puo^j- 
niDtiiiir iiKtlim». nnil rimplnKiTm. Tt U n» cvilu-n'tit Lhut it in nftvn 
nricnMiry lo cut of! the portloM 1o be examined, 

1, The odor i& nmidlly "sluJo*'; in frti»! broufhitia it ia 
mon» or low olTon^iv«?: in ^nf^oo, putrid aii<l Mid, AccoH- 
kig i4> r^Td«ii, th^ pua diiicharged froon a ruptured empvonia 
often «iiiellf^ liko tttd ehrrnf. 

5. Thu reaction i» uaimllj ulkaliiLe. 


If \\m* ^[mAuiu ln' i^jin'Aii ii|h>n n plsitv ici T^io mcinrtrr nlxtvi; 
dw<ril)od, a niiiiib**T of prcitfiantic* may bo seen with tbc nok^d 

h "'EictBodi«" <"Iinitj»">,— Th<vt» iKxlk-»— iK* runitm 
" fj^r^jjiruAi \>r\fX'/idt/t " of iIk- aiieii^rlit-'-«^« fouiict lu 1h^ uiuci> 
puruf<^»l iiputujit uf cuii-imnpttvMi. niid (*!<))fcijtlty in «iid Mwevn 
the itummiitnr tiuijv<A at the boltcni of lli<* vtwh-^l. They nre 
■mooth. whiliih-jelldw, o|>nqüe. Üjitteoed or (»leonvex bodiö* 
varying front a piii-hrnri U> a Ic-iitil i[i *\». Ttivy oan rondily 
bo i^UtH br m«Lii« of n ttiy'dli? i>r pinec-tte and «prcA^ by nli^hl 
pfrwütJh* intJ» « traiispHivnl Us^r betwrvn n ri>vi-r-gla** nml f^liilr. 
]( i>i hiIvImUIo to rmploy for cxflTninatioii only a tiimU fragnit^nt 
IM lorger Uiau the hodd of a pin. Small, uiuc-LLQ-oover^d crumb« 
of brond may be mistaken for thwo bodiM.^ UauAlly ihi* diJIor- 
«ikei> ean be rioled when prewnrc li ninde npoEL 1h« cover-ftUs«. 
The geiiume'^rk« Ihvüi«'' i^nn Iw enmhe«! lik^ebixw*: tbe bn*«d* 
rrainb «liilm fmm Jiider Ibe eover-glawc DUlrii'h't ping» (wo 
page 201) may nl«» rpipinble *ricc bwJi«-*' Tbe microfcopc 
will decido tbc qwnliorj. The "ncc todi/v^ arc of grvsi dUg- 
noific valuta becau»9 ihty crmt^iiit j^^/tV fii^^rt and Merlin 



2. Fibrin CoHgnla. — Tlit«? occur in alnuHt evrry cftw of 
cn>npoiis jini-iifnniki^ (mm üic tliinl \n IIip u'lmlh daj of tli« 
diseaae: i^e,, dormg the etagc of hi^pati^ation. Tbejr axe slcadcx» 
^Dowiah-whit« or ycllowieh-rcd thrrAcU, from Ito to three milti- 
iiK'tCTd tbitk and onc-half 1o ecvernl ccntimctore long. They artj 
Hut iufre^uentiy dpci<loi31y dfndritic. (The ai^tlior found in ft' 
t^pje CAM? of pneiLinoniR n treolJke branching conguliim tvdre 
cM»timrf*-rR in Il-h^IIi.) Tho f-hohcr thri?ads are »wn on oun-ful 


n^. Hfl-— ^o»iOili*'^ in Croupouo Pronnbiti». Natui*! SU>, 
lDr«ttn After m Fht^iosrtk^h.) 

«EuniAAtion mudi more rendiljr tiiun Üie lomgcr oac»^ bec&iue 
latter are not rarely rolkd upon thcuwdvps. By shaking vil 
wat^r in a teetlLih« the coa^b can eoinotiui(>& be fiiimd mora 
o££ily. Tho nmiiber of ronguk H very vurtnhl^. It h not rm. 
to fiml from l;woiilj to thirty or ninrc in twrtitj-four Vionri. 
Their flbrJiKiuii cluiracter ib shown Lj Uidr Gwelliiig and fiolatioD 
in acetic ncirl. 

The codgula flppe«r in & highly churn Gloria tk form. 
*' bronclufil treea *' (Fig. 8(i)^ in croiipouB or flbrinoue bronohiti 




tJadftT BQch circiifnsUnov« they are usnaily few id Dumber» but 
KkmcUma Attun Huch a aize that it may Ȋfelj be concluilcd 
Uk4t a large porÜoD of ttto broncl^Jal lubuldr By^t«ca is occludoH. 
Ucee treelike coaf>ii]fl aro usuully v-Iiit«, but are cooaaioDflUy 
licged vhiti^h red- They m^t frequently appi^ar iu tubular 
form, \vt* oiit-n lut Aolid ftr flnt» duiooth fonnntion*. U U by 
DO utcaiJK tatv lot tin; trunk na ni^lt Ji5 the bntnr.hi^i to vhotr |)to 
Inudoufl which aiv no doubt piHly due to air. OcciuiioDnllir 
the coDtcnta of the tubcä thcingelvoe arc bloody or mixed with 
blood ; mor» f i^itAntly, how(rv<rr, they Are tiih'd n'ith air. They 
arc a coTlitUnt iici?ompnTiiin(»iit of tho bcfiro-tiu-iilinnf^ iügoaih*, 
vhich fiy><iuentk occurs jdiopal hi tally or prinijrjlj, lot: often in 
dipbthena. Th^y are casUy oi^rlookod by ihe iöcüperiraccd, 
^rrauA« tliey ofUa do not appenx in the eputum a» distinct 
«oaf^ia, but rolU4 up in a mor^ 9r iet» denm ctnt; tli^y are 
roragnltcd by ttic c^pcrietic«^ b}* their pccalSar r«<.'iikblaDt<e U> 
in«ftt*fm^u*ufa. By »hflkinK in wali-r i)w whIs lyin rvjilily be 
nafatdwl nnil tbn ItmrnhmjE. tnvlike ci^ngulum bnjuj^ht tuto 
tjcVk If OD cxominotioD of the tiputntii ncilhc-r thcw a)iJ» nor 
Molatod throadliki' ft*rm* arc found, it is then ntlTimHo in pvory 
cas« of croupou» bnnchiti« or prwumonia cnrvfully to waBh lb« 
Sputum fn a aptuhiin glasa. 

3. CiurKliÄiaiin't 8;»irala. — Tn the glaA^jr-tlimy or tenadoi» 
icrnus iiiurxi-fiminv rtL^nrtfinttic^n of a^lhnta patianta. Very 
rarely in other diflcn»c8 of ihc Ircndii, there are fi>u»d, «ttU 
ft»*rc or ii^i» rcjinilnHty, amallt floccuknt or fino« rflirdric fttruc- 
ture« wliii*b ar« cliAractvriMd by lliw gmyifli-whilc or whitiftb' 
yclloiw c^lor and o flplrai twifitlTig nr tranKT^ntP irtnrkin^ whirh i« 
frequently rei.-i.i^iiixaMe even with the naked eye. For a more 
dotailed (^o^riplioii »m "Sputum in Bronchial Afthmn/' 

4. Ihttrich'i Fhis^.— In tho yellow or jETf>cDiJih-panilcint 
cediraent of the aputuio of fetid broncliitia and pulmonary gan- 
grana (Ina often In chronic ab4Pi«8 of the lung tmd In phthlsio 
•jintum) ÜiL»n- are uaually fouuil mmiejtjyfi wliiliHhMi-tiow, 
»month, jiiti-tjtfld to benn-niz^d ^niuulc«, wbidi can readily bo 
"fohcd out" with A noedlo. They hove an extremely ofTi^nsive 
odor, arc of chcovy eiiTiBiHti--ncy, and ciui roudiiy bo crui^hod. In 
addition to myrindü of liocterin, eoimiion lo Ihc oral cnvity, th<»y 
contain ninner<>na fnl-rry^lalu an^ oomt^iofiflUy m'VTifld«. 



5> lATge Fmtniii^nU of Tiifue aro found nlmoet piccIuhivoIj 
in puintotuiftf ffait^rvnf. They uppoar aa graj"i*h-_vulbw or flifi- 
ralorod. occAslnoaWy illUinctly blaok. ahrefl« tnib^O(Te<l in mi]Cf>id 
pun, Thfir nature lam be ileU^rniim^l im\} by the tHier^mrupi?, 
vJnce they usually <:on»T[>i imly of a toiiUfH-'livtyliAMie ur. niure 
rarely^ of an dastii^-tisoiio stroma, 

Ö- Cftleifi«d Ccnor«tioniT mc^mbrannuii rcmninn of thi^ «whi* 
oocoocuiL, etc-^ nn* ruivly oliH-ntd in tbf »putnm. They will be 
OOElsldercd in the npiK'n^li» to thisawllon (*ee paj^je il'i). 


Tili* Wiln I» n »Htlfifudory rt^nlt only when a cnilcnl 
•cTutiny nf tlic »pntiim boi prcTioupäy bmi ma'k*, nnti it con* 
lirmp mmiv intcr|irctiitioTis which a simple itifipcction of Uie 
fiptihini coM «Tiiiler only probablo. 

In fho iiifi'rnflcnpic piflui'p ihnri? msv Im? ronnil:^ 

1, Etd Blood-cells. — After n tn^i* h^rnorrha^i* l.bow? ap|ie«r 
ntit only iLjialtLU'il in fr>rru- but ^Ibu In rotiK»aux, Jii the rubig- 
irioufl /.■ipt'i:tOL'atiün Uii?y nrc w?lüom nrraiigud in the form of 
miilcönx bnl mere innhttrd pilIo by «ido. in old aputum 
fio-tnlU'd rod bUwul-ci'll •■yluvlntt't"" nn.' nlto obwrvoil, 

2^ Calorleis (While) Blood-wllx (|JiiKH'iirpuHr!rA) i<[m«(i* 
ttit^ the fnnjorify of nil of the (Tllnlnr rhnmitw nbftTvwl in tiic 
hpiitum- Tbi-ir >i/-c? varirjt anil Jili^'wisc Ux-ir form. AIhkj!«! all 
of ihvn\ ate mullinuoiealoU and the majonty prwetil nf'ufr'f 
Ithiiit! fsraDuli-*«; ooily in the aputum of a^fhmatica arc nutn^rom 
r-ifnnopfiilr and rjiiite nnmerooh' htisophilt leiit'oo^lr-^ i-ejfiilflrly to 
Ih? fimnii («T pii^i^ IiVh*). W. Ti-Hsriiiillcr UM-'rilMS to llic 
incrrrLHnl number ii^f ctit«iiiiiphlli! i^e-IIs in l.bc spiiluin of lulmrcu- 
ioufl *uhjfvb» a fiiynmbh' pi'<>t'no9lic sigiiilicnnoo. a \urv which, 
liowi'"v<:'r, hail not rrmninod nnc« tit radio ted, 

Th« loucooyt«^ pogAwe the property of taking up in thoir 
oytopbam Vflriona Knhsfsnris, PoHl-pi^rnvnl, nltirrr? Mood-. 
I'oloiiiig iiialLer, I'tr.. t\ny tiv*\ü^\i\y (>hH.T\t:ü uilbiii Xh^^fv c«lla.' 
Furtherinow, it ie not iinpmbable tlmt tho majority of tin- celU 
iliHij^mtii] n» "flIvL'ilar i.'pithclia" arc varionely nllort'd forms, 
of haicocytt'i*, Tho protoplasm very f i-^^ijiiont ly shows fine oi 
coanat^ly gnuiiilar fatly metaniorplioat«, wblch i« charnetorited 



hIktw It ilrritfrJhj lU/fi njipnirflnn», rrft.nnSling t}int «nm in 
cnuh«*!] n''rw'-*iili*'tftiKt\ F(»r tiit» n-aprm tlif> Htn' iloi^iiatcd 
by Viichow A» rA^0^in droplet*. Tlu-sr l«ri;i\ dull ^pile^ulL^4 are 
«Ifto found outeidc of the ccll^. Tit« »linpu of iho cell« containing; 
Ih^m is iomotimM round, »omi>tim£« ovoid, ut ollii^r titii^ ^iiie- 
whfit polygonnl Id addition lo the droplota, out or «cvonil 
vmitiilHr ijudfi an; visible (^rt' Plate IX, Fig. IS). 

Sufli «11* <an be BCcn jn ilniriitL rve»y ■[lutuin. «vfn In tputum 

Vbp fnt»prt>t4riOTt <if Lhi>«v tvllx Hh nUvcilar 4|iiTUrtlimn ha« Ihhcii mid U 
now jURtIf combated. Di4ii[)|:iiUbr^d dJuifiniirt and pnlltotn^k' nziJit- 
omlit« l£- Wnpncr. ("ohnhHm) linvp »ironglj cmpUiutjod flic titinrUo- 
Idlilf of ih» drtfa rtM-t'rt«^ In "ii|>pui't o| ll>Hr tpillij^lidl olmmi-tor, 
Xf*vrrtlip|c<«*, At tlir {»rpnvbt LJriir llirrr Bp^iciim la 1>^ ■ c!<H-iil'il tj^iic)i-nry 
to «wept av rornvt tin» vlvK Uini llifj' UTv rjiilhrlUl m iminir. Wlipn 
dUc!Uuicig tlio «o ruili-d "hPniMMian n<U«." w» «ill aitnin rvf«r to Lhia 
rnuotrd (]iir*Li<>ii. 

$. EpithalJA. — Ccirr^|H>ii<1lng U> Uw Tariout kinJa nf q>i- 
theUuin fir4-4^<Til in the 'lilTi-rent luntv^us mein bran ^ii Hning t1i<f 
mpimlurv ^mmflgiVf tlii*rM i» riimiil in the sputum nrjtmjnous^ 
ejflindrif-. nnd tiiittfit rpithrliuin. Tlit fii-sl m fouinl in Urge 
niii»tH-r« in nn^fi-pharyn^i-jkl ripultin^ ( morning or dtoanii 
iputuin). I'y^imlrk crib nrn aiivn mft with, npcciully m the 
Arst »lagpff of acute cntnrrb nf tUt itppor nir-pnu^^ft« nnd In 
aeveiv p»mxii>niH of onu^birtg. Ciliiitnl «-pitMium is >40rloiTi 
obM-n^rrl. hut not äi) rnrvlv an^ t» g<-ncmllv ^Intoii. la tbt^ first 
Afiya of flcutc catarrh (cor>-üi und tlie like) and more »o in A 
m-wTt asthmatic iktUck. cilifttod ipithcliiim i* fro^^ucntly H*n. 
nK" pfopumliftri Ttnu\ not Im- Ißo bnf^tily mtiiiLnvd« b€*cfln«ü. hn a 
toIp, Ihi' dliHTj iiiovi'OTi'tiU «an he obwrvis! only afl'^r ih** Ik'lrj 
hits biiTi natrhi'd fr*r »imn time; fiirtWmon?, frndily r-xpH-l«- 
raU'd )»pijU nn»t In* rwiminnK 

In the moiv rbn^titi: rt^riiiri ol broncbilid i-ytindric cpitiicJium 
w raraly ro\mit, und t'lliatt^tl (>pitliplium aJtiiMt Ticr««r. 

Whili? tbr sjjnsmoiu i'i»i11i<*1ia «Tnimt lll^ra>H ppr«TVf thw 
tin and stf*m;*ly rrfrflrtivi- iiuolcuf, Uiv rvlimlrir piiil rilindric 
riUat^ prfwnt ujanifold morphologic chon^m. Si^mrtinm* they 



are jj^n^ntly fiu'olU-n und gloAcy; nomi;timcv tltry nre dttitorted fa 
sUrt]if rtiul jiri»viJf.'d Willi more or le« large, tatUliW prolon^- 
liona. In addition, tiicir prütctf^la^m if, u & rule, altered, mort 
t^oavAGly ^anular, fatty, etc: the Quclca«, howcvcrj ü Qininlly 
dUtinctly prcöOFTod. 

The "aluolar epühvlin" liavo boon coiuidered nndcr "S." 
Hie Autlmr b^lievea Üw\i fthsolutu ideiiiiflcatiou U aitlr^-riielj dif- 
ficult. By UitTM' ff4? tifiiully midcTi^Und Lim iHtjte, QVid or rouudj 
aliN) pnU^-^nal celLi, Ibroc to six timr« n« }ni^ m a white bit 
oorpuiiclc, wliich Arc found in nlmo^t cvciy sputum. The uffuuUf 
Inr^tT (H^ll-body U i.*narfioIr fcri^tilnr nnd t'ontninn rinr or K^xirul 
"vfiiii-liMtko" nuclm, Vm frc<iii<*nlly thp jimlnplnfiin ^h«»» 
Iho Hue, fiiglilv refractive fat-ilmplets or clidl traiifilticent mjvliti 
«phorul« already dc6urib«d in counettion wjll» leucocylte. Not 
aifptqut'titly theee ore druwri out iulo putiitiar ihapcs or hive 
ooaUetiH! to Turm lar^ droptt-tH, "i'lie fdt And raytrjin UK veil tB 
the pI^UL'iit i^ntianloe Uik*^n up by tho prolopljum ütü ofton so 
di*nK'Iy hf*jijtcd «o^pilu^r tkit IW micli-i ar« Dlijicnrtsl, We vill 
njfer to Ihrir iit\^\t\ jitid ^i^ilHcftriw »lien diwuwing lijc jhi-cilHwI 

4- Fatty Detritiu, f unno-l by tlie fnily dc^neration of c«Ua, 
occurs froqiK^ikUv m tl@ fonii of vory fine &nd «oiiiewlijLt cofiKcr 
fat-dropJcts. ThE^y aro found eepeclally ftbiinduut wt»eü Uie 
■putuin |m«»ent« n piirulunt eharnuU^r. Tbo driritm «'tur*, 
nnton^ «LIiit rundilioivt, c^uilr jtbiindTLtitly in pTU'iiinoiiic npiitum, 
At the time of rcsu^li^tion of tlio ciudotc» It u o£ no c»|icci^l 
dia^Oi^tie »igniHcnnec. 

Ö, Ztaitio Fibera,— These arc somotJmee observed aa isolaCcd 
fibcre, but on> mf>r(? frcijiiPtilly arrfinged in a delicate notworic 
(reticulam). Tlioy are dietJnguisIie^ from other »Imilur de- 
Eoenb, wjH-cially iHmnefti^t^tL-etie fibers, by iliejr darlt. slmrp 
oqUine, — donbli- contmir. — tlidr lii^ii n^fractWe indcj, and their 
dcddod rc^»i»tnnce to neids imd uJkalies- Tho inarparicnccä ar^ 
tiahle it> niiiJül'S füUcrfßttrl nüfdlcs and fornign adtnirttirfu (wool 
und Uf^en fibf^'tc) for thttm. Fiit-;;ryslu.l necilli'Ji liijimfy au^ 
form fab-drope on hcnting, wtile the elo&tic £bcra remam 

Under ecrtain cireuniet&iiooe the elaetic libera may be derived 
frnm remnants of i<iod rcmainiDg in the moutli; aa a rule, how- 



«rc^^ tho«e Aben uic eouief tad iliov noitli«r tb^ Borpontin« 
conti>uT rof ahtolar amuif^CEit ch&r^teUrUlic of tboee deriTpd 
from Üie luu^ (m*? Pig. S<). 

TAtf Wtu^itf )f&nn orrur r7j»^l! fihaivhniJt^ tn JA« nAcrtrtf- 
^^icribed "citrpofa oryzoülea" In cnijth priptiraticriu xnadr from 
INvrtioiiK of Ihfsv b(Ml]« thf^y Are qnito ^jKliuHiy i^howo, uFtinlly 
vrlUiriiEt Adifilinn of acDt\p itHd If ihcfut hmVira nr« aWnt, llif» 
difTrmit. pnrlinnF^ nf thi> Rpiituni miivl hf pinminiul nnd fimall 
partkl€J>, abi^vit the siic cf tlic Lead of & pin, rcrutmxl frifzn llic 
dcQ^, grorD[«b<y([low mssH!« ait<l criiahod bdvroci] ai (^ovcr-gU^ 
ftsd a elido; or lorae lOpvr-iXTtit. poUffiium or «odium hj-drato 

FS^ ST.— BlaaUr ftb/rn tiom a Crushed Corpora Cry sotdpo- X UO. 

(cnu^tic) Elution mar be Bidded to the sputum. SiiouUJ ttoM 
mplhodft not ffiicooed oftor wveral prepamlioiu Imro booj nmdvj 
iome of the sputniii — ■ U])!<f|iooririi) — iiiuitt Ih^ niivnd with «d 
e<{ual aciiiiuut of lO-]*erHX'iiL cütmtit! p«U*h (or Hid:i) and briiW 
uiitti di»f)Iviri] Aiid Ihtn dihiltO iritH four ttm» Jti^ volume of 
irat4.T axiii Allowed to deposit n nodimcnt in n «»aic glaasu After 
liiviitj-four hour* tbo «uponMlnnt fluid is poum] cff and »nwi 
of iho foccnlpnt wdiment Iflkm for oiAmiDntioa. Ttio cUsiic 
fibeo low rnimr of thHr »)>«rpnrf« of outline hy ibb melhod. 

AüiiTc frum phthifiU »nd tbc urt ulccratire jnoctf« of Üie 
upper airpAufLg<^ a« a neult of fijphili«, dulk fibers occur 



principally ill pnimfinnry aJmrriu, iin«! in pitlmonary fjtn^rfne. 
In iil>nccva tht-y iwcitr mma'timre in nmnll. whilo or gTATieh-jellow 
plui:» or Uukea »^f llio trtn-iuloivd ir purul^nl «p&tuißT "r — »od, 
tliU b, to u LvrLnin dt^^nnr^ chanirtprutic — in long tmti^'fhrfdt 
wbldi, in mldifion to ninny th^rtn^ btintlli«, slwap fhaw n Jrliottv 
alv&fl'tf rcliiniliinu 

In gnAi^nc tbo (Lii-tic tiWr» are occaaonally abMtit, 
bccAUM they aro di^solrcd (diirc^od) by a (ryjttiißoid fcnncnt 
fiTft dcecribod A« proe«nt in Uiiä ffmtiim ly FiloLno. Xovortb^^ 
le»», unffuf'ätioi'kabl? «x(«|klioud Iiuvl' bM-u obw?rvod by r^Ublo 
autlioiittT« who, fn addilrm to the rrmnrWirivfiuru« fibert iTU*n- 
thuei3 tiy Trauljft, cktit-UHl ilenw liwiu'-ftlitt^Iit rtnti|»i!«vl uf rlvttic 
fihvra in jiulmonury pm^rt-iif. The outlier him*rlf has rrpiMt- 
My «ocn tltcm in j^anicrc-nc of the ]xmg^ and in & metapneumonic 
pulmonary gnngr^ni^ ho ohsorro-d for fliiout from oight to %un 
(IflVH Ihc (»xpuUirin of gruyifili-hlark ti»aiiii*-nhrf^l& from flvf to t<m 
rontimpUirs Iotij.\ in which tile i^Io^tlc ftbvrn wore very wHI ppo- 
ecrvctl. All tliat la nei:ef«arv ia to cAamine th« z^putuui aa frceh 
aa p(H«iblo. Ori Uii* othi^r hbnd, ho Tjiu^ uovet »eon ola^tic fibtrra ui 
branrhifiehm, m Ih« f|>utum of which oondition tiity are aaid 
otx^atiomiJly !o ooinir. tinier gaiigrt-iio had sitporvon'-il- 

6. FibrinoDS Coagula. — Tlie I'mif^uhi (Fi^. SS) viitibln in 
Hi;.' nwkrd t-yr in (.■riH]jK>uä pnciiiiioLin und brtjrithiÜA (ftyi pnRC 
Uli*) thitw diaUiit^t fthrin structure on nilcroBCopic eiamination. 
Tboy coD&ißt c*f d<*licalG and conrrc hT;;hly rofMctivo tibrillSi 
which are ufiiinllv arran^pd pamllM m dpn^e bitndk^ not raraly 
intertwinpi] to fonii n dcnw^, feltükc Htriiclnrn, and purmundcä 
bj A greater or leader L-oUvttion üf leucocyte», R^^d hImid-i«IJa 
uri?, UkCTTise. fm|ü<'ut]y protiiit m large numbors, and not rarely 
rhurrotB ti'}fital& uIbo, 

The queelioii raiBOil by the fibrillary armn^ment iue tc 
whMhor Ihc a|ij>onranco nii^ht no! ho duo to clotu'ly LipjiToxiHrntcd 
thrcndfi of nrdiniiry rnuruf i(* Lhi^iili?d by Hit? tjbrin rmi-IfdiL If 
tliQ llircada dieeolve by ailditi*>n of ncetic add or arc nindr more 
tranaparcnt, the diagnceia of (ibriu m n^urod. 

WhLlo pnruuiOEiU ^hr'iti ccapulu rnn bn Imidin rrmlily tu»«d Out] 
(brakCMl Up) ind uximI fitr cniuli iHTpuriKlDiiH, ihf arm» iiPfH*ifonKUf>i 
UniinAt'-il 0rt4£Utum of brt»mtUiuI cn>ujj viTmt» n jfrviitDr rtHÜlnnw te 
ilu'M! fiui^L^dmr«. UBiiAlly it It poBÄbEc only to break it up {tcAsvl laIu 



«nwltcr bihl »rnnllrr «lainpi, wlikh. howvtr, ajc taHy <» a f«v placv« 
fmerallf «ifllfilmUy iraiwparrq« to iIiaw th«t tc I» Pompmi.'il of a huiiic- 
fvn*0Ui« gtJvUninjr, DiiUik^t ulrriKiJi- llj< iMlilllioa at notiic add tha 
«lump« ai* mad« to «»ell (tbc piiniitat fibriHarj «tni^un, bowcvor, («9 

W TTC'iiiniLtfd onlf 1r iWTtiaiiB aiml« froni Mii; iiii<tiihraiiit wliirTt Ila« Ih^ii 
lianlfnfd fn alt^ohollp 

7. Curfchmann't Spirals Art t^ht^ww iit Fi^. 94, 95, aod 9ß. 
Tbcir riiiiTDWcopic d<;^-Ti]iliuii vill be given wlieii <}i>«ctiMin^' the 
»puLum of astbnui, in wlikh llicv nro Aimoät cjxhvtivflii founrl. 
OccARonallj thvTareaUotound ib tlidEpntumof croupoiu |rm;u- 
moaia and broiid^itift, u voll as in potmonary «douia. 


S. CrTstoli. — The cryaUls found tn tho «pTitTiin nret 
dmr(iiUT>*vd*-ii cryntuLi. fnUy-ddif QftnlltN and rftH^Iti-*, iHhI«»* 
(erin plftU^ am) linikatoldin nr bilinilrin rry!<tiüü. MucU t»i>nr 
rtrelj\ tVTOpin, Inicm» And *CTvr«I »>ihrr*i nrr föimd. 

'Die Charoot-Ltyden cr^vtali (Fif?. I^d, ^-) orv dchcntc, very 
sharply pointcf] ocruht^^lm, wHk'h occur in wry nriablc »:>*. 
They pm«Tit a Mimrtim™ WDtiT-cImr, (runnjinri'iit, «ntni-tmiiiH a 
feliglitJy yellowiitli-^n^ii, lEhinr-vinc^-likf^oilor; thry Dci:iir cithrr 
iaoUted or in i]<it» collections, vhich l^rc and ilicn; otc jun»- 
bl«d toother, or in imifonn r^y^ folbwin^ tho mm^ufi ahrcds* 
Ttty tuaally prvaont wfTlI>iiuirkod pointed «ada. Id tome cry»- 


MK-«OSt:üFy AND tUEMISrilT. 


itiar^mn or i^iirfure Imlgiugs or a peiftUijirlj imdulatetl uootour 
or tu« ftlhiimce of a point. Othcm. o|:aift> nhov, iiui««jd of thft 
smooth satUicc, liitdj Krontil^r inoqualjti:^> which itidicat« be^il- 
ntJig ilieiiitr^iilioii. Somtf J ift in («Ration fomu «an bo cxptAm(>d 
ai dorirfttivi% of the crjr^ttU mi]y by tha gr^mjiing of <1im 

TJw «tyatAlfl wflT* ftr»l fotiml in ttio iputuni by Piic<1iclFh In rr^apou« 
brvuchiti». ()ii Iho bLlicr hmiü. Lcydi-ii liiul din^ii dKnitiofi t^ tJirlr 
fnv|iiMiL AiViirmiM In a«ThmjiUn ripiTtrmjIion. Siiiiv IttAn-ftt ntw th» 
MJD« kJtid of crytt»!« in tlii> blno«! »ml "plcon of mv« of Ivakomu, tha 
crjitaU Lbtg rvcdrvd tltc Damod of both lavcBÜKitorm. 

Ad hoe already beea briefly ataUd. the crir'^taU uro of vory 
frvqucnt occurrcnt»! imbüJdtd in the «pimlv in the flpQtnm of 
broroliifll «ilhnto. TIk-^ aro by no moan« rarcly obierv^d In 
fifrriru/tU! hranrhiiiA. Tim fiu-t IhiU. Ih*- ttjäIwU (wriuir *jimallj in 
i\w. olA *pirnl foniffttioiis riMiilrre it prolmblo Hiöt thpy arp in 
■omc wny coQDOCtcd with "rcgreMi^c niDtain<>rphofiis of tho 
round cctla" (Curachmunn). Id the antboKa opinlon, their dc- 
vclopini3Dt frr>m c^lindric (cUmU^d) efllt te maro pivibable. SbI- 
knwtfci'n inv4*tigfltinDs «re in h.irinnny with tliis vimr. Thia 
authority, coufidering thfroptit^ (phybiual) nuil elieruii: dinracler- 
istics of tho crjstÄlfl. conduJra that they reprweiit ä crystnlUfus 
mudnüid gtilslancc, Tiic bn^tir the aaUunatic fubjt^ct ia free 
froiu papoiynrnft, — that is, the more tinie allowed for tho forma- 
tion of cryatalfi, — the mow donaely the npirul« arc stadtM with 
Üi*?»Ä crystal». The fn^nb nmoous iwn^Jji whiVh bavii romAiiind 
but n short time in th« moist wnnnth of the bmrichi show few 
or no crjatala. That thty, however» could h.ivc dcvf^lopcd in 
them, also, ia fhown by the exptrimcnta of Ur^n^r, who, by oUow- 
ing usthma spitttim to remain in n looJet dmnibrr, was able to 
(icritre cTyaUl-furmntioti which wna previously uliumt Cnn^p- 
qücntly the CTT^tni« which Cui^bniann justly df^i^naM sp 
"ncxidcntal fonnrttionfi" otherwise rcwmblc in erery way tho 
epiealato octahodra ohsmod in the blood Bad spleen of letiheuiia 
aa well aa thoee in tb<' etoolfl. They are very anatabla and difU* 
cult to pmeeive in pr^paratfona, but tl>ey pri?eerve their chan^ 
ten for morttha in dvc<>iupo«jiig vputuin. Th«y rvndtly ditwilvn 
in warm vrater, acida, and alkdiea, bat are in^tvhk m alcohol. 


MurKfbfroni- kxamixatiuk ok thic spirniM. 


Thty iu«y be pcrmaiuntlv pravn^ by Uig fo1la»tii|{ mdhud^ Thv 

-cmi, «abUntut« volutioQ for nhcvi drv mlauttu or for liotf atj hittir 
La aIhüIuIc iltroliol. Tlirn itiiiiird in nvak nk'ijh'jlio folulkou uf fuuhsio 
fd««H<l in lyl^t} mil imboddcd in L'annctn baUdiJL yiMtinn ol trio air 
^rkd picfurativB for uvo hoMi in abfolulc (dcuhal und kubiv^^iicut ititiu- 

gitoi rrry good rwiTt*. 

Ftttty-Aflid CtTitalft (Fig, 89) no<njr ühirfly in thn fftrtn of 
mari/arin nffdltt. These arc delicate; traa«parcDt, ueuallj lerjF 
beautiful long, curved BOcdJca which ntc acldoui isoUtcd, aud 

Fig. «U^lTBt cryilAJ Nc^afeA fc} m^ KoutU« fbj «nd Mu^a 
of Com! (cl X 3fi0. 

««ually appear arrajigcU in drr^ broom or rihcn£ikc bundia. 
Han and thoro ihey LJ« ia groups and App(?ar in roticnUr 
arraa^^iont; «o that they may giro rlM to ooofnaioD with ^Iha- 
tic fiber», M*pr(*ially when their cnnlour b very ahurplj deftnw! 
and liigfiljr r<Tfnu:tive, TUvy artv brnrnvi^r» nsvfr denilrUic Vtkt 
tbc eUatJc äben. If tho obJect-glasB be h«at«d the mxvll«« 
Tapidlj dia^lre. The; than proMnt "düUnJ^*' placi« ui Urn? 
oOAlour (u'her« iolution be^liu). B; »Iromjt protfu« upon tbo 
ooier-^hiiw *\icU I'liHM^H in forra cm al*o ftir produced tmthffut 
pftvi/tti* hfJiiinrj. Wntrr nrd nriiU ilo not nffrft Ih«^ nm!!«; 
caiutic alhnlic» diivolrc (bcin with diJTicult;, Tlic needles ara 




c<>iiiffK'U*ly (!in>lr«0 by ether flm) winu aloolioL The crystaU 
«rc coi]?(Uintly pru»r-tU iti Ditlrich'» pliipt (which wv. page SOI) 
In fetifi hnHJchitL« luicl puimotiary ^wdK"''*^- *ni«y t^f^ occur lü 
tho wmuth jdbwj»h fni^mt^nlK^ uliioh un^ i^iptM^tonikd hj many 
perfec'dy hoAlthy individn^tl^ bv timply hflurking, atul hftvr- Ific 
oJor and (^oiiAiMcitcj of «[lcivi\ 'niL9>iT fi>r]iini]ooi> Htv found üi 
Uiefltfl^fttJD^ ficcrctiou of the iiunll niiiccu« gloEd« bctwt^ra thcr 
ciTounivalInte poptllie and iJic cpislottiPi oa weJI a§ In the Incuiifo 
of tjie ton«ib>. 

RtfgtlU futty tryHftU {V\g !>0) are much more G^ldoni 
foiii:il tti llio Kpiitum. T1k'> nj'jM'^ir aw niwttc-f'irDn.'*) »-fritcfiinn* 
nliidi inav jornttimcA present great fciiiiUarky I0 actiHurnj^^rliai.' 
They never fonn largo agglnTncrAtioDa, howciftr» occurring 

usunUy ntily ne iA<tlflt<Ml nmsll mHpttnft. Tbi^j luivn a dull, j'nl* 
lovrish folor and are toiut-wliat translucent. Ifciitinp ^f the 
prcpftmlirtn, ctliT. anO alcohol rapidly Ji*8olvc Ihcm and at once 
idonlify th'*)ti jie fatly crye.Ulfi. 

Cholesterin (Fi|f. ÖJ) occura in the woll-kmiwn» email awl 
lar^*? rliornlni.' ]ihit<'H, wliitli jire Rrnii|M:'d ti>t'r*lln'r ifi lar^e imiii* 
|jL-re auppriminfMtl nm! ini*bit*^l, mtd not infa'qm-iilly pwsi'iil 
nolchtil nnti jipplikp nwrgiua. ^riii^y are aeldnm obttcn«^ in tin; 
Sputum, 'I'iiov nro moFl frixjuonUy obpiTv<'d in tliv pin-head- to 
kiilii- niiHyij pnijiftli-ydlow mii*»t('t Mtm in ncuto or chrüni<' pul* 
monvTfj ahifrpM. The flnthor twiop oSs<'nri>d tln^sr ervitiila in 
Tcry «UIi--4in»'lling, muro-piirulcrt liibi-rrulpUF »jpiitiirn. 

They nrc n^ndily »oluble in ether nnd hot akoliol ; ami 
iitsifUhh in watiT, alkalir«, and «cid«, Uo adiiition of euIpLuric 




flcid solution begins at the margins and produces a rcddiah-brown 
glietening edge until the whole ia transformed into a eiinilarly 
stained drop. If some of Lugore solution ia first allowed to act 
upon them, the brownish cryataU assume a blutsh-rcd, grccn^ 
and blue play of colors^ 

Hematoldin GrTitalt (Fig. 92) occur in the form of brick^ 
brown or ruby-red rhombic plates or columns and as delicate, 
bowed, similarly colored needles. The latter rarely are found 
isolated^ but usually lie side by side or superimposed in groups. 
They frequently appear as though they wore in immediate con- 

Fig- 01. — Cholesterin l*lateft. Crueh Prrparation- 

taoi with the plateleU. Thoy an? won radintinj^ in the form of 
brushes or whisks from the four corners of the plati>. Ap n rule, 
they are »seldom obwTved. They are to be hioktil for in every 
ca*c of pnlmtmory absffsf. Here thi^y an- usuiilly f<jund in the 
pray or browniijh-ycllow ^'ranulc?, but iilso in the tli-nse, yelhw 
pus. The author found tlu-m once in a perforati^l empvema 
and once in a case of i'roui>ous pnenniiiniiL with retardi'd resiilu- 
tion. Here atti'ntion wa« at once dinrted to thorn hv thi? pecul- 
iar s/iffron-i/clhnr cnli.r of the jniruh'nt sputa. (Mu>r-yellow 
exp^'ftoralion with nuiuertnis hcmatoulin (UiliniliiiO rr^i^tal^ in 
found in perforation of hepatic echinococcus into the Jung with 



synchron oufi oppiiiag of the 1iile-<1iict8, Iffia often in pcrforBtion 
of old pleuritit: ejnidati«. Tu tucli vawß tlie j^pulum i« cbaracter- 
ixed by a gnU-hiilcr tflÄU. Tbe cr>^Ulft are met müt moBt 
abuodaatlj m AmnUf browuiEh piaiwoa fomit! at tho boitoio of the 
«putura vftwel, 

Tlie gciK^ia of Jhes« cry^UU mid llu^ir nllwr fculunn will Iw 
dierilR»(M) wlu'Ti iltsmhing the cbumrlrr» of Ihn i<]ruturji in catxliJiC 
valraUr Icsioiu. 

Bare cryfiUllinc fonnQHoD& arc the foJlawinj^; — 
TyrwiA (Fig, 93) occnra in th*s form cf dGÜcato, glietcming, 
00lorlcfi9, coDglomOTate noeilE« wbioh uaunlly form double vhiflJci, 
Tliey origiiiflte during furtteiil pulrefflction induoöi] b^v liacl^rla 
or ft^rmeiila and are formed tmly m old pita-fod pprfor^atin^ tDto 
the Inas C^"Q Lcvdea-Kaiuimbcrt')- That a ctTUin period rf 
timo in nccMBury tut tJioIr formation ia ahowu by on ut^ervotioii 
made ill von Leydcn's clinic, in Ttrhich tvroniii was ab»«nt in 


Fig- K,— Hvmatoldin 0>AUIi. Pulmoaftrj AbBCOH. 

rapid rcm<>val of tha piie^ whilo it wnn invnriibly proirmt whi*n 
tbe purulent matter bad bceu mUincd {with Cfjicltuion of Atr) 
for snn^e time. 

BEMossritATlojJ. — Some ptis ift allowed to dry upon a floM 
elide; the crjstala wLich wore prcviowtly in eolution now develop 
in Gharactf^ristic form, and can ne^iallY bo vary dishnclly Ken, 
particularly at the uiargina. 

Tyroi^ia is rL<iidily Eüluble in hot u'ater aud aaimonia and 
diliiti^ ]iydrn<di!utic and nitri« adds, soluhlc with diHiL^alty in 
acetic acid, and insoluble in alcohol nud etb^^r. 

Lcuoia (Fig' 93) occurs ahnosL com^timtly fisäfjciatcd with 
tyroflin, but much less frequently than the lallor. It likewiBo 
dovelopft in cfinncrtiriii witli proffij ilrrornpi^silinn by tho nütiriTi 
of unknown fermenU in purulent spnluni, Tt ff»rrns ilull, glbton- 
ing sphtTuIea whicli occoflionally ihovr a distinct radiate or con- 



«ntric marking. And «re readily »olub!« in liot valor aud dilute 
acida and aUuüic», mA insoluble in «tb^r, and dm Dit-ivby dio- 
tiu|nufili«ii irom larj^ fut-drop«. 

Leacin on be dcmoEuttratod bj atlovtng «oiim of tlir ptu 
lor fiUiiDinntion to dry upon an Alijvc1*gU« or h}' «vnpnmtiiig by 
gpiitli; bpjit. 

Crjftab of tripU phosphats {ammonio-ma^ttiaii pho«- 
phato) in the vt^ll-bLown oDÜin-lid form ; calcium oAii^ftf in Uie 
form of envolop^ I'fonnd by Uog«r in uthma and by Furlirmi;^ 
in diabetfi^) ; finally, osfcium ^crbonait and phoiphatt may be 
merttionef] aa imusual ooDatitumla of tlie eipectoraltou (imk Sec* 
tion V). 

Fttf^ V3.— TyrMÜi it) and Ltfudu fifj. [AUpt i?f;:;o;irfl«} 


TLeteih^Upioihfixhucca^itüiiA ihrMsh funtri (»oot, ophtha) 
may bo biicßy ui^alieiifd, vliicli rii^j be put^ut in Ibe »pulum 
as unimportant conijtittii?nte. Tlie iiiorpliolf>v'ic fo-atur^« of 
tlu!Be forma of fiinp havo alroady boc-n d«echbod in Seotjofi 1. 
If I^Df?. tlireadliko tuugi are found Jn the vputum botli of Ibo 
foniui jiist tuentl<>nMi1 ttliould firei be thought of. 

Vft7 niiirli \nn nfirn Ilu>rv hulj bt *fcn In llie «putum Uin ftin|-niiH 
bi7ir> whioli bclu^ni; to tha mold funsi alividy cOQaiilvrcUt Th«ie aio 




«cikmi]^ 4rrrr «tvn In tlit henrihjr nlr-pniHA^v 'nit niin^ And IiwaUoiIi 
uKhi^iijE^ raroly. in <llnr4«til pcr«on« in whum dwo>rpotition fjtt^mtm 

or In «inn^Miin nith pti-iiriLiiiiiii ^ml ^'-iiiorrlmv-i'- InfaivilnEi, 

In Uiu leun^-l iciinh n»>ri' h]H>of|y-purii1i<iii, u)iiv(iinttH unly ealioo- 
pumlrnt «kfri^lnmtiun, rn^Fuu» fnjzmciilq nmy «llmct ■llrntiirn, Mwrci- 
■■»npic'iilly thptr Will lir Fttinil In adiUTlon ta oLattlp llbrni llu? iiijc«ltft 
■nd fcfiht liyphco «t m^liU. 

Uuilrr ivrtjiin dmimvtiinrts nttinitinn *houl^ be* ili [■(*!■ Uil U> 
tJic clcircnt* nf tietinomyvc»^ The *im|ilv iiiüco-punilcnt* much 
low oft4^n bl'XMiv-nucoit}, occotiioniilly fnipc rn^pkrpy-jVlIy'lik«! 
epiitiim fIkiwi? hcTi? and lliorc iflolnl»*il ntirtuh tfritUj, u:h\iUh. «f ; 
(jrvinUh-ytHtMi- f)ivtrutet. which on prt^Äiurt? ;iniT(^r a covor-glatt 
filiow — ill iiiliJitirin la iii;rrii'n>U[i fliill nr lti^4ilv iffniulive oiKviiid' 
1]uilii> — wHv^ «iiii in i^ui't lirniuJii»^; aiiiJ w^jimi'uUiI Ihiemlh willi 
i:liil>-:i1ijipcd Midi. T.vjfic adiimm.vteti^i (rusetUw) iritii thick 
Uirt'Adi» riD<] dLitjci nml oloHtic; fil>r?n occnEiinnnlly nliui occur. 
M»m- fiiH) -(U'^ft'TiopnW h^mytcjU^»^ and ftit-^riiniilc ccih» »re 
ahvays proai»nl. (hW »Inmlng, etc., ^(?e pngo S4,f 

tn ndililioij In llu»[.\ h grvat. varirlj of fi**inn fungi whoBP 
ndiiii^ltiit- with th«; tpnliiru iiiii'^i bo roo^jTki^rJ »h wholly iiitijc:- 
niticant occur in the moutli. Jf it ia dwifL^ lu gain iuformatiou 
In tliift diweliön. dl that ia oouMftflry j« to »crapt- thL' ;;uitis oud 
tjjtt'k uf tliL^ toiiLiuc with A ifpntitiu nnd ciuniiho irtk'rc>t:Lv>f]ic(dly 
the fiml»*rJnl i\n\* oliUifiml uriül[iini'*l, (\irn, htirilh\ nnd npirilta 
will thm Ijt w^ii in nrtivr molion, which in thi: UtUr cjripcc^ijtllr 
irt rlTcdod b> iu<!nK'ndrnt inovcinr-nt^, in the other* only hy 
\irtiir of Dnnrviun moWulnr iinj^vmcntj*- 

In th^ sQCtion on bAQt<*ria it ha? hri**flv bocn mcntinDfld that 
diplococci of Iho Mmo nature aa Fi'ünkclV and Frii^niUndirV 
("otTi OL-oiiHiiimilly ruritr in tlie luiK^d ^iii] ornt mucus i>r ht-nltlijf 
individutil«. Tliih ffict muni W br>nie iii mind »hi'ii an fixamiaa- 
lion of the? *putiim Tir pafhogmif hurfrrvt in undt-'Haki-n. 

^rim fcjilowitijf pulUo^-L'iiK' LdL'turm orv uf w^jt^iül impor- 

1, R. Koch'fl tubi'frh hiiriUnjt, 

It nocirr* "in pnn* ndtnn^" in Uii* h'iitil-Älm|HMl mvroUc 
p)üff* (rmifwosK wiiith thftv by their cnntrnt of clartic flbci 
th^'ir on^in from luni^-tiwiie. Upiinllv, how'rvrr, thoy must btfj 
looked for in the ypliowish or givrinigh-ypllow pii*. WJtIi '*erj- 



fflw i>xc«*ptinna it <^Än be foimd in Qxery punibnt or murti- 
piinilfnl pputnra from a Uiberculous sul-joct. M^ro fnrqiienlly 
liudiLirj eAum 11 lull If u iff a dii<?flj uiutoal ^|julum k'^^* iw-^'ulive 
riTAultti. TImL biuilli oct-itiiioiially occur in r'>ujiinctinn with 

£. FräAJUi'ji jrnnino^Wtv« ig of tptj fnqumt orcurtvncc Sn Ui« 
nihly 4j>i^riitn nf jinfumoniia püllvnf« without olT«rinff «ny haml« fur illf* 

3. ffJi-tpf4ro(^~f mid AtnplkvlfirtKti ftn* iitfl uiu-atniMon. To tbr 
firmer, «a ^h knnwn » rvrln&n I'lioln^'ir' tvilr r^n Ih> «lirihuli^il In nmnj' 
fonn* of phpuinunift (MVHh''pll'tt«iiiK 'hr oftrrr ajn ur'nnhUiii*nj oV 
«nvnl 1q pUH from atjaorii uv iiertuinliil viii[>yL-[iLO- 

4. Tl)i> i>t<tmln't Mi'iUuw ahoiiirt b# li>r>|uH| for vhffn prvtilinr alTw- 
tieiW «Kul in rniitfhirinii. h^ttlcr», itl^ 

d. JufArrf firirJf'i iirr DbHi.T^f>d In woolwrtviB. nii*|iH<krrv, tU.. ua 
tttttfrotiMtviti of puJFiiupnry iti^omIi, 

fl. Iiipftlffritt Uit-rili nrr of ntfl otily «A M f»r ii»lUe/ occUf 
In Ibf i<iipiM-tiitiifi*i] r(ir'iitlii'hn''H fnunil In «ii'intilury rrM(i[i, 

7. Influfmn hiiriUi on» foimd quilts vniiNlBiit Ijr in Ih* {mruUnl 
■jiiiluni tjf U Krippe patkottf^ 

The lucthoil* of (i*-nionfctrotirm ani3 thr pcniliftriiW of the 
mJctol>ce arc giv*'n in SMion I, 

Of th4« uiimftl pariLiitci Ibcro app«>dr in the «putiim cchino- 
eowic vwicle*. (lieUimuni> »nd cepconiona», 

TIh* ßr*t «tm finmJ am vi*ill-pn>*ffrv#*! vff»M*ii «r raanlfMd »holt 
prwnrv only hy *lin-<lB cif mmihruav nr h»»k]r1ii. Tliny cunw citb^r 
from ifko lang*, v^irne Utty rhli^lly wUk« tn tin- rl(iM li^Mrr lubr. or 
frurii ■ rupluivd Buppunkt^ ii:-lklnoooi>pii«. vhich. ü* n nilp. k ■Itiinltil In 
t£i« litvr or mon? r^n-ly in llip plrLtr», 

11m »putitm it nlM^iy* liloodj In pulmonnry vclilnoFWCUv» or, «rlirn 
iheni I* i-uminiinl^^tJon wKh Lhr Tlvn. btb «tnlnod or <H-lHir yvllo« pol- 
mtJ' Tlir tDMniLmir-Klirali' «ra tlmtni^UHjU'il l>y Ibdr untfvruil; wlill* 
»olor tnrl lhi»1r Tj'tulMicy it> rurl iroH tip» iil ihp in^rylnH. 

Ifi/Tftjtn^pjftf^ tbffre !■ wcU in fllloly lnft»rrl t»Mpr Uni'llo- pf>rf»H>l^ 
parallH »liiAtiuri. ttUhh U rli»nicU.ii»liv uf frhtaorwrir nirmAmnr; In 
Ilit> yniiii;^>r nitil tn»rp ■l.^ljt'nti* fnrtiMl liMVt Utla «irlAtUih I« n«nnlly liuUv 
linil. In >ui'h r<i^'- thf diognotti mnit T««t ii|wn <lHrclii>ii of Ihe 
ir/ni'h of haoklrlt u^nl LsoUtAl AooJtJrfn. whWh w obTiou>1y posllii« 
»TuJwn«* fil 111» HixU'rii-n of ||h* ft^hlnooor™». 

Tlfco -roljpf^ (L»i« mrvly fmiml itnd <>n^y in »n injitrnJ «latr; tb« 
lii>ok|pla. nboiv povrr of irniMmicY in nivjvli fmtrr» nr? ollcncr M^n^ 
For 'Ii-hUIImI dt*f<npU<kq. vXp . ■<<' p^l-p IW, K"!^. »4. Xol |Qrrw)iUnt!y H 
U iKCTMtj to «blrifnge Uif ■putum. 




Th« coDtcnta of tlio retiolc« b « pdtfwtly «le«r ««i«ry fluid vhidi^ 

ifc frw of ulbumln, but <nj7iuüik ■ucclnk «dil uid ^t^Jura cUorM (im 

DUUmam Fal&oaBte (Mit) muAlljr RutDifuln it« prcwno« ia Ih« 
air-rMLf<uf-'4 Uj n «lightly ttfnji^lafiit, ifn^cüld, ll^t or dark rvd-ox- 
I«*ploralion in whiuh Üiw Wooil !■ pr^unl piinct^krra er in iitr*»ki or T»fy 
decjdnll)' EU (Ai>u of Lh^ olh^r rtiintlituNiU, cnvtr?* liriitLi|lyii£» i» Mrv- 

Mirrd'U'Hjdriilly (hTf nrp ofi*fiv*i| in aildtttnn f" wlillv and ml 

wbk'li mit \ip i(x<u^iii/,ti1 uh lfiiiv>n iiviiitB oiTi *U}i ■ Imi^d hm», TL4'> 
Ani E>vi>ir] in AhAp" xni] \iii*-,v*A a thin» brown *h^l]. Tnr nit^rv dHitEif^l 
dv*4'Ti|itiort HfU [iiij^i l^^r Kig- 11T, 

Tlie ocf^uriciiiv üf fYirt^ffifrjcu In iht cipcct^^ntlDii dtrllvd from & 
Irathiy opoiunl tonmllar ntscefla, aa wpH u Itn froqu^int appnarftn» 1ä 
thn BputuiEL in puhnoniiry ^ungpont, hju aIrruJy bft^ mfprnsl to Cm« 
tiHfiL« lOlJl. WiLU^^'t »rrj<»iuJi«3]y «aw limilHf o^jifcta in byetcHL- «pulum 
{tpv piigp V4^). 


pulmonary obIcuH (lung-ttonei) nr*» vory rar^Tj obsrrvpd irt 
the »iputuTii, Thf) are ex]";i;toiHU'(3 in from lentil to btviü si/i?, 
önd have ft slA)n3r-harä cOQfiisUucc; thcy are aoinetira» smooth, 
fit othicr timce C4>vcrcd with smaU and lar^. bluut or dpiculAti* 
pncoeBGa. or are eomeivliat braiieli**ä> 'iht-y f<>rm in ivü»iEio4l 
branchial «ooretioiij probably in «uiall JivMicuU or dt-prt^^iuufi 
iri Lhe bmiLcliLu] laW; nivir in tliF? iiirfp|!i»jL{t!c], T^tjif^iuiting cott* 
tii[iU nf d nivilj whon' brcjm-Juis [ihji bu-orjic oi^iliiilii]. Cnloifl- 
cation o( the inüitmtcd tijwcA, «hich so frequently occompani«« 
tiibcrcubiie ciiifttricifll formfttion, mny also lead to Üic formation 
of etony-liflrd, coaree concretiooa, which may gradnally bocoine 
loosened by di^nl elation of the KurrouDding tliuues nnd ht 
I'Jtpt'IW hy violent fito of loiigliiiig. Filially^ ejifolitiliou at 
caldfifil liTcnchuil tjJamh aiid Üitfir appvuruucu in tiic »putum 
bos beon unqueetiouubly obaerrcd. 

If «tiiivit (m^ucnls nf mkIi Aonen aty BrrApod ofT and tltt rrArlioi; 
prodDcod by ndditlun oi Lj'drui'hluric Di.i(] it w-AtcLt'd utidrr Ihv lulcrif 
vuuptff Lber« vUI invannbly ba obirrved ilHliciL-t CO, formatijin — « proaf 
thtt tbry OTQ Gan]p<i£cd of onleium caibonalc, 

Many of the foreign bodies wbich cnier th« bnmdii may be 
rlislod^eJ and expelled by fite of wu^Liug. The «piflHin at eudi 
jmtieuLs, protukd the cou<3iti^>Il is ncute, is Lisiinlly bright,blooüy, 
and foamy, but ofton afsumcs a diitinctly fetid character. A^ide 


from a great variety of foreign bodies, fruit kernels and eeede, 
peas, rye-beards, blades of graee, etc,, are especially worthy of 
mention. In a case observed by the author, a piece of calamus — 
wbich the patient had stuck in the cavity of an aching tooth to 
gain relief — entered the air-passage during the night and quickly 
elicited violent symptoms of asphyxia, with profuse, bright 
bloody, muco-foamy expectoration- In another case a grain- 
beard, which had entered the bronchi, gave rise to intermittent 
fetid bronchitis for a period of tea years. Eye-beards frequently 
eicite pulmonary abeccßs. Israel saw pulmonary actinomycoaip 
develop from aspiration of a fragment of a tooth (see page 
83). Out of a gangrenous pulmonary cavity operated upon 
by the author several foul-amclling tooth -fragments were expelled 
through the fistulous tract. 


In acute catarrh of the air-pauagei the amount and charac- 
ter of the sputum depend upon the severity and e\(ent of the 
disease. In the first few days the secretion ia usually trani*- 
parent and watery, as in an ordinary cold, and becomes thicker 
and more teoaeious and slimy in the second, or "resolution," 
etage (sputum crudmn et coctum)^ The viwidity varie« with 
the amount of mucus, which is positively demonstrated by coagu- 
lation on addition of acetic acid. MicroscopiraUy there will be 
found, in addition to tran-sparent mucou^s shreds, variously 
shaped epitheiial cell?, espotiaHy numerous oUindric and goblet- 
cella, in a more or k*s advanced stage of mucoid change, as well 
as large numbers of round cells wiiich prc^^-nt feature« already 
described. The thicker and more opaque the eocretion, tlic 
greater the number of pu.i-cells. 

In cbronic catarrh the cTpectorati^'-n is almo-^t constantly 
muco-purulent in char3ct*;r The amount is i^.m'jtimes ^li^'ht, — 
e.g., in spite of rt/ver*-, ai';n'avaiin^^ t^iwi^h In "cat'irrhe i'-r." 
(Laennec),— fomelim'^ reniarkably profu-e. The lait^-r ii kVj- 
ca?e in bronchohhnn'frrhen, which dep*n<]- up-^^n acute exaj-'rr- 
bation of a throiiie catarrh and v?< ex< iied tlifough "coM*,"" 
inhalation of m*:tl:aiii'-all;.' or ehfrr;;:« ally irrltalin^ .-üb-unc»^. 
or — what is moat probable — by infr_-tlJ'»U5 or toxic infiu^ne« ar^- 



iitg from <!t^cnn^ petition of tho f^^rdion. The «piittun ii tfai 
m|wni<it ill hrjtt' unmiint^^-nnf^half fo one tll^r and more- Tb» 
intlmdiml m tic (i-puru lent »puU an.- vu1uiiiiii<»m «ni! an- uHuallr 
CQmI? cspwtoralc*!, ^\* a rule, ilintinct »trati^^üi'm fXTVin», X\\e 
put K'tllinjE to the* bottom and tJiv mucu» oolloctinjc attcnc m a 
chüdv. *rTo-miic*iid layer. In riwiy eft*!!* tht- lulli-r furtlicr 
&e|jfirjitt'S into luo lajers— abovj* tla- pii* «trutum Un^rp im a, wrfiitt 
Uytr And hIiuvv llml u inucn-funmy Htnitnm. 

Whllt' ti^n^ \fiv^ 4Titfiiinl4 o' ipiitum tinn hi? rainwl iril'i^tif niiit^h 

*r™4tf, Vi ■ccuiij|jiLj|M tiy »ovi'jv »tllimntU' ill»liiiliumt", Tlir *iiutiiiii 
la aUo V(*ry profiihi*. riin* |o cihk bihI «im^-rmll Jircn* in litflnty-f^ur 
ligiLrf^- hnt ftif Jr-M »v'r/ilj/ tvtluiut. iiU'ri' n>-rii mix^uM foM/hwii Iiiii'iittmn K 
^uddrn r\utri^fLlttiiin of cliicujie bnnKliilLci (folIuHidtf «-vric L^ildtt IT^vr 
not lu tho dtTtlr>j>fikcnl oE thi« oondtlinn: nl'O flm iWiDaFj eo&tnu>t*J 
kidiir'y Lh htid lu favor U> ui't-'UrTi-mH* |8trUlnp«'llt' 

TIk' »puUim of broQcliicctiuta iK-i-uijktt » t-|HH.'iHl puHition. 

Ah (a kTiricL'n, thp'f ilwHup in I'yiLiiilriii «nd hHct^iil^lml fnrm a« fl 
FMull of frt^urni nnitc r^XAOPilmtiont of chrcviiij bntnoliitU, or m the 
ivflult uf FuntiDtHlU- (iroiTuic* octiirjinif U tht ndjrLUirhood uf th« 
Ittmu'lii, >üh*ll»ir tli"« tiiv dui» Ic» nt-atiii-ml adU<**iünj. of ih« [rkma ftf 
to ihHnETkmutrkty lliK^kminjE t*i tftf inlrrlnlxilttr ruiiurt-livn li^ur «Ktfrt' 
lli^ iirrnitun' and tnieliun i]]>uii Llii.- hiirdiiA vf lhi< braJU'hi nnd pri-vcriimg 
iLiiLfomi di>tHbuiiuii ^if tli« rraplroil uir Sti^alior ol tli« u<>iiiillj larK« 
HimMiril, cif Hiii-(i<tir»i Hnlroi-nti'J !iy Ihf iiiirnini-il niui^t'U» iitiMiil>iaiir ^ini- 
ihicr^ fiir|lH>r jiji^'iiivjilioii Thp iiuii'imH {iJi-ri»1ii'iinir ih jinrlly Jitrii|ihi<^ 
«ftoQ gnutlj-, thiokt^nixi- tUe i^|>ilhidivni in u-onNj' nU^ rnl i m Dddilinn 
tu ^('11 f>ri'nr(vit! t-^hitdiii: vti\>, Uu-ic AJV t;hit-f> found CT'lihcli« in aq 
oc1vnni'44l hiiif^ of miui'^id i)i<^Pm>i'ni1i:in nml d^prLvftl at tlitir HtkL 
Putrid d?*'uiit)K"i>(iiin Ltf tha Lii'nduhirctAlic cimiLontM in^y IcncI ttt iilfcni' 
tivir pi(i('L<!«nrB ri.-«ü|liiie üi the dtvrlopmrnt of &ii titrating ravky. 

Th'* i»j[[MTh>rfttinii \* L'bnnu:trri/i'il hy lln' ttivi lliut the InrTl* 
viiliinj Ajiutn au* \t*vy vnluiiinoUH imil »tv rAjn-'lIt-tl m liirge 
amount* nnd in <|LÜck «ucccssior by (light I'fforfe of ctnighing or 
pn««iirc mnvi'Micnt* ( conflo<:fiK-iitiy "mrxitJiftü rspfctaryjlian" 
ia dpokcn of) ; it is thin, muoo-purulent, iieniilly "iwipid" in 
odor und only occnnioiially ofTenHlvc, nnmnly: when nruVrgotng 
(iMTHTifmsilion. fl iiKiirtlly ■<'>[iitmt*^ inh* a ]Hiriili?nt and muoo- 
wrau* ijiyi^r; lew »fU-n into ilnvt lajcr«. 

In ndHition lo puR-corpiiaeU'ä (which are uaually decidedly 
fatty), mncoiil Hojfononitwi epitlioHa. ond oonntloan putrefactive 
bact4.'ria, m<ii^ywn ^rjjxUii» aw of not iiirK-nncnt o^eurreaoc 


Much more rnn^ljr J^tcin nti'l Uirnn» nrr fnijiid iii t'TA{}i>ri1nl or 
lined prV|mnitioikti. Thi» nulhcr hn» tirrrr »wn cin^tic fidcn in 
thiE rpiitiiJtv; ndinutnro of Mnod ifl not infniiiHtitlv mvl willi- 

I\t>imi|«miii<'n ^f the? bnmchit*tiilic ftwnytion ffivi» rin.- to 
f«ti(l. or putrid, bronohitit. Tlu* Sputum prrvlbcifd in t>ii« tif^rc- 
lion [^ usually yitv aluinclanl. t]\rly ^-rei^iiiuh or moro grayi*ih 
ffpi^cn ID color, u^imlly liijni<], and cxtromclj' olTeivivc in odor. 
Ou loni- utamiiiijr it alwuv* »cpantott inl<> thrtt hyrn. llio up- 
^nn-^t of vhi<li U tiirtv muc-o foninv, witJi Hiacv villf^u^like 
|jro|i>Hpttioni( Prti'hinK '"I** <1*C tnM<lle» dineolort'cl, ^rj-i'iiUh- 
yHlow, flutti InytTj wHiIl* th(? IriviT Ihjit n dpnuHy piimli*rit. Ira 
(Til' !rtlti-i' nrc Mj>[H'rn!i'(l iJ»' iiüimlly ffiul-^rni-Ilinjr Bittrioh 
pluK^i Mio form aiLil coni(fc*hion (fat-nccdlo«, bucUxMi, etc.) o( 
which have ali^ady been describod (pag^c SOI). 

Thp fipTittJiTi o1 Abtinotii bronchitit procpnl» a (Ipoidk^fly 
ehffr»cl»wti^ npp<"arnni-f* This .fw^n-^ in iis primflry ^inn l« 
diivfly olw4cn<"d in joang or nitdille-a^i^il *iiljWlji. and nboul 
twic»? a« ofti?n in iuaU« a* in fomdl«*. It \a H-lilom tiWoriwl nad 
th-m uBimlly na n chrrtoic affrdiim wbieh is ['iihj<'cl to oxnccrho» 
tjons ftt ^i-ry ^anahh iiit'^rvuU, I'horc i» nut mudi doubt Ihot 
many, if noi dl, tafan of anth fibriitous br^xidiitit nn* oauFts] 
by diphthrr'm, Thr niithcir «iw fhv Fticli i^*«* in wbJrh bnr- 
UTKifci^io pxiimiiinti"» i^>nf]rntrd ibr dittgnnfli!». Thv f^puliim ü« 
Lipiiiallv pmfii#<?, rnicoid-fnaiiiy, and I'ontaina a# cwcntial con- 
!»litu<:nt<i the cro^ipoua bmi;<rhing coa-ulfl. niroady drtcriboil 
[p^iXCB ?0{>, :;o<j), Tho»e ort* flomi^timrt ri'ro^riisivl nl odco, bnt 
nHire frt*(|uently they are conct^lcil id tb» itputuni^ Ax Ib'^ir 
eipoelontl^rni tiftrtj n'^iuinat pn-Ml i-fforl, (Iw »ipnU nr\' iiMinlly 
tiii;ic"d witli IdtK«]. In ndclition 1« (hi- mnjcul.i. Ch/irr*ii'I^eifiirit 
CTytUlfi nri^ nol iufrLJuiiniHy obw^nwl: low oftcD Cursr'MWinn'* 
gpiteU Mid jrrnmdnr blivj^l-eolorinif mAtttr nnd tiWl m^ro rarefy 
^i1iil»i1 rpilholin nrv *«m, ,\* onn^poac bmnrliili»: ir ^xx'asi'^D- 
allv oliht^rvin) in tiilx'milmm Mihjivu, It h «dviinbEe hIm ti> 
ciAiiiinc for tuberrlc bacilli. 

The sputum of acute cruupoas pncninoniA vari«e In eharac- 
ter iic«»rt]iü(r \o lh<* dtlfer^iU ^Ui^-r^ "f (in- aiTLvtJon, 

1V# <!l4tiii|riiiBh in toTttf pimtmoniB llinv *lfL|EV« «cc^rdinir ■< Ifav 
afffrtrd pultnomrT^ artn ^hovr^ more ft If** int'iTH' hypcrfmi* Imncf«- 
llun), or Ü» fornuttun 4tf txuUaUov In Uu BJiiMti and bffi>ii£liiiijeii, or« 




Anallj-. TMoliilion cf tha AmdAU, In tta* beginning Uib rftpllliiriM ^re 
grtfliry dt»1«ndcd mith liloftd^ thfl BandAt« I» at firirl nioro »croiiUp luli 
H'ljUMiLly rtitriKit«] »Jtli £TVui tiUTnlnn of leai'ucjl*.'", ml bltiiKlTUJimwlM, 
Miiil iiimiprimn flnr iini rriAru. iimicLlly vb^i^ilf i'llnpil, Ahrin fhri^h«!'- 
Jn the Blo^ of molut ion, the rtd blood «;orpu#c1ct af^x^nr dd'olom^ the 
lioiGCPcyU» la grmt part f>itty dc^i-uiiriilpd » &iid lli« tüjiln in *n aJvoDccd 
ftlatd af dUinUgTAtlfrn. 

At tlio öüi*€t of tbe Oiaeoao Üxo «putum ie ftcimtv, very toapli, 
snd sticky, and yeUowlah^red in tolor In a niotlL'rot**Iy tliia 
li^«r it Ls IrutLciiihrtTttl. Owing bi tlie vIkJiI cliAmf^tcr nf llu^ 
ipuiunu it cuu be uxpocLonitiHl only ^vitli tliiUniUy, Micro* 
KOpicAlly it consist» of mucua prccipitaUle by acetic acid, red 
bloodH;orpaR^<« usually arranged fiidg by udc, and frrah and 
old (soniflwli^it grnniilRr} round cdU, 

In the second *tJig* tlic rust-colored (rultigitioaa} or saffron* 
eohnd (cTr^cea) or morp bloody-miiTOid ('Mn^KinoJ^nin^ ^pnta 
coalesce to fomi a thorougbly incoq>orated tfTi«i<i<4itri iiihah, ^(']lLrl1 
adheres to tbo eputuin veeeel oud chu be sr^jJumlLil only vtiih a 
nccdlo or acieaon. If Üic vctecl ia tilted, tbc frimtum oftea 
ntmuiivtf aUckinft to the aidci^ or the whole mace glides out very 
tlowly. (Jwing to th« diflk>uLty with vtiicli thfr cpuU ar*^ rxpp«to. 
rnirt], Oiiry c<'iit^>in niimcniuM bir^i^ Air4)L]bl>lf«. CorriKpouiling 
to Ibfi fibrinous cxTidnt^ now poiirr-d ini« tho jilvooli, they pR'WTit 
»mall. light-jL'llow, fibrinoua clumps or the abovi>dc!*cribcJ fibrin 
ikr&tdät vbich ore not raroly fiingio or brancliing. Tho^ dbrin 
thfoada ore Gnaily diffopeatialed from Cur&chnwnn's $pirtiU, 
wbitb lire alao oocMioüaüy observed liere. 

In addition to the characteristic niBt-oolnred sputum muco- 
puruk^il Hli'L^alta ncid llot^euli inv ul-io ob-it-i'vcd a* a. reauU of ttic 
occtnjipnnying bLOiichhil catarrh. 

With reaolutiou of the exudate (tliird sta^e) pro^jreeai« 
decoloration of tbe aputum occur«. From day to day it grow» 
low yellow in color^ böoomee niufo-ptimlont. adlieroa -liphtly or 
not at flll to the wnll of tlio spiitiim vessel» and nmy be more 
readily povm-d out Jn si-pnrnto purls. The ixiiu] musa inL-na»«» 
and the cojijfiila dit^ippcnr- MicrGn:iJpiaiU]f \iicrv are found 
ctdufly ivuikI ccIK far advftn(.'(!rl in fdly drg^nrration ; aiso 
granular cclla ^nd smnller and krgcr drupj* of fror fat, isolotcd 
or coHoetod in .tmnll dumps. 


Many dmnaii^rv from the «ppoarancce of tho sputum h^ro 
do»cnl>od «r« not infi«qu«iitiy obeorvod vithout fioy appftr^t 

The ruät-wjbiL'tl apuli^iii may be ropla^'td Uv llmt of a dectd" 
etiti^ bloody cbnincter. THi» occura m Die w-olled travuiiatlc 
(ooBtnaion) pncunaonia and in «Irunknrdd. Jn the pnoumonift 
ACOOmpuiTiDg congeatfon of tbo ]<itc&r cir^titation t^w Amount 
of DcoiJ in th« cputuin is nifto proiiotuifL^J, but tlio i^uantilv of 
ranctiM imd (-iimunjurntK llif! I^niu-il.y i« 1n«> mArkrvl. Tint injlor 
(st first brirk-rcd) And dinractcT oflcn nibK^iiicntly npprosch 
that Been in iDflammatory «dcma; or only occa«ioDal epntA arc 
Cipoctorakd withcut the propiosifi boini; altorvj in ftoy way 
thereby, iml«e)4 the deßciGncy of «i;p«^o ration ia due to grifft 
general weakii«]^ of tho patient Wry cJoudy, opaque aputnni 
U pr*-HuiL fntui Iht^ Yi-ry Grat in pntftuuoDin utvurriitg in i»eo|>Ie 
miiTcrinjE from pre-e.\i6ting bronchial cat^Trh. In nurh caM» 
nst'CololTd admUturca con bo obftor^od only on careful ciam* 

Tho CTttnpniift pnntmr^nia in ta ifripp^ aUo prewtnl* a uiini- 
lar appearance. Frf»m the flrst tho expertnratinn here mn^wta 
ftf mu(t)-puni1ent or eveu punileut-iiiuüoid, oltoi luuipy apula, 
vhich but rarely poea<«a ft pato-ro» or nwty ahade of color. 

Jf with the pnrumonia there i» co-cxUtent klrru* caUr* 
rhalb tho iiputnn: often ahowv a difittnct grctnisk ahadc, o«inj( 
to t!je admixture of bile-£?ol coring matter, which ha» paftaed frftm 
tlie tfunee into the afiutiim and vhlch ean readily be detected 
hy the well-huortn rejietii^us. 

Frmcuiic«! fiTMtgnm flatntPQ ti nUa obun«d la Hflaifr<i nto- 
lulioD <j| lU«t ppfiuntciiic ciudiilr. A« \k fuk% itiU 4WuloTntii>n i« of no 
further pr<ipno4^llf »i/Tiiflf»nfK Id m nuuilnT of iir^unliirly pn>(T**»lDg 

Titiiibr hua ilrdWD nUrntioQ jaad »nprdiae U> i\\v auiIiui'k vJiprnt-nnr. 
Justly ua). Ill both IntiJini«« tJi« pnen atniriiwj 1^ '^TpffFitliln tn tniia> 
forukDti'?^ r>f thti ttlonHJ-ouIcirin^ in^ttirr diuolvsil m ilw «jiutiim uudar 
thu Ul]ii<!iicT of oxyi^rnp" u ib «Ibq to I« kvd in llip ni^ly. ydtov, abI 
l^r<«n ctlwoTomiion cnvurrinj^ In ttc UikhI H|ioLt tn bruialrp cl tht ifclD- 

In delayed r^'folution unnmnliy intctM» mlfntn-f^^nff 
exporlAration ia nccapionallr ob»crvc>l 1'ho autliot baa ilr»dy 
atated that he ha» «een id ene caao of tltia charader bcautirally 


iiirmjtftvt-y AND rutaiisTJiy. 


fonocd hematoidin cryslal plaits and neodtf^. Tlvtrc irofl no 
rea»oa to «Ukpv^l the f>n.'»tnc€ of an aIim^^^i^. 

Id pKnimoaie of ehitdrfn Xhrnn* i^ Uhunlly tii> iLiniluin t^ b« ob- 
KT\Til, Im-.nm- it in jiptirrftllj ewAlldnnl. Tluit whkh i« cX|v*:ti»«Uidi 
hawr>viT, iiflMTi kIiow*, (»v*<ii in >fl"iiiiiiii' Tnbnr phnimnTili, a niiri|»lr 
Mt«rrhql «harcftor^ aiM ji aal ruflt culiirc^t^ A «loDilftr Appf^rancu of 

i»l ÜII» (U^n/, miti 4rf till' infli/n/'. 

Thn mifnrtiiriAlHy not nir*'ly fatal t^rmtnnlion fti cmiipoi» 
pncuiitonia often cccvra u tl» n«ult of iaflaniniatory [pct- 


Tho «pntnin ie dctjiUudly liqiiiri, tSaik brown, »crortiucnd, 
Svamy, joim^jnif^e^fike (jnn d<- prunraus, AnJrnl)^ M\f\ profu«. 
IVU'irt'ii llii* s«cTn-fcmin> |inrtinnn Www niHj nflrn hn £iM>n fnorr» 
tc&«ciou» »piiita df-mci] from Iho ^cEuinc crQU]jou» iDilHimiia- 
tioD, t^liich alick lo^'vllior in ii (iTm, i^olitrent inn^? uniJ il>.Mt in 
the browuifJi-rcil tluid. MicrvvcupMully ihorc are foitod in tlifl 
ljitti?i\ id addition to r«<l b]ood-cor|fuac»Ice, only a fcv eellfl» wbila 
in t]ii.' forriiL'r. afl^^r '''feHHtn^/' tliE^i-i* um hwu iStn-iu c*r>a;;i]1ii uud 
uumr^roiiH uilorli'sa b1uu1)-t'u^|Ju^L■ll» (U'luin^ylis). Additüiii nf 
Acvtic pir.irl prrK]iirv(t »nly a i^liglit procipitjitc in the pivparatlon 
tnkcn from thcr fluid portif>n, while, on boilin^f, q more or Iras 
thick consul Jill nn ie ohtaincti, tnflicating tbt? prn^(>nn(r of a Urga 
amount of AlburHin. 

TIk» HjjiMiiin juHt drt*(.'r|hed alwnj« rtiijr^'<wt* a wnous, if not 
Ü filial, ijnr^üijHis. TermiuaUuß Iii puhiu'imrj K^u^reue or 

flbsi'rw ii* vri'v raivr. 

Ill gangrene (Ik' ^pLituin i^ropi^utr; u cirtain ^^ntilnnlv in Ihat 
jiul rfom.-rib['{L It i^ bj no rn«iu& rure to oUwrvi', on thi' mlvcnt 
of pTiImonnry jiuo^-^fCTio, thai th<* pnnioii^ly tt=na*'biii: nibjgirjoii* 
»|iiit.]i[U iHvninL^ rnorL- Huid uni) brrrwiiihh u\ L^ilcir, wjt)ioiJt at 
ünt pi-€i»enLiug llic pntrid, »tinking« pnthngnomonic chnrncteT, 
Munifirnprntlly, in contrrtnt t" tbt> (}rccc(ling form of expcclom- 
tif>n thv TV*\ lil<K>d-cor]iu*el*B aro abiiost wholly Oeetroyocl; &o 
that tlu> majority of Ihcm aro in the form of "cbadowe/' In 
iidditinii Ihcrc mjiv br *ih'1i sniwll nuA largp {i^tHtif-fhrfflii^ whi<"li 
nn- niLimlly f4>uml in Uli? bUrkip]! fragiucuiba jirmuut in tiio 
«put urn. 



Aft already mt-Dtionw!, tlie »piituin very wdd becwmi* 
utreuiety olTeiiHiie in tnhi. The bruwninli-reil co!t»r ghw place 
to A more f]irt^-f^Pciiii<lL i>r f^rtxa pJmilc^; lli« iiiijudily U coq- 
flidcioblir incrniiAod (onc-fourlh to oni^lmlf litir tu Ivonty- 
four hour») ; tlcc (v>njiiLtüricy itt lujuiiiiiihixlf utuully tltikK A^ 
fl nil'% »rpnrrttion inUt thrf4 lajifn nipttllv Inhn jihm*. The 

mucd «ith air. whlcb partly projrct in villoue form into th? 
liroAti, üirty'jE:ro<'Di^li liquid layer The lower Inycr* vhich i« 
i>£ variabit? dopcb, i» com[K>^oii uf thii<k, eohoront pus in vbioh, 
in addition V) tli<? aln^ady «lotKnboJ l^ittrich pbipt, tlirty j^yii^h- 
yollovr. trrrgulflrly flmiirt'U rru^[:it*rib» ttrv imbcitdt-HK Mirro- 
icopifnily ihrvc nrc urualljr fmiiid I41 be iMit-'Ak coimcctiv^tiMU« 
»hmU. whirh fmrll tip in arclic flcid; thi^y ätc »urroundrcl bj 
m^'rwls of bnctt^ria nnii fatty «fiitrifuira, fitdm|i£. fat-nocdic«, 
and durk-blnckiuh figmrnt nnd htimwifb-rin. Hnniitotdin cryt»- 
Isis nn? ^rry »clrinm fmind, honrvrr. l^laaiic fib^n. which arn 
ofti'Q aWnr. iJiiiWbti.^lly nct^ur in pLiliriOTury gflugrvDC, a^ ha« 
alivwly been »lentiünt'd. 

'V\\v bacU'ria ottorriiij,' in tlie «pnlum at oooo remind nnc "f 
{\if appoimncc wbKh inn aJwayv bo ohrfrved la tho Eetntbiu of 
utk-Il^qq mm:lh«. In addition to tars«? nunibp« of i«wi there 
Bpp rt-t-n bftpilH, it|iinlta, ntid Ibc b»pl<»tiirii'inl ibn-Hd* hr-lnii^jin;; 
lo liie algn<i int>rcT mnrly> nW, m^^cmioiin» fonit^ Tlic ?mrEie 
flora ar& obKrrcd in the frn^ent» token fnvh from gnnirixnoii« 
csvitira opened \t*t thrrapcalic purpri«*- 

Of du;i[noi*lio iraportancr ik the fttcum*noo of yntudo^ 
MffiU baciHi, iriiich con be diktfngHmhpd from Kochfi tiihrrrin 
biL'illi i'liTy li_v mn*fiil ntainiii^ (miv imp- TlT rt ttrif). 

From Ibin di-wriptum it in ni'n tbnt l\w «pittijni nf g*n- 
p^Qc rc*cniblni that oliiunxtl in ft-tiJ broui^hiltc exiwclorati'^n» 
Indeed, the mwmbhinco may be auch u^ lo render the diai^ofia 
doulitfuL In meli in)«tniiL\'* tin? duteclinn of tittn^fm^mfnU, 
whirh may ur rruiy nut rcmtniti f»liiMir fd>ers, «ill decide thu 
^iiwtion, MiipLiUiotk of tiiKuc n«v«/ i>i?riit> in frlid ImmchtliN 
but ifl Ibe rule in j^ariEmie. Xot infnH|uf<iitW fi-tid bretudiilis 
other p'>rti'>nfi fl tlir lan;{ v afW^einUHl with )(An;n'i'De. 

Pulmonary gnngn^no ocinuiionally follown crotipou« pneo- 
IDonia; vhpthrr it is iKually Ihfr gi-nuin« cmupaiisi form or not 



n]ipoai« tö Üic aiiüior to bo very doubtful; more probablj it Ib 
preceded or ic^companicd b)^ (he aapiration of leroi^ nbstuiflW. 
Ijirgp foreigu bodies (pit^w of lone, fith-boDet, fni1t-«taii«, 
LuUunH, tftc.) iiiny give? nw tn pnt'iimniiin juiil gnn^it^e even 
after long loilgmeut. FurtiiL-rmorc, puhn[mni3' |::u]gii;Dc nmy 
develop in fi^tid bronchitis nnd in »Tippurutitc und putrid prec^ 
QMei ocuurriD^ in tho luiigliboThood of tlio bronchi. Fiiuilly, 
embolic procvA^o« in tcpilc t*cinc!itinii6 and injuries of the tiionuc 
niay nvnlL in gangrt'nr. 

Tbc principal cliaifictirrfi of the aptilum are tfie same in all 
casMj ikflmctyi oiTc^sivc odor, fluidity, pna mingled with tieenc- 
ehrodB and fragmcmis, with a constant tendency Ic eeparate into 
Utre9 lavör». 

The appeAran<.>e of ilte i^^ntum ia dtir?reiit ui polBMiuiy 
absocUp Here the expix-lin-iilinu pri-seuLA n pumlj' pumlaat 
character and l eliglitty atala odor. It is pmfuM!, (r^peciallj at 
the ö\it[*(üt, occnsiofljillv bomg disc^hcirgcd to tlic nrnr^imt of from 
onc-httlf to one liter in twcntj-fnur hoiinj. On standrng» separa- 
tion into iufO distinct loyer» occurs : below thn aJightly greeniph- 
colnrnil, liquid nppir Ijiycr, thtTe is i^cjiofeltJ^I a unifonii I'-oKcivnt 
mass of pii£ in ufiiiJ], when spread out, large ^T&ylfah-jollow, 
irregnlarly ^rratcd or ^lucwhat amooth fihrcda or «mall, ^cllow- 
ifth-wbite or blatjkish granulös and yellow lÄh-biow» flocouh caa 
•omoUinü» bo found. 

Mirrmcopimlly tbe shref^s kIiow elnstic IiImtb arranged in 
altcMilnr fnrra uud dense und but Snlightly torioous flji'nndif ; tht'tt: 
arc also found a great number of microrocci» «pcci^illy the 
tiijffihylococcus pyogenes atirius, fat-cryctAl» in tbc form of 
ne€(lloa and roiicttt-^A f^eo page VOD), and decidedly fat^ pue- 
celle. Finally beautihil heirfitcidin orystaU in neodloi and 
platea arc not rardy found in the brown 1'>ccvili- 

If the abftce*« follow* croupous pneumonia, the expectora- 
tion is oftoD niisced with blood, aad thOD hoe a ckocolate^roiisn 

The? sputum ocjcurring in ckri>nic pulmojvjrj/ abftcfag prMcnl« 
a »imilnr rhnrucUr The ptis i» profu***, but iiwirtlly contoiiö no 
t iwup-aiirrds or only niicroscopit cvidcm:n of d[&infi^n*ati"Ti 
(clastic übers). Hrmitmilin c^y^UU do not occur, but von 
beydcii has oct^iuionally found ohotc*icrin. 


It h plffffi ihei the »fiutiun in perforation of empyemB 
iiiueL jkwit« gfi-at nimilnrity lii thut draefibil nbuvr. Tliu 
fiputum »a likcKJ^c pHmlcnt and inlcrmittcotljr di^rhArgrd, but 
jilMFfij» murJi more pr^fupc (nn hijdi oa from four to Ero llient in 
lnrcntT-f<}ur hiMirv], and pro^nU tho coihg Flrßtilknti^n and 
ftlmoKt the tame mi^ri^t^opie rhnrflotpra. At a. rnl^ hfivrv^r, 
tliG ÜMue-t^hrcdE are ßbecDt nnO plastic fihvrf- «rn nnl^ ociuition- 
allj obwrveX F&t-crj^UI*. elc, are proeeat That fyronn is 
otiaervcd id old suppuratiöu) m tlic pleural ciivitv wliicli occa- 
Aioadll^ fr«e)j comtntmtciLle vith tho bronclu has olreudy boen 

In rii'w of ihti fnct that flrfinomy^r« mitv give rwi* to mul- 
tiple al>»crw% ID liti^ ]atig*i\f*\w, r s<inrch for the ra^fungiS4 
granttia should ht tandc in every cose of pulnionnr^ ab»ccMi> tH« 
Diij:ij| of irhich cannot olhcrwiBc be cxplmncd. Tbcy appear M 
ydJovish-Hhite ^mins» about the siti? of a inilL^tMcd^ ^o micro- 
scopic appo«ranee of which hi figured on pa^ S3, 

Th« gIaiTi^<.'rH bacilluA fllKtulO aUo he sought lor That trpto* 
lltrii and CL'i(Titi^r>njLs may occur in the ptu of an abaceM-cavitj 
in the ahemicc of anj pn>of of tiicir patliogvnic couuection v\ih. 
the procc» hji£ been referred to or pajrc« 01, lOR, and 816, 

Finally, it muiit he rotiicmbonn! tlut ptirxjlynt *^utiuu may 
ho inr^icAtm of rnptnrö into Ihft )ung« of nn echinorncnt tryst 
of n<*jghh<»ring part«^ When a eommiiiiirjilinii viil\ the bile- 
diaunela exiat^ tho fputum prc^onta a diMinctly ocher-jfcJIoig 
oolor» hafl a gall-bitter tnfitc, ocd givce a dielinct roAction for bilo^ 
coloring matter Mi^r^i^c^picaUy there aro found, in additimi 
to the ahreda and hooklels dcrlred from lhr> pRrn»ilJ>, h^antiful 
bemnto'iVlin or hiliivihin r^rj^uU. In a ea^ Db!r»T\;xl by ihe 
«Dtbor there nrrv uIao present niimcroua chioteAlerin crysiah in 
■dditioD to «hreda of membrane. 

The :iutlior ^^uld cvpocinlly emphasise that ho alto oitf^ 
oba(T\cd tin oolier-ydlov ipulum lii a ehronlc och*>^eolnrpd 
plniFol »tiuTntts whk-Ii nciTficmally etrnnnuDiciAiixl with tha 
bmtichi and iMTn^iittinl the iTrztiw of n peculiar, gliatening Quid, 
rich ill cholei&toriii («e page 210). FVhinococcaa waa oertainljr 
RoJ prmmt. 

Tk« Expaotoration in Pulmonary Tubtrcnlixi«-— Althmigh 
every aJTort hat iviym the eiiTli^t limn hwn ntadi? to deteimiue 




n^rtnfn fenlnn^n m frhanicli<ri»1io of phthUi^ »putuin, obti-rvei» 
htviv bwrotiii! iiion- arul mon* (vjuvimTLnl of llii* uun'linbilily at »urfi 
«vid<^co III txact f^wit^ir^ Thf only positive proof of the 
exictenoe of tubtrculoiis ii obtained by fftoinine the tiib«»ifi 
^aoUU conutn&d in the iputum. All olWr fi-ntunn; of \ba- 
tpiitiim bnw btit A r»*lHtK-i> vaUk'^ «mc* nontitlxTruWiK fiiibjpt^ 
niajr L-AprcUinilc an cxaotlj itimUur «puUitiL NVicrtWi^^, ihv 
eipcctoratiou of tuWcnlous mvlivjJuitjA or thof^ »u&pvctcd to be 
tubwculoua dcinanil« carofnl coiiAidcrHtii>u for many roftiwEe, 

The aputtini U nmoo-imnilwit ©r mofQ pumkut-mucoiri^ and 
qiilte tiioroiigbly ii:i<?orpopat*»d. Tbo fonuor occurs wboo no 
d(*üuK<ii iliwlriittiou ijf lisuuo hi» riK vol (K.vitrriv! nnd \% wholly 
iiiichrtrai-tpnt'tic; on the other hanil, the K'tr-n»! variclj, whii?h 
occur» with tKff prctcticc of cai^tie^, prrMUt« typic f<-*türp» wtiicti 
iiro worthy of mort! cTrlniW dcAii-ription. Thia tpiitiira i* chitrac- 
roriac^ hy nioro or W^ num^roHs "bfill^*^ " Urg.j ßlohulnr, diB- 
tintrtly pnmWt mnüis which prwirnt a rougb^^d and m^isipd 
eurfarp. Wliwi ilt^puftitorl iijim a hnionth »urfoce Uiey spread out 
iuto tin almoat round furni nit'] art; Lhi'i^fore de«igDatcd no 
nupi^iular spuia. If tli^y arc expectorated in n rend oontaininf 
water, Ujoy t>fteii tiuk quk-My tu tho bottom (fnndam petona); 
olht-r*^ prtvtntod from sinking by tho pivKMcc of iriucoiit chrodit. 
nrninin upon tJic »urfn™ mul fifint thrvrc on ovoid or «phtTk 
inatMw ('jlchosum). In the laUi^r ii»n*w*, pRrHciilArly, tht ft*- 
»urcd character of cavernous ftpiktuici can plairly be soon. TFjc 
donecly globular, alitjnet air-frco charnctcr of such aputiim pcr- 
mite tho oonchi^ioQ that it onginutcd in a cavily, bidoo otlierwieo 
a large nmoimt of sir would certainly be included by grndu»! 
formiilion of »uch. ^■loEjid»:'^ in Ibe bronolii. Tii iidililinn to Ihi* 
globular »puUiti], liowever. Inr^ luuouut« of mucij'putuleiiit 
□uin>ra oftcu occur, whidi obetun- tho cUuraetemtic fealurtn. 
I'urthcnnorc, Bimtkr globular i\>nia arc formed in other oiul 
uontuberculona cavities, especially in «aeculoted broiiohi^^ctnpis. 

It U by no mcaiiii rmx- for tlii«^- otlif^rwiw^ i«obi1rn^ tniinmnlMr 
spiitn to otjfllrsre. TTnilcr such tinunjelancf's iL i# i]i]if<" dilUcnll 
to mnhe a diagno&iä from tbn uiiii-roscopic appcnrancc of ttc 
e:rp«Gtorfltion, for there ig then teurc^ely any differenoe betwo^ 
tbo tubercidoiie oxpcotrirattr:in utiil that pns^mt in e^vere diffneo 
broncliitifl or bmm'hii'i"in*irt. 



Of KT<mt Trtlu4> in nch case« u tho fnqacnt admlxtiu« of 
blood. Ai huE nlrc^y bmn m(*nlL<iiiodt thin blitol ni^t infhv 
ijtimtl^ oi^Mtni fr4^. It «^^metirno AmirA nnljr in IJia fnmi nf 
Mngle or -«pvi-nil pure MoihTj sjnilu (1ii-riii>|il>h]ri). winir'iimr^ m 
Ur^ aiiiounU, aeldom oxot^tvliu^' ono-haU lit^r ( ticiuoptyvi^ K 
51oro fn^qiicntly it ia mi^ii.'<j In diunjje r>T «Ireaka with the tiiuiyk- 
piu or ia more thoroui^hly incorporated with it, »o thnt the 
ftpiit^Liii liM A clit^colAtdlkv upjiCMimnoe. All of l)ifw V!iri«>ti^of 
umii!! imd Inrtiu hiTiirirrtiKKi« »re ci-rUmly (Wning of iran*ful 
oomiflfTAlionf »inw r,iprrJf!n« hn* ^howii Ihnl tuhoTcnloniii rttp**» 
cially fnvor^ the fr^xmmt npul'ion of blood, whether the hlocd 
b Hmri'ii from Iflr^i^ tcr^tI^ lfov*^r*in^ (ho cavity OT froni mich 
locntod ID tli^ valj« vbit^h nre «rod«<! by the AcETancd of d)»D- 
i^gratioQ or «rapp« «* th*» rppii!t of ^dnal "diapedMiä." Not 
rarely. howL-ver, the fi^ui'iit udmutun.' uf blood lia^ trd io en^/r. 
CoiweqiMntly, in obscure cae» it should be rrmcnibered ihat 
cxttdly «iuiitar aputa mar o«!iir in other nfToclionfl. yitophsms, 
whirh will lulor bo ronfiiriprcd; echintK'tcctu oi the Inng, which 
oiitittfn ^'itif* rW Io hlofidy i»x|»iv(ornticjn ; (rrJiW^ff'^raiw, iif/.t/<im, 
irtc., fatnr the oo^Tiirn'iirr nf hinftdv «pnlA iti mnny fom«. It 
llionid flLiobeh'tmf in mind th^t uJcrra of the Uryox andbroDL-hj 
(»yphitia) and many UjTtti» of hemorrhagic diaUic^i»« Hc^, tufty 
lead to pulnioTinrj hvn^orrhaj*e. 

The d.?twtinn of eorpon orTioidaa ("LittJtfti") it of proat 
JmportiirK-e. Tt ha» nlrtudy Uvii ^hil'-d ihnl llit-y ^rvf chunu-tfir- 
i»-d by 1li(? birK" ainouiiL of idaMlin fdn-n», urrjui>cnl in alveolar 
fona, and of hftcilü in ''pnrv tTultiirc" ^hieb thry contain. Their 
dftrufmlrati^tn pemtUs Ih pMiiive afsnmpihn of a ^cMrueiiv$ 
(eoie^iims) pf^c&ss in the iis^ue of the frm^. 

InfoTiitatloD a* ta ihc origin and nl|i-ijiftcai>iv of llic» »miicrth, yt-} 
%(imi*h-whiUf, AfiAqii* plug« «n bvaC bo ohlainnl mi tho nivm^my n! d 
tflltrrulfiu» lubjoct whtuir lan^ ara Allnl tritli oavl^lc*, \pj cBrrfuhj 
caLBJiiLnJnt; tin? cuntriita itiil HnKn uf Ih* lnUer (cK?«vaUon»). Bcarnjlj 
*uch ft CUM voiild bo foiinil in nhU^li lUftf iHxIki nm ah4*iit. (tfton lU 
tfl t*n (tri! inürc *rt found in a »inirl« mvity. Tlwy u>tHiüly |jc |Wr{TcUj- 
Itm adJ Eiwivahlit ujmii ttic vrnU, ncanrthjirh Un'y »re «till partly ul- 
htr^at to til'' •Am*. Thry mtD o$i»tcl*Xlj a|it to h« lOfTilrit In th« «imII 
d4pr«ft»h>riB which a» «IidükI «fwiya piwnt lo »nry otvtty wall. Erm 
with Iho ntked ere the ahxilut« IdfUtlt/ of thrw t>olIr-» iHtb th« 
"l^OMVt* prvitvnt la ib« «purum U unmUtakablc. 'JliAlr lili-nlit^ b tuUj 



This condilion rereäls tin? great value o/ tli^ir (letcctioo, u 
Virchow showed lo&g ogu (iu Jjinu^iry, 18G1). They are not 
r»ftcn met with, AltLougb euch bodiee «a» b« foond ia tlic 
luajoritj of patienU in vrliom puhnanary cavitic» «xUt, Ihe »oarch 
of the Bputa ofttrn rxjuirM muoU lime. A* n rulo^ tbc düilniclion 
«f (l!«iie call Irt' (lH(^rmm(Hl by thfi pulmminry plijvicnl »ign» im! 
Lhu tubcrculou» nalun? moiv quidcl/ c»Ublinhcd bjr the dcnLoa* 
«tration of tubercle bncilli. 

Isolated elflfltic tibcra are not infr^t^uenlly met nitb« if bii_y 
of the grocDiah porlione o( tho pus aro examined uudcr the 
iniGroieopi>. Their detccCtOQ U facilitated by the addition of 
3-p(Tr-<»nt. rnnntte *odu I« thi* prupnrnlion. If thi» doe« not 
suucccd, boiling with rÄiihlii; »od» i» rpfirs^arr (»leo page 51)- 
CoDfusion with fat-cryetali c&n ccrt4iiily bo ATotdc^ (»ee poges 
109 fljid 110), 

The tHhoffiiloTiH charncti^r ef th* sputum is a^tin^ onl}- bj 
th? demo nitration of tnbercle bncillK Tit]w>rcn1r>us Fpntnia U 
disLitj^'uiiiliPfl from all ollior Vuuh of e.^per-Walif*!! by Ihe pre*- 
cijce Jo it of specific bacilli whose wit aa (iKCJlers of lubercülrnsjs 
hu been unquL^Httouablj proved. For this rmson <^rn>inaliGn 
für bacilli U of the nimost impoHnnsa. In it wc hnxe a hicaiia 
of doterniinfltion which far t-xct^U all othor fonrn*rlj" known 
raothode» "The Uth^rcU haciili ore not only a caiac nf iuhi^rcU" 
liMia, hut iJit trrdif entire of it; viikmit tuherch haciUi tfr^e U n* 
tu?icri:ulfiaiit/' The»© worJa of Koch hold good to-day, and the 
mnny yi'urs of invcatigatioiL which have pawed einco the appoar- 
ODce of hi£ cominunioaliOD (ISttif) hare repeatedly oonürmed Ibo 
correetn^d of hift ataten^entd. The rare instanoe^ in which the 
moat cnroful üTtiimiimtiim fiiilut to »how the bacilli Ui the »Lputunir 
in fipiU uC the exi^lt'ace of tuhi,^rculo»iH, tjAiiiiot iuTAUdfite then. 
Compdretl with Üic enormoai iniijority of positive üiidln^ 
secured, th«^ cn^re rimply tench that no;,'üiivo rcmilU of one 
01 leveiAl e:tAmiiiatioiii! of the sputum do tiot Justify one in 
pOflJli^lj PTchiiling thi? pnwticy of titht-ruuh»*!*. 

The givalpi^t pnirtirnl \nhiv. of the ^.■^^lmilln^i^m for hiveiIJi la 
In oasca in which a tii^picion of tubcrailoT^ii« cxir^t!», but cannot be 
GonJirmed by phjsicAl examination. In such infitancci; the dem- 
ocafrntion of the ba<'illi Jn the often fieanty aputiim settles IKe 
diagnosia al onre; aoil in "ot ä few cjim« of another kind — i,g^ 


ptiüutEuiiiitt^-cxaiiiiiDttmn for Uw imrilli i» of i!ivi»ivi- iriiptirlniiri- 

Tlifl /«TIN uid fiUtRArr «/ ht/^tUi occurring in t\t^ -piilitm may htt 
brioBy outlincil In Section 1 iv b«* bocu staled thai tlit' baoLlli fouiiJ 
In tho wpiitum wry 1iit]nvnUy (»rwwnt within Uitfk bodlt-t oU^nr ajm«», 
wlüüli wtn 1trmvt\j iiit<-rptrtnl ajt (pcnMn WliaLlapt ur rwit thia vit^vr pt 
«ormrt miJ a|rtfTlcal>lc! \u aH InqlAncn 1« wry iiUfvtloQa1j1& Th? uuiriljrr 
of laoiUi cftru d^i^Dil« upon iLc ckVcqI md «evvrily o| the pntliolf^gtv 
procfva; htdic fever pdlu^iiU vbubIIj rxpui^Lüraltf nunitrou» ta^Illj. 
SiDF|iUi>iJH itni|iitv>UoiixMy iK^fur, liiirtnim Tlirrt u» »fioMHly ulTprti^l 
■ubjffcU who prrmpnt a (;>utuin «oulHmLng but or^cadtmul buoilli, ^ad 
nonfcliiTc inJUiJuntB in jtvod iiliyniuij candiijon whu cx|iwtiiralc cuti- 
»bb'rabltf itE:mUM^4 <if 1Iii*mi. ^ijcIi rKiV-L'tii'nH »lioulil \m I'orni' lii nilml 
bfJoro « jiriji^nKin !■ oiprpuHJi roortnvtirj tlto oUior «liniool fvaltin.« 
inuat »lag be cdnsiJtn^. 

'fliff oooiirTfTHV of piCttdDtnberole bKOlUl [«nrymn bnrllU] In the 
tputiim in vfurthy nf Attviitjuit. In ifuMMful tA-ktii Ih« Htiuiliut cnr* 
iJlgalil bfl tnkrn In itujjiiui; jji ohIit tv rt<.-luili< IIjIh <-iiiiii.i< i^T inm 
ipogn A3 »nil &4J, Ki4rLhi>rmi>nt. Ilu' miEhor v^itiI^I hj^rc einphnt^Efi 
tb« m p wu ity of (iTiiplciyinj; turip coMrflu«»« (or vlldei) am) «crupu1«i)*ly 
clniiBed ctftiiiüiaUüil diiLn and btrriluted nesdln |by biAtinf lo ml- 
n«aB in flame). 

Hnatlj, tbfr «bangti wblcb tbo »putmn undtt-j^^o* durlog ibu im 
pii'^nful lif tubtrtttfiti may br biirfly cuin^uli'n^il. Aix'UEiliiiti !■> ^niiun^ 
out conctirrinff r«f>orljf» th* puni Ivb 1' mucoid »puliim ol T)ih*rrti1<:fU« 
»abJrcU ftHkJiuci a niüxr^ miKcid characlvr aft^r frv^Ufiit mb('u1&ncL>ud 
iiJJrvÜoriH kif tulx-ii'uliii, niicJ lb«- ititmljrr of liaL^Lllj i* iWLd>-i!]>' dlnilM' 
inhrd, 'J'hp latlt^T not l-rifr^iUfNÜy |-i#4'>nt *vidi>iiii« nf di^^MinrHliian aiiri 
OfVUI in lüSV^ ;^üO|n m'*tr oftril Ibnti J» <}(lirrfri>4 Ibc catc iu the 

i^uluEQ. U U not rvn lor tlie ipucum to be lln^Evd whb bloud. 

The ipntDin in bronchial asthma i« H\\ovfn in Kf^. 04, 9JS, 

«x>-Aina vari«e witliiu vjJl' liuüta; eomcttmc* only one to \va 
tab1c<9f>onfuliL, ftamctLuic« as much oa ouc^hnlf tci three- fdiirtJift 
lEt^ i« expoU«!. Tho grayid-wbitLV «xtremdv tonat^ioufi, mucoid 
»piitji rtinUvriT t£i rrirni a hofuti^'iiwiu:» maw vhirh h oovt^rerJ hy 
a lay^r of fonin ^'«r^lbli^J; thu Lcatm white of e|cg. If aa 
adetiipt h mflOc to pour out a portion ot tbc «patiim, Ui« u]ii:>b 
niatä usually cotno nwnv. The {»»riiirn to be ozaniirn^ uiuit, 
tbrrefore, be «T|mrat<Hl wiOi u imdk» or i>tli#T apparativ. Tlic 
character of th? s^iutimi vflrirt DLVMnluig üa the pinrn'^ni« nn* 



TioWt ani3 of nrly niMt to two dnjV durAtioa, or Uic djupiun 
coDtinLiv» for mooths vilh dtbi^r frciiufnt or occuviohaI cxAOcrba* 
tioniu In the tirrt intit^incc ihc cxpcctomti^n, wbich ixu\y (on^ 
timea rApiilly incrrrfuro to onc^hnlf litci or iiioro, itFUnlIy c«a«es 
after scvoral dkyt, trhile in othor ca««» the amount varioi bvtw$«ii 
{\tiy utid oiie liiindred culiic c«iiÜriiok>n», Hud is rjijiidly aiig* 
uieiit^l odIj iluriug the parox^stu. Here, alvi>, Lhe ^dyidh-white 
color üml viecid dturacltr of tiie Sputum iä ]iriiienT<l. (In long 
ftUmdinff tht> üölhmütio oxpoclonitiou btvom« tucrv flui*! iimi not 
infrc»j«i-'-iitIv us^iUTiiofi a i:,'^**-^^':» ttugo. 

Tf vrrinll divEded porlions t^i tlic vpiilum aro qirrLiH upon > binck 
plaU, tLcro vrill !« fauciil, in n TiiJtjmit/ of ca«»> I^Sig iH^idt and b«' 
tweriJ Um tfiii vihlj^uli tti'^ vitliUim |mH-HlnMiki>Ll"1>it]Tiil Hiiiiluiii in&w« 
und inu^ftim tlirritti fuviilijir «i^likfi 1rHnH|iUTnnt foriiiEilinni (Vurteh^ 
viatrn'it MpirrthJ. TIihi^ nro paitJy sjaj d\inij>p-. hcn and ihvrc Hrckc^ 
with ydluw i ifürtljr j^rnyls!! wliilc, KftTHviTnel^ ijiLiloil« i>r iplnitly 
twiftitfd uhrfda, ■>Tie half U <^ne nnd ond-lialf mUtiraoUri ibipk and front 
onc-bnif iQ tij£bl rcJiltitirtTA Utü^. 

Mii'romvt/tctül^f. tlicpc' budivn. ubli^li un? ufU-u 11;irrt wiLli ilUD- 

ImiiBjrnrrriry. Al Oir-ir rxli-^-mJtir» tljcic cnn fit.-i|ui?ntljr lio uljhi'rvi-d iho 
innonor In wMi^fi tim imiiti^rDiiH twinlvd rUirillu' viljii'h 4-'oiji|xihh Xhv 
»ptrml »}tpTiito and nrnXv. The thrtoil, ttainpoiv*] nl iiiliji«toii» diffvrent 
ntirllltt*» bi »nrfüuüdcd hy a l.Tivn*pttrcJil inui^ou" -licnth wLlcli \% oficn 
«tTiddpd niLh Tiiimrrnn« rnrrnd. r^auilatp. and <IHknt?< aptnilk ><lmticiil 



(ffllVh In oddilJciii i9 the tpjTftl ariDiii-rinciil of XXtv indiviLluiil AWiTliir, 
niAajr co^rK-r twtd« a« VpTt ai knotted Hn«! bnp fnrmiillnn« ar« DoLlr«- 
vUfl ill tljfl cout« o( llie ilirva.i tPifft 0*. Ü5, nod UÜ|- 

ftnd Li oul^ here »nd thfra intrmipUd m it« mirvc by n »Knrp tMrisI 
(knüitijj^l in Uid apint. In Fiff. »^ (dnwn twom il pholo^mpb) U vU.1 
bft »t#Ti Ibflt a pr'cultnr Hpinil winds amund tho clear ■xli InUrrupUKl 
by A mmilhfr of nadulRAt niiü thot IhU ccnlrtl portion In intilo'od id « 
laf|-tr ipLiul iinnDtJi* Hiiimll. 

'irhLi poHinn at tUi* ipirHt, whirh riirRflimnnn djixijfnn'fil ai the 
C^frdJ fly^f* i* opporoitfj it» u innjr>rity of <o»** lo 1« voikiidficd ■■ an 

Pitf. M^-^hirwbiiiaJmV ^i^u.iL with CtuUftl ThrM4. 

X nil. 

opLb MQnldDB 0f tht mu^mi* «pfml, luucb Ich frM[Uriitly u « MpiraT« 
boitf CcnnpnifHl of s lioinuici'iiE^njH nuliiitAni-r, ur df drlicAt«. tniitt«! 
flhhn»v Surh » *yntrftl filH-r fnii t* BriinnuHy pFüdiiff*d hj flxitig one 
end of « Enni:oui thrrnd upon a jrln-« f'idc fenil tAtnling tfuB uthvr end 
tiy mnmi ot a |uiif ol fuiivjJi I^iu^r/. 

!t ht by vt) lutüirja r^r«. ««pcctjüi; in the flrvl Asthmatic par* 
oatjrm r^^irurrins ift*r a long paiiw, to \]nd tffUou^fieclK^ or mflr* 
uniformly ^dU>u't»h, nomat^at ^ruHi.ior, rfrn^* thftaJst in tho 
apntiim whiHi rai^-Tuaoopicauy rfiov, in ail>Ii(ioa to alivn iixfüa- 
tinot »pirnl tuiKtiii^ tlvme clumpf ajud »trcaSuof «Idicale Chsr^ 
cot <Tj>tak iii^irfitli the maicu^ of round cells compo«iag Ihe 
inuitle of thr npirnl, Aw^c from thfir bri^t color, Mc» or^sCtil- 



litdcr^ $pirait ak oftcQ rccognie^ hj a distinct grating irlicn 
c^uthcd between tbc cövcp-ßlaM. 

Som« of lb»o jdtovr» Iiarlcy grda*ln>d b^iEdi ok lo dma^lj filled 

Obaarvpil. N'i>vorl3i«lvdii, froni th^ whnl* mttt^mtnt]iie ini(»rt>ttioii, il Tntj 
with A i^rifria «Ir^c of fTobabilit; be voncludfi thut thr-jr arc alU^^ 
CunchinriDu Ajjiink. CurKhinium Ioei^ iiyo cxproutil ihU ilcw »ud 
do*lgn»t«l tho farmAtlon o| cryital« ■« "ago plicnomonft," «pwliH^ bj 
tlio AppcAranci! of Hi« yL'Jlow crytlal ]mdm fornm !i obM«i«<l piurtlcalart; 
in i\it first laiuAjam» ucvurtiiij; ailvr Iomie tntwvftl«. In vuiiport ut Uili 
view ih« «iitbor »n piwnt tb« faNovirig cim*^' 

A moTij 27 yean otd, comoe to mf Lcipi^iff cititk i*>r a^tlitiifltjo 
tronfcds wlildi had vxUlcU foi two day^i, TUtt dlitinct cxiLlrBboiy 



Hg, VU-- CLtrvcJikniuin'i Spin!, 0<nnfii>ii*d vt Dt^liul^ly Twt«t*d 
Mi^i^üUB TlkrmdB &ud 6pindl«-Bha|]ed Coll«, X S'^- 
I u Ütr iri'tLphvrT uvrniol ami vinillpii ortlndrlg bihI rlllilnl c«[li (jb) : tin 

dytjJiifA aud ihp balilms of tha tlionix liulliTHtv HHtliin«. In ft fliika OT 
«liutiiTn vliii'h (he paliefit ooiigbi up ftro lj]ib«dd«d ivwr&l jvlldw plug« 
vblch grutc on cniklUni;; u»di?r * tovcr^^lafiA- AdmüiUlmUoa o( potd» 
slam indWi* Is lo||o«<ii| in Uif np\t fflw dnya T<j profiii» fliqiwHftfHUftn nf 
tiiL vxlnmioly vim-id, coiillu^'nt) aaJtfon-ifeftow HpiLlitiLi, in vrhich tf^'cn to 
tlic Qakf^d «yc Uir jrlln^r color prmiils Ibe amumption of tit« prcKiaco 
of mimcmuBH lümueit, «iLl[ilmr yellow jfraiiuLc», nnd Mtttnt-vi ntu ^f:x4 
rti&n«B«, JiubL'dili/d in t|ja cxtrciriüly tcnn^iom miipüid inalftx. Ufitinot 
piK-^mkidlE^ Alt] dirflptit, .\l\ Ibc flGctnli «liow 0(1 riiicni'icitph i^xdjiiiii^ 
tJon grt^t TiuinbTH of tmIhu',!' ;ii]d hLrikitiifly liti/ii ot^Ubrilm In {iddUton 
to ortrctufrly ttumonjun 4«i}«iii.ipjii[i^«i uml n-ifnfivdy numi-roui tDnjtcH]«. 
Ttif padfitt fortntTit; hful fn-'inrtft fttivrk», hut for a ifrar and a haif ha§ 


ti/it had a äiitffr paro^om. RttpiU ünprortDu-nt lolltrtr^d, «vitb 0i>ni|>tpT* 

fttkr tMrr, whm tli^^ imlicul hod vi-enl mild ittDizk« mnd Bgulll ririlnl 

The Biiiiiii^E in wtiitli iIl* »|>inl tviivUitu of Ujv inuniuji wvirultt 
no(^jH f^n nnly h* i^irnji^i^lDivd. l.\i nahm Ann Bllribut«« th* tiriiUil 
form to th« flpirnl iriod« of «idirtoiUMi of Ibc ttntr with the «wrwT 
IjiQaohUL bnuLcbcflp m dmonitnltd l3f F. E, SchuJUc. A. SAtimldi 
otplalpi ihalT «cflurrvnr« Uitmtiflt iti« mff'^fy of ihv *f\rx} nirrivuioDU 
of iho impiml ^r. thwrt »n be nc doviLt tliaL thv fotniAtinna i» ve Mt 
i^Bui In th« ffiitum «n pE\>du«(l In tlin troncblola. f<ir A- ^hnUti 
fauad iWm In Utvu «a «oll a.4 m Üid aiiiatl«r lüroiifltl of a p*iiva1 who 
djfil duiJiJi: VI atihmtitic vfltJcJl. Nv iplr^l f'L>rmAl|otin Wip found id 

Of whtt Blfnlfl«CLa0« ate the »plraliT W* win ii«( b« in ertor U 
«« a»ujii« wLlli ('uivr-TiiTLAiin UmL vIl'^t ^ri' »i iiKlKiktii^n of in «xudi- 
llv# l»n>Tkr'liJrthriL Thpir nlmcinl rfn^tiinl n/'m rrrtirn in ft^rhmn, nnit thnrr 
pwdiinr form cxrlvdc the aaminiptJon thnt thcj arc AitidcniMl «ulmLi 
i\U*% ol dl« tputuia, Tlicü ■.tniulUiiMLiK oixuitvult wilh ihv fioiuciu^y 
Whl liohmf-* of UiA Bathtrintie «tUckt, ihvlr profUAO ji|>ji#q.r«niv Imtiuxll- 
»tplj bfl«r Ihe parckjffiD^ and thcir ftbacno* in the iat^rr&la of AtlAfkr» 
bid kite tbftt ihcy ilnud iu cAUkuilvc rcUl^itii to the »lUi^k. It maj b« 
M>inn«d ÜtAt a moT« ir l<44 «rrvniiv« iv^i-liukiAn of hnnfhiol» wiTh Ih^w 
«püali CBunM Ihr incrrfA^inj; djppfie»» tut Ihnt llift tru« paroxjMn bitffiiiB 
011I7 with tJi(? apiitin or tho bninctilfll irinruUr mumnitar flben fBi«niiFr> 
iiyn]pftt]ictl<^(in>' tiidiii-^d \>y aNtiTuelkoii of the braiiclktolo« and dj«lm- 
vor ni th« »Irroli (ApfvArini; vrith ihi lalwird bn*1hiiij{|. That a err- 
ta^n *'iffTltAMi-' w»itkn««fl of 11h* ftir*<-(j*d LDdMfliia] I» alflo (0 U« «■■ 

In I87£ ron Lrj^lcn. vho obocrml ^tubulnrlike formallona* 1^ 
Ubinitü am«* nf jtkllinui. PinphaUrAll^ "rrfrmlnnl tttim cipnuini; any 
Oph^m a« to tb« imdiro of lb«u atriurtiuav," itai vflff6Hfrff ftpaiai 
Hgtitthiima oaJjr to fA« (nrvfol«. Howmer Ihc fact tltat IhfH an aWnl 
lo nuBifiVoiM raiwa of aiillima In vliU-h ihr «plnU nro pr«»tfnt anil, IhArv- 
forv, cannot pOMibfy purtli^lpHtn in th«* dt'^t^lnpmrrnt of tlif utticnk; aiht 
thaU 0« ffcff ofVr AuitJ, lArw ttf^fT fAi'«nVi'j'v ud/mrj bf rirhtrvM anä 
arh€T9 in Mftnttptptt» finriiMtnilti {^cr fn^je S'll) M fAr dD*f»fr '>f arthma. 
wfieakx tiffHinMl ihr rCU tiattffrtal fo fArm. 

W. G«rlMh hjui nNV-rl th« irji-it ilut thr Kj'iiar» arr prmliift» »f an 
HUdattiv brfifioblriMtKf. ^cvtrdir^ In hiin, tt»*jr r^iT on'^Jnrjf'' oflff 4n 
f h' iH^Ofm «i^ und oMrvrr bnnoJhi by 4trnng twirling novomtnta. afttr 
Um iinunu-t of « «Ali<i*|iout or v)iiiliilndj ihey anr mÜheMmtr, bwi Ui€ 
n$nit <if fkf ttrtkma. lit» %tedc]»y of inflfifF Mvrvtlan, tlka bilauw 
dyspjua« and coniphiln pniauMmh of (Kr tuiplralfrry p*M4fu ar« iakI 
Iff Caror tbeb foinialloiL White the aullior rra^ily ndinili that thvc 
awaoMots may (M^ra■lonalrJ givi- ri« 10 tho <l^vvtopnu«1 of vpiral 





TTiuciouft forrriAllctn« (t«« |iagio S30), U ftppffnt« to liim oiot« Uaii nnUirv- 
Mme to fonclu^ ftwo tbtt poMiIbiUtj- Üt«t the OarvcbmAoo Apli«lP 
ocfTiuTlaff In asthma juv nni thp cmuv. init thn mult of tbA MtAck. 
Aald* troTTi tbv ftLct ihAt Krhmtdr. hat dimnnulraltd tlM «^»b fai llM 
broarVolfA at «iilojtt.^» wlii^« ücrJoch AilniiM iMr oriiKn oul^ tft 111« 
mi^dhtm xiif^ Jind «otrvr hrnnr^L iiprti'-li nvrrm u« nn oxpUnxlon of 
tho following (|UD4lkänv: Whj <lo »o intwrinUj' iitii iJio «pirAl* her« 
uiiJ iiimT wr Wl ntn-Ij An rnntir ulhn diapAKv Ari,N>iiJp«pied hy 99rvir 
4ly]Hnnk «ni 4<[iii),'hiiii;f Huw nun thi« tlipory tv* bsniKiTtlnd wIfJi th« 
imti tliat numorou« ■piral« oiLii aIaq bo fgoad in the hot tafcI^ p'^rfme 
«putam! Iluw i^itrr tlir ydtowci.vtlflMjiJjTn kpliuU Im ex|>Uiiiuilt WIjj 
iin> only vitry ßitr tpir^U »Ini'ii^t nlwHv^a roiiml nnil l»if!(i nrif« hnl vi-rj 

That A »|iJr«1 amn||viiieiit of mucut can uciiiirtDiuiyif be produnid 
in tha larg«> bronehl h/ v&ol^nt »IfatiA of coughing «nJ fom^d iwipirftlorj 

niovtmi-ntji, biut bocin impr^Htail upon Iho author hy Ukv nbmirvfttion of 
m fi(jlral nboul lliiitt'i'ii orTLUnitlur« < H lonj£ and fruiD vl^liL lo ten milU- 
nictor« (I) 111 loir, wlii'^li showed |ier|cet ajilmt alnictun and a bright ni^iL 
Thf iTiiiriftPT and Irnj^h At unai Inilirated d tarjEe hrmu^huif %* thr pUoo 
of ud^n. 

Apthfnaiic sputum is almost always tharecifrhcd btf it» rich 
content of eo^nophilc cellg, Ity ttaintng dried |ir^ofnliMW «iUi 
wiitrrj ftilijiion of fnsln anil nietlijlon'' Mtjp or CheTLzyTinkiV 
solutioD» Ihu fict can untJily he ^eruoD^trutcci. 

TLia feature cuii uImi bo Join one trn led tn /n^/^ j^putum, li 
i iJrop of ('hGLLHjr'DpkL'ä eolutiua be allied to a tloke of »iieli 
fiputuTn IULÜ tho [atliT ^'iitl^ cruKht^d uni3<>r a oüv^r-gtjLC« uflci' 
tht' Mlniii hjM ncli'd for i>H<*-liiiU miinili-, OiJU'i? will be kwti uflfr 
u Khort liim-r—brat ni'tcT niu- htiii r— 'Vc-rjr numrrniin Amnll nnil 
vi^-ry large li^iW3x:yl(?< with co^lnojikiHc gmnxdfs and a/^o *oiT*e 

Permonent yrcparfttlona of Splrala. — Tli<-y ciin W iu-f*rivr^1 un- 
fla^wvl in plyi}4>rin <tr in u riiivriEn- nf 'H|iml pq.rit of ^Irrfnn *ad 
Icyuloiip. Accordin;* to the nulluni'* cAperithfrt LH'hflJch'a henintax^tm- 
i-iihlii fui.xluju is lje*t iiUüpl^'il U'V ttiiinliig (mv ya^v^ laj i, Otiu ijr iwii 
<lrv|H( «f thia «rtliiiJcrn nr« emJiIiliI to ihe frpah «ptnvl. niht iift<>r ffiiTi Ave to 
1vi; ininuto4 n cc-viT-fhtf« r-locvd ovTr it , or the mivlare nmy t^i? iitltrtvrj 
ta fCow H]it1i>r Oir ed^ cif ihc eüVcr';;!^» und thi? <'iccfi «vihed otLt ^l,h 
^Ijuvrin, A ririL' of d:iTiiiiivr vu-vnibU »urvi-i ta Ux llm ouvtv and pT«' 
>i-ül« (pvH]nir*UipiT, Ki^- 04 and P5wvre iniij* from |rfi(itijiinviui;t3i|jhii of 
Bptrmlft nlHtTifir In Ihfn miiniifr. 

II ij uul rati lb HnJ m ciBllmialifl iputum oattrw bliidkJHh lUid fino 
bi'OwfiiHh-it^il piffnifitt crlt^- Rtvn v/ll-U tlif imhvil ryv it caii Ij*- >4UJi]ii>vjl 
tr^ u-fial jmrfinfii of thr H|iufiiiTi 1hr«|t may Iw- foimi) Tb^y nppcof aft 


flnr^ duAthkc bodiu imbedded in Ibe mucoid irfoiind ■ubdnnol^ The*s 
cclU «in ai^aln bo nfemd to itli^n «pi-akkiiy of "htjiit-taion" »pulum. 

TAff Vm^ of t«iAm<f'iC pafJ^rjfj üfun fttiovt u decided inrrpaiiF in 
coflinopTiil«« diLrin^ Ihc iHAioiifLiiiA, «ffpccaaltr in iIk rusyf-i* form olmnc- 

In pulmonary edema the epnlum ie vatcry, chirflj- nermu, 
but slightly mucoii], ^ri-cui^li >vhitc. and usaolly ifi1oii£cly fcamy, 
rowEbbiinc toAtcn «lule of tg^. MKroecofncalty it ift recognised 
Iftl ^^15 c«(luför, tlHD, mitcoid Mt^rotioQ. It u iudaUj ob^jcrr^ 
only in dying Bobjocta. 1l is repcattxlly met wittip hoveip'or, in 
maJiy eliraiiic reTinl miicI lir-iirt |iu1ei'tiI« willjoui tfie uUjiick la 
quceticm eiidiug fittally. 'Vlic rputiini, vl])L.>h in not uifrvf^uciiUj 
observed in fAvorabJy progmciiiig ca^cs of plcuml pAraccntcnis 
■nd doscnbcd as "ej^pcctt^nti^n oihumineujtc," pofM«M« sudi a 
fttroog nsonil>]3n(<o to tlint junt dcstntK^d thftt ft diatinclion oH' 
cot b« made Tn boUi cu« tlio Eputum Js highty alhumin^wi. 
fis the boiHag test prov», adiI aW (X>nl^ii)« Home mucus, as b 
^TD by th^ r>pül«ftccDce pToduced by addilton of accUc add. 
It ia a poeitivo ÜJ^cation ol the trunAudnlion occurriiij^ iu IJ16 
alTCOli and bronchiolesr iiud in («rmiual cjiat« cvon into t)i6 
Lu;g«r air-pai^^ of the long, wliidt usually f<?}low« uiliaiuUon 
of the Mi nidn nf (hi> limrt. T11 frfirrtomtion tilbamitrtjur 
it Ü pfThop*" d\ic to oiiriornial penioiwocM of the TWflK'l-ftalU in 
the [rrcTiou'ly comprntrd lunjE» 

Til« ppiitutn |i4'n(idii«lly i-rpt'^'IaTuU'd in wh^tipinp fitVfh U Vflp* 
l^Hy trantparciii mml wucoid [f^iinjj] : it it ujuaHy tbin. tuiijEb. und 
■dkiHi^ In »nilattiicy, tad often uoo«ualTy voluininou*: «o Ihvl «t rh« 
end «f Uie f4roxy»in mauÜihiU «re evpfHed. Net JnCrequpntly it I» 
mlxfil «Jib rudiUrd tiuiU^r. 

CtoMT ftiAiiil&ttioii Btif»»« Ihvt It m « tpiilam rtry poor in 0f4*— 
oocftjkloiudly coatAintiig dllalcd T[4lhcbLinif inltatcly milcaid i^fttl« 
nrid n*arlltmt ,— till» (fi^niHnp apututn (rmfifiH iif lliv JUiokiilA OnTjr In 
U» IbiH »T*g* do*» (h«* •frnftliin b>>nii*r !••• futifniv ami moi> y#*l<iir, 
■nd AbovB iiLjiL-(DMopl»1ly Ibe irktrodrr oif »putum coctuni «hkh b«* 
alrtitdy of Uin Iimd diviiueü- 

\V'b4*tUffr tho b*0T»rU found In llw «pafum by C^idc-n-ki, Hc^vl, 
Mid Koplik »re Ibr r^rilrr» ol » h*oplnt' ^-Mijcb t* uti» tindf^idcd Tiny 
ara inmll ovml beflip» vluitf mi\t u^ujiltjr »lain inure dtvply fpAtar flt'40' 
iOf. ^Iiu bAfllrtin» IbiB tbeip nddJl* pnrtSoni» ubrntiy tbo furm aI ■ 
dlpfecvccuF* a pn-"fii1'd. In reAUlyi lbr<y nn <bort foJ« whi^b crow In 
tho fc>nn nf dHiimle. drapUkp n>TiimLn »^44 Ütt oMitmij »rilripnl Tn#4fM, 
ind Ik^ upon lÄifll«'- ufrum pkU4. 




In la prippe, oho, there i» ai Unt obwri-thl, Init ofien i^ly 
tnoiitorilj, o nputtim cruilum ^hich «oon pa«K« over into a 
fjtatnm coctuin. In addition tc a fctr niiicd^ rnaci>-punileiit 
riiNCi««, il roiitAinA piiriilr^fl, glnlniliir rii]iii|w \rhft\ Üw iKiipi?r 
p/jrljims of li)c bj'onL-M»il IuImm are invoIW, A* hai alrai<?j 
been mciiUoned (page #IJK it U in tlicM punücot cluaip* tliat 
tJio aLort bflOiUi flfflcnbed by Pftnffcr nr» fouuJ, Tiu? more 
puruk-ul cliiirut-t'>P of tUo «[uttum in cut*« oomplicattxl with 
c:roupouii pninim<;niii hufi flUo bcf^ti diMniw«ü in conuoctiou with 
pntiimonis (pflgp 219). 

Tn llir nHln-«! a» voll ac the rtidr-tl cjo tlw '^1icui-1«ttDB 
apatum" (Plate IX, Fign 18} pr«aeiitd a very c^iaracttiristic 
appoflrancG vhich, Qycn during lifo, pt^uiita a poaitivo condQ- 
alon «d lo tho esiatonco of brown induration of tht} fung. A* i« 
known, tliti allirralEon [& princ-ipally foimd lu tliciiv forioa of 
diiunic Vitium ci»rilis aaBuczAtL-i) vriUi mon! or litm iiiEt-niut nknin- 
ft-Atatuititi of coiL^tsli^ti !n ilie )i»H;r circuUtioti, jmrMtruljitl} iri 
raitol eicnosis nad ioaufHi'itincy» but ul«o occwioimlly t<» a markcLJ 
dogroc in Iceinne of the aorta and in myocnrditii. 

llic Iung5 of r«l induiniion nre llrm lo coh^liltfopy. Imvifjr and leu 
aLa*tto tlmn nornivl. und prvuot « color ahuJlng Into yoMow. browntth^n 
or n^Jiliflh brown- Dn ini^iiuoTi UitMi^ arc n'rü^vJ at riidhj' pi^intA an)tK 
op t«H latjp'. frd or djirkritntCijIoiTil <|Milfc, whilv Uip lifMtii- ilM^lf prp- 
■tnt' a y«lIowiHh or moro nutoalorrd npjtiMraiL^o. The cHplllhrj' loopt 
(if Ihr [tiiltiLtjMHij' nrtfry» whu'ki Atv iiBdjillj ci^vt^nü with Jrlii^U fl|MtW 
Iriiiri run] jniiti-it ^uilji urtf '»HvlHif liil*^ l-lit* [iiimiii of llir ulvt-ijli, tuvt 
V'ififi' Ir'ii^ir^l I*' inhrifr an iHlfii^ffjf tlil^iStii tf-miril tikf l-"nrii. jarodin^iiiiE 
Jn-iiJi'U tmnonJii^ at Ilii3 uhrnlh VcLluiTt Imiwiitih iii), |i->* ifflrii liUt-^k- 
iih |»i|;mir»t ^niniil^D Atid Ttnl lilchhl-rHrpiiU'l* " iliiiilim^" fiin Ix* nv^-ir 
lu the <>ou)ici'livQ tiifinp u wvU m in tlic ulvaulij partly frvc, pmil; 
kudusieJ iu rüund, ^^^aK or ajilKOIe-fürtn cidlei. 

Th» (piitinn corr»f>ond4 with ihi« dnitomit! itn^ln^ xa a rAiuarlt- 
«blc dcfH^i«. It iiri<4«nt« iiTrUin ililTi-rtiii^^cF PrcordJn^ ai it la exptct^ 
Tiilt'il In tlpnrs of FuJrt|iuriktlve cuinfurt or during nianlfcftnUont ol 1ii> 
UnHb <iLiny<»*tiun. MjjwcJully niter humurdmgii: ljifuri'ii*jii- In th* HtpiI 
inAtunrf it in iiMiall/ Arniitr, and only l.wi} or thr*^ "putn of B^slit 
uiütrunt *inii I« oiUtitk'iJ lor rKuiTiniiilioiL Tlirn:' i^ill \tc fuimd m ii purely 
iduvokI. «oinowbint viBciil,^i'lntinniH,clQjir or ptiW fellow. ielLti>iu brovti- 
U]j-tuijr^d malrtv, laoUtcd or dtiixly coUcottil Ihic mid L'uari>i: ^«-llvw «>r 
bnJwnlHli'nid lE'^niiW- Nuw Hiiil Uii'n it iiikiiiit^liiit tliirk. nitiiorfli-lar 
duttlik« dopoHit IN alio obtar^'oU. If luoh a jirl^üw or rtililnh, uiotllisl, 
iiitK'uLiii ilffltc i* piiiitcU uud«r a t:ovet-Rit*B, ihrre will at oacv t« «ci-n k 


Iat^b niintlHT nf <ii-11fi arrVDffrd In tgw« or msHMn tmbfddfvl in s bAAnm^nt 
«itiilKiK« whiob U cither more or it-tm homopic-ticoui or mixpil with br^rht 
ra^eUaliko drops, Tlic cell» ufc »BUftlly slmiply defiaffd. If«iu cnc to 
n™ lim« Ufcfl ^lamrfrr ftf it poller!*« hloodrftfl, ßT roan^»*!!, nvni. iplndle. 
Or poljgonal form, smi i;rmmlly buvc ano ur *«v«nt1 Ti^ie^ki-Ukd nud^L 
Tha niwIeUB k ojLcn i^urtly or coinplcUtr olnruml bj tan and roam« 
gnuulfftp vhicli til thf^ [>rotopta«m. TUpti- gmmilni bt« of ihr nature q1 
n^eltn, vary a^ldom mttf« rufractivis Ihan Iat, but trhhall^ oompot«i! n| 
fii/titrnt- iL HLMiirt tm«^* UlU tfiv ri'TU ü> iIJiruM^ jfuKlrn^^^iOki^ |iiuiLii-jit. 
hilf, il in Tirnr* Jrrt|iii-TitlT »TTnrp'H vlTlüri i\n* rcll-lnnly in iliv inrm o( 
flu» and roiLrtc graoukv. Ira^ii^iili, duinpii, aulI ü^'jbuJtt, Not infrp 
qiiEtkll^ only • CcM cuamc ^Annita an? iccti hi llii: mjelinUkc alKTcd 
pri^lniklum. In uddblton la t}i*M rlmrniH^Tbitir oi>]Th (litirti f*ftn Ti« >«»n 
nornuil T<<d ind <v>1t>f|(Nu Mood C0T|>UHcic4, and not rarely fine and 
vnrtcly Ktanulir fwra pi^n^tnu 

Shotll^ aftof Ilia arilvkilcnr'c «f n hamorrluifiit^ infir^Uün Th«M 
|Hj£ni(int-<Tltfi ATT fotinJ In lat)^ DUiLibcrp in tho uau^I^; brov-ni^lt-rrd- 
ttftlncd npiilum, CcMb coni^inLnj; coanel^ c^riuUr browiiltli rrd plj; 
ni*Bt on #»|H-i.'iu f ly pumt^rüLiaH in addition I» mttny rrd th>rpii(inrL«H. rUd.« 
praoun can bp nuitpi^lcd from tlip inacfonct))i]c adinialuT« vi I'litv 

tt prt^nGVtt^rd maniJfvtitUowi oj fjPOf'^ion ore pfTstnl, wblch ftrc 
indlcftlod by Incrtttjcd dj>|>nrA, Lroncbilic^ rfkUt. rtr-. tbr amuunc «1 
tputiim ka nffcn inrrratml tt^ ««ijrl^lj or on^ Uiinftr^l rrihir r^limptm or 
even more The coitiiiUncy it K<ni(Tn'hiit diminiili^, bat al>rnf* fiuil« 
lliin and nj»d luminous; ihj tliat lliv >|nt1uiii «Iioah h U-iidriicy (<j iclidr 
mit a« a ivihitrDiii maM r>ti iar«raion of tbp v<>AMal or.ntainin;r IT- ^rfntra- 
Uon into thrive layer« la nlao ohterrrd -an upper foamy muci^id, a middle 
vrU'iDUiMi^» «ad R lov^r crayivUwbJtc» plffimnCcd Layer, ilttn uhI Lhcrr 
r*n ba found aMffhtly pinilMit fl^mLtliiraa. C^rafill *xaininai]i>n of iiuoh 
vpatum iriJ] always »ho« plfini'^t iTACfull, |)txn-tdc4 brown Induntlfla 
luu dtveJopcd. 

Jn ft« iwi/oKfy 0/ ow* *A* pigment U of a fftUtttc, ydhriHsh- 
r$d, or hrr,triujth'i'ed tr^or, and w tJicfiby tlifferfnliritml frcm 
ihs carbon ptytnent fuutid in otruost «rery spuinm. In mant 
tjutaDcc^. however, thorc occurs in addition to th« brown i*b-r«cl 
plf;[meiit oil almost glifUting, black pigmrnU vliich if uuqnc*- 
tioiubly produoefl Sii tlie *aB\fi msnn4>r as tW browniah rcO. It 
oftm otcun in Inr«^« aTn'>unt in nddUioD ia \hv U(l<-r, lUirl ä 
dwtinyuishod troin Llie conl piprinit incloKi) m the cdb by Ü10 
m^ch d«cper and cryiUUinOr gliMcnin^ l^bick. 

F<tT AbToaa irho hii careAtllv Klixdicil th« plgmentHScUi here 
tocrib^l and hn« nouiparcd tliezu witli Uiow proof-ot in »ccttOB» 


UTCRoea)rY and aiKw^nty. 


of red» iniJurttW lung-tiHÄUC, Uieiv «in he no ^<tM tlml the* 
ore wniilar fonnatiorm m tvtry rwpL'ct. For ihi» reason E. Wftg* 

ncr ^]^>■i^flJfltl:nl tlj<-'iu üß "hfari frmfta <cU$" 

What h the nature of th« pigment f Tlio firT«utnption tfaflt 
it 3t& flfrivwl fponi thu blouil-cnlnring mtttt«r i« fully jm:l>(lprl- 

Ai'cnrdinit 1(> %'inthriir, fJiv pi|tiiii*Qt. fiirmulinti nrcim hj wiip« nf 
Ih« colorihif miitl^r ffoni the rvd n^^UM01^B ddiI diiTuruou into the ncixh 
burluicd. Avhrn.' tt b n^ul^ted Into pigment gnuiiiW or crf'ttaU: or llin 
tto^'torf iilpI^ ronJctcc. I'lthpr »ingl^ or In iiin»«oi< niuL bcoitm» Iran*- 
furnifd iiitfl pijrmrnt. In bvlh innUnore tlif picinrnt »my b« jfHow, 
nd, or hT*r|< 1 rliffd'r, ifrniiHtnr, or rr/>itBlhno. Tlip bliiml nmy unflprpi 
pigmcAt molaniorphotii oven m the oiipkllirloii, Id iidJitlon tu the p% 
imTiL itLiiU'M'd ill on]]* or 1>iiL|£ frtn ta ilie liiuiirn, Oit'i fuund »iarnrnl 
thfUfHli in lliit fX|>i]lHrir4 and I'vm iii t-1i^ lurifr^r vpiiMt-tK. Thf* htmxl- 
Mlorlng QiulUr may, thrrcf<>r-p. bo tTiiii«fonijpd iaio pigment vrlthoul 
£ii)itid|>LilEüii of euiilibFlilv vlU. On the uilitM hdrkJ, llir fjLt;L flr-t <Aj- 
u*rv«4l hy Tati^Iiai»* Iiah ofl^n bwn i^unflrnu^l. niTiiriy llinV n-il hlitrtd' 
c<it]iiiHoTv>i thrinh to ■ pi^iicnt ^diluIc ooly after they liovc been i^rjt 
up bv i!ontirLi:tUt! cdli. Üiv ptMuit-ul f^mmik bdiig HiibAiNiiii-nt.l> Untit*- 
h>T)t\f(\ liy <l(Vi*(L<-n inln n TunnTtaf or wii*ll ftivmiUift- In oftiif null «t irrt ion 
to cryivlKiliiirk hrmaluiiitif. whirfi in afrrt'inif, tho (lij^mmt jenkniitci und 
cintitpt nlMioM ntuuyk mudrlit tiyin; conM^iitnity. iLt Niiumanji's mg- 

It Saa bwn *iii>*n thnt tlii» ( hpmopiilrrin ) fno Iw foimpd opiy 
thmugb ihc uin^jioy or liviiuc vv\U. — Ir:.., tliln» lUiuiri.— h'Iioi p» iho 
flforrout hciuAtotriin Ifi origlnaUit n^ U« mult af a otiaitilt: dlAintv^ruUua 
frmot?» which 1" rlTnlril nilhmit iliv iitUtivntitin vl titlnj: tinnUL- (Neu- 
icmnn). flfmi^iiidi^rin pi.|Emi*nt In ii>vijtmi1jiti^ v/ith f<«|ir<rln1 froqiirmry In 
tliQ Used ccp|ini.-4.'lUc-liMi]« f?olla> whii^h. acooidin;; to ^pumarm. nmy aUa 
liUM' dturlitpr^d fmrti wiiiiil^iij]^ I't^ll» I'lfJtliiiiiiiiif lali]iid-i-iiipu"lde"< 

\f thfl hr\in-W'^ini\ «piifriiTn fotirninm^ pijfmriit-<vM<i i( iiiihiEi]||«d lo 
tho iron traft^iM. k will bo f^ird that the majoiily of the oclli oHiiitijc 
llio cliarn'li?[l>tii' Dfrlla-lillic r'tf<ir. 

Thfl tust Ik iiij"Tiit'l«^l <>lMirr with Imali OP, bOtl«T, with Aty propu- 
r&Uonn b; JiolntJn^ iht piRmpiiUd nputTim floiK'tili 4nd «prtnditig them 
out »itli * fftoiÄ i»ff*Up tiiol uii lion ncnlleM. 

It i* rory a4vuntn|7«kiifi tbpii to tn>iit tin* piT|>Br»tioD for from ono 
fourth to cue hour «illi * ä-pcrccnt, »Intion of pt>lflSBigTii fcnuuj&nid, 
to vfWh from 1 to 3 dropi of puro Iiri liu hcr-n tidded; or rhe dry 
pnpur&Lion in Amt Lrciiti-^l Utt iwu ininutrj ^vÜU putiixuium f(>rri>i<ynni'l 
•Jid ftilerwanl ivitli frura 1 to 3 dropt nf 0,ri-tH?r vent liydfOL'bloii^K^frl' 
gtycvrkn. Tbif rcni-cinn It \rry dUtinrlTy Khnn'ri by this blur er>lfir, wtiioh 
OfUa bc^om« niopo lnt*in*i> during tho following Ivonty fr^ur hoar». 

In >|]ul.iii]i |JM'>i.^ni.'<l bj tlm milhnr Uu l]iif*rf-fuuilTi>i »f a ytar in 
a loo«?ly i^ov'rvil vittdi-glitHti. *Tid wliit^li bI, fiimt ^onUinrd only niLUtvr* 


nua jfntniiTAr. pi|rmi?nti>d ü<rWt, it wk« foi?nd that ycTloir ind bromUh 
red n^rdlr^ mil plates hn<d dcvrEo^triL ^'liüc thu pi^nxrat-civlb hIiovf«! 
■n Intent« Bf^rLliiblup utatiion, the «lUmiwEliilar farnuilDDa tdidjUdtiI 

Xot hH |iii{nii-at*-i-L*IU (in thr Uwiir cif \\w Uiu^ nml ui tlic 
?*piJtt;m), Lfttto^cj, r'hf^vf Hir imn ivnriion. Thin i* cridentlj 
rK'|]L'n'|i nt iiptm npc Nnther the froifiltf farirt^ä nur the M 
pigment ra^pond« ic tht irw* rMciit/n^ 

On ihf itthfr fiaini, n^rofi^iiifl: fn NViim^mi iinH F, A. TTofT- 
iiinnn, iirntjitg the "siXft-tdU" wliiL-h refeeinb]« tlie *'bejirl-!ü>iwu*' 
cells !u form and use and in »Impe and pculicu of the uuctcua, 
there arc often Mmt u*hich give a di^tin^t iroit rc^rtion. 

In t'ieiv </f iAc äifputo as ta the griffin and ti^nificitnc^ 0/ U« 
"hrarUIetion" e^tlß, thaa facts piu$i ovrir be kcft in mind* 

ArcordidB Ut SocnmrHirfpJt. Iloffmniin. nnd olhn?. the *'heftrt' 
lulon" rHIi nrc ütvtolur rpUhdlA; ncoonUni^ Ui ctlirr*. parlij flli'ooliir 
tpitlictLA. pnrtlj wüinliriuK irfill» (UiohnrtJi). While {ho nnijörily of 
oWfTTiB AtT cuuvinord fft tilt «ifnifiinnvt »f ihfr cv\U In tbv tlinynonii 
of bnwn inrluralitm, tboro l> now t.nd llir<Ji rvimp doubt Iti thli dire? 
lion, (.ineo ihfy xn nl'o ownilcinnlly Biet with in «oxipouj poeutmiiiU > 
htfinupU^iu pltlliinin« Jiriil ««liiitui. 

Th4> <pit)ii>1ml nriifrn 'tf 'Tip "h'-nit-lrwinn" r^lU infl of ibr intirpho- 
|ogt«]ly «iniiliir "nlvrolnr cpit.h<<]i&" \w bavd i^bklLj upon Ihc mar 
|ihi>]vy1c fpfctiiK'A- - Uuvti'ttr. Vifi'tiou , <.VbnlkPiiriH T^vuhijulii, ita-\ irlln-f > 
Hki* di>iiM4-d tbi« find buvd inor* rir \v<* itr<in^Fy ri'ii[iliii«ivd tb* iiitoffl- 
riOAt bMl* for »ioIl a poDcliioJoD. NdLioaDn nlc^o callr^t uUcalion to iLu 
peiracL rctcmbbiiKt: of " Uc^n t»lu[i'' udU to ibi!i *' toot-cclU" foiiod In 
OniiniiT' pbaryiif?»^»! i'\jKVt<>riitiuii- 

Biuojtrro ^ndrav*>mi ti> ovnvftm* tht"r difüeiiTtipn by ^uittijpiUh- 
luff iiru form* vf tilnutrir epilia-fin: m broad, tbln fono «riUi l^atk ovil 
nudvui conlntiting a i]iii.4<m>[ui and »iirroiuidtil by a few proto|-lk>ni 
Knuial»; itnd x hihuiiI Hiimllrr, It?"* Hftllrnnl, nit)m oval or itolybrdnl 
rrll rii?h tn j^nnninr iirornplAiin and mrirAhiiiff ciiu< nr iwo nDclK. T)ii»'e 
w<iv B^id to bo ctptciLlly ditpoKd to Uko up «flaMiut, et«Hi to «how 
active iiTuUfrraliiiii in luAkriinhatoiy [iro^mci. and« bj ?lrLur »F Ibn 
rfuty rantmrilllty Af Viflt priitnpliUJn. to luoarpnniia oAftl^Lmt, r^l 
bUo«] tfpll«, anil fit- Uli] mv^Ein- ilropa. In afuwdr to tiu* '>bjf«^li4n Ih^it 
lUL-li tfrtta ai« abo abundantly fmtnd id »licht Dofda (and In Ü^^ >o-ul]cJ 
phar^ngraJ tptiliiniK ItinciriTo rr-lfTrtA tlwt It m»ii not ba aatiinift! froni 
Ihi« Uut Ihry atu n«1 d.-ritcd from Iho rung*, but ralhcr thai it la jutti 
flabi« lii cvinrOiiiIr' idiit "cwn luHd catAirhi «t Uu> aSrpkvaf«:« readlty 
extend Into tHf- [iihk»?" 

The author dor^ nnl •bar«> tbU Apimon. Ii aiivdin to bim ua^h; 
to conrludi- that ttc occiirrann of tLiao two c«U-|ataa («1d«atty Urn- 


M!rRoac<jrY anp cHKMiffntr. 

tii?al with tlic ^'b^rt IhIou*' Cttlln «ncl the "»«t-oollft") H bIvk^y «MO' 

ciatf^J wilh |mUid(jiilimi itf Ihn aIkuU. Sunh * view U uünirftry t* Uic 

Vr e^f'rimi'ntal palhnl«^' »rr »Ino oppov-ii to HuKonrn'« ia1«rpc<*taU<in 
of lljCAc crllt- 

liv yniing ^liTWH-pijt whkh lu-d bfwn mHjrclM for two hour« to 
bcvbthiniT of l&iDpUli^k* TKhlniovitfi'li nnv^r found juij vur.h |>i^viciit la 
111? cffflAcTia; biit l»e did ÜJid it in thn IniL-ni-jln, ithich vv«a ^ftn 
two rtnyi BMiimc bti "«»ivUlipHt^iil" oharii*i«r 1'>»I h*niior*. In ruhUu 
vliirh biLd rfcviycd LuttulnxcLr-jtt iiijrclianfl of Bwino erjiij|>dfr* cuJIurr« 
niid at tbi- Hinie timu uu inji-clluD ol a cArniin biinpcriMoD tuta IIjc |ujriilAr 
vein, ho obncrvcd In tho ■Ivc'ifi, nflpr t*patj' four hour«, Tymjiliocyl« 
incliminj: caniiUi axi^l lars/c o-J/a ojhiarfin'jii; ftn^tV^i. 7Ac ?ijffci- «I/j ff>f« 

IrtftjfT/Kr firjfnrf* iru* yrtiutt Si:/ JAf ^ff' 'Ärjl rfit'u «*•« roaloinftl ntrmN. 
ShftiJ wc tcr« aitUmc tti&t ttjc pl^^nicLt waa convcvcd by the ku^ocyt«» 
CO IhA oiiitlifllAt l4 tiitt thi> jiiH4iiin[il iiin nf TuTifvFAviliinTi— th&t Ih« 
Mrmia-hoMkn^ iQU^^ni^yi» wiuidfrnl into the ahcvll, Wn inrorparvUd 
Ihe bfltilb, und then omumcd aci tiiiibclioid cb»r»<tci — roucb mofc 

Sinr« K1irti<h> flonrnnnL^AtioTi« in nfcretK« tn nrHln>f»hi7iV j^rnifi»' 
tatians pn^ullar to loucocytea» It ia lo be hopcil llmt thl» controvcnty uiay 

bA flH»M- 

prabti^m by numrmus Rtalnitij; i>xp«rtlriirn1s with Ehflkh'« mltture^a U|ri>li 
«putum and iu<:tid:» preparations, it |i «rlaln lh«t a jwrtion i>f tli* 
[>iKinvi]tTd cell* cannot ^o alninTd « dinlinpt violH iritb ^ih»r tÜM) t«i-ftdd 
or the Ti«>utrHl Rtdiiilng noliil ton. ind tbaT> on lb« oth«r liind. b «^rtftla 
numbor of tb^m ihow dccidod vidc^t gnmurAtlciiu, Tbo ujiprarKEuwA 
tibljiitirJ, b(jwr*rr, y^ hy no (urAii> *cry JTi»lrut:tiv*i. Thi- ltc>t i^*ij1U 
VffTt* KfV'iirn1 nt ii^jF •iii3jr''nt1orfc lij Ntniitirij; ffTaft «piitiini pmprinir innti, 
l?f Dchron oil nly with our inv^nltj^tiniiH. von XniifTt'ii «>ni1<Mir<>m1 tovhtiti' 
tlait Ibin quc»Liün in a fliniUai inAnncr- Ik concluded thixt /runjcvtfM tu 
fffW nJiaKff»f»rrj*ff/iriirt pdrLicipcitA tn T-hogcniuiA of '■|ipii.Tl-lMifin"collA- 

Trom whnt Koh been sntcl, it nppmn tn Hip ntitlkor thnt tho 
aiFiiMipUnn most nrnrij corrnJsponHing (o rrnr prcwnt Infjwkrlgc 
of tlie subject ifl that the "^hrnTt-Ialun" ceJii »irs cJnefltj wandur^ 
inff cclU, vbich have cither token up free pigment or hnvc 
fonnod it from red hlood-öirpHftcks incorporatod by tbcic; fur- 
thermore, thftt pome "hoftrl-lcefon" oelb poeaibly orlgioato from 
nlvc>f}!)ir qnlh<*liB whk-b hnve eitli*>r im3f»j>i?in.lontly talfcn up pig* 
mcnt or hnvc it conveyecl to tlii-m lliniu^'li liio dtromntophorc* 
(Kare), M in the extx^mcil t^lcin, by tlie circubiting fluids, or 
throujffh the j^cncj of aclivc cc'Iül 



/Ire the " heart'if^on" ealis cf patkohffic valits m hrotert 
ituJuTtiiion of the lunffA? Unqaeelinnabl; 1 0<-ca£ioiiii] cod- 
trndictorj abecn^tv>E^ which demonstrate tho cccurroncc of 
liomwidenn c*>]la m ptioumonlo, phUiiaie, or (uLlima are Dot lo 
bd ftPTiouflty cojjflldoryd in vj«w o£ the faüt tlml llio piffaienl-collfi 
are eonttantl^ fomul in gtcct numbers in chmnic vtUtim oonlii. 
tn tiu! funnrr iiutdinn'« iiii ot^'Ji^iotihI pignicnt-Apcck ?s $opa or 
oidy 41 frw pijLTiicnl-er^lifl cnn bo osmoastraW bj iuierc*copic 
cxaoi initio & ; in tiic latter instance tbo mucoid isputomi which b 
m4cr<ncopicüUtf characitrulic, contains numoroua eroall and 
Urge cliimpe and grabs oi pigment an3 gwat numbon of 

A^hin, ID thv former iiuumce t)ii^' inniit be c-iin-fully i^ouglit 
for, txid oiilr oixanioaal cclla nrc Icimd in the ruiciCFCnpic Ücld^ 
in the latter iiutnnce tJ:cy cannot at all he orcrlookcd; indccilf 
th^ ire BO numeroiu that one ifioftcui nlninfit lod to believe that ft 
tiiviif^ prüpar*tion ü Hii<Trr c^aminalinn. Wiy eft^n lh& cells 
(in the sputum s» well oa In the Iprt^'r-) give tlie iron rtacttun ; 
not infrcqu^tly tb^ rcapond indifferently. For Ihi» ixwton tJie 
ptopoH'd name "'htnjoeidcriD cclb" oppoan to be wholly iaop- 

It bis already boon montioned that Uie "heart-Wion" odl* 
mtv nprv'iully ULtineniUBi in thi- sputum f'lr a timr! iifU^r the ntcuN 
rencc of a hemonha^ic pulnicnary infarction. Appnr<*til.1y, 
cBpedrtllj favomblc cr^ndition» for the formation of pigment art 
then olTerc^r uuce the prriccf« usually occun in palienta with 
boart diMAM (tnitral etonoeia) and brown induration, and eon' 
«if^t» of th^ difhifw Infiltmtion of the iatoratttJal ifffiu«, ahxioli, 
and brondifolrw with red bktodHyirpu-icIm turru<pouiIing t^J Ibc 
area of the lufarcted portion of the tang. 

The fputum in fr<^h infartHon sometime* con^i^ts of pur^ 
•omawbat dirk blood; more frequently it is mixed vitb mnciiav 
and leaa «o vitb nit. The bloody cxpoctoration oontinuce for 
Mrerat dii^-K nr mbsidw nTlrr a f<^ lioiir«^ (Tcponding upon tho 
orient of tJic infarct Microwopically (brfv «r»- fintud ai»|]Li-iTd, 
red blood <orpiiPH:lv^, cftcn nrrAngrd in roub^aui, ivud ti>iially 
iaolffliod pigmoBt-coUfl which inorcnM in number with diminution 
of the par«3y bloftdy €on>titui>ntJL 

Inhjat^rianpfrirHnripuUim iamwioDallj cJi^-r^eJ, whidi 


UlLKUSLiPrt' AKD L'UifaUli'XltY. 


ia uauallr easily coii^hM up, and owii^ to its dUtioctly hh)t 
cliarHc-lir uuijr <ifloa give rUu lo a >tu|ji<-Li>u ()f plitlii^is. Tbo 
Sputum niav ^nr iitty:i ttvt'mh}** ihUi m^pliTTrv*ji^l!r. II pmcr- 
aUy pnsentA /or im»-^ a tini/orm reddith, flvid or hr^ihUi'^ 
chfiuicUr, and Hi^poüiU rorncron» miDUto, gruj ^^anuk^. l>eli- 
cfltü »trunk» of pii* lonj or nuy not bo pixwnt. The qu&Dtitv 
varit« lM.'twn**n Iwrnly-fitc nnti on? hiir»ir<'d cubic cpntim^tfr», ft 
Ta ohi^'fly r"\pK|rtr>4tei1 mI nigJit nr i^jrly in tJii* (iiornin;^. Ph>>i- 
icai i^igJi!» on Llje päit of Llie n^pii^ilury Lr4L'l anr ]tbäi>ul. Tbe 
general appearance and other inaiiiftvtäliond ore indicativo »r 

Microßflopic eJKomiivuttcn do«« not ;;crwnilL/ rcrcol ni ninny 
red blood-ci^lU a* vroulil be e»]M.vti>d from tho c«)i>r, but ^nat 
nufJtiMfft <tf gQiuitnoiis fi^nihalia, Ifiitwi^jt», ni"l iiiir-m-orpiTiüsinn 
&fe preseüt. Wagner ouce oUened boUu^ii lüfttmLlbg incA- 

That a certain nmount of caution ebouW atwaye bo cxer-' 
cisad in tho into rpro la lion of sub bloody «putum ia shown hy 
l\[G obftLTvjiEtuiiH uf WiifiK-T, in tiiit« of t^lioAi« |Hjtit'i]te hittorcl« 
Willi wcru *uhr*('ipK^Htly fmiml in Hut spiilitm. In ilii« rcpnrd 
it pboiild b<? rrinmiJh'rril th;il pr»lifiiti who for y<^ar^ Imvc *vifffrcd 
from by«tcnn not infr^?Jiurntly FU<:oü3nb to tubpffiutopiji- Thu 
eontinuanca far u^ef^lrs of a sputum of a bhoäft'mticcid character, 
tht grml nunibtr of S'jvümous cpiiJicIüil crUf (from ton to iwenty 
WBr? found hy Ihe author in a field of Tmjn 350 to llTiD jurtguillca- 
liuu !), and ihe ahaencn of (tt&er<:/c hitciUi art indicaÜva of hys- 
teric Jijmtum. 

It is most probabio that tbo poculiar cspocio ration U doriTod 
from tho oral oivity, and is inducted by suction. 

The diagTf^is of tho neoplaama (tuinora) oK^wrrin^ In tho 
lungs luay ofti'u he greatly fm'iliUl[^l by iij.ip<*t:lic>ii of the 
Bputum. It is g<^ncrfllly »cnnly und almort witlmiit exception 
muco-loniorrhn;ric, bill m» thoroujrhly iiiPorpomtt*d thnt a pom 
or äG8b-\^at^r color or a r'.tspbcrr^-i^Hti'hVp cbarflctpr is iippiirc*n*. 
OUvt-f^ein or eafTrnii-ycllnw enlih'd »ij>»luni ii* ori-Rainnaliy 

At time* pure blood n^ay oho be expectorate at interrala in 
eauit or kr^ amount« for day«, wooka, or even montha. A 
severe hcmoptyäs b cot rare, but fatal hcmorrlu^o occurs only 


in CKvptbnal cue«. X^ry r&r^, alao, aro tbe <'&£ca in which 
tnntOT'fragtni^ntj have Wa ob«>«r\ed in the spuliim (Elirllch. 
A. FrÄJiJki'l) aii[l lu vt\t]ch ''iiiulUforMWHl ivIU, wMch were 
&mui^L'il m lur^c cluiijps. tind rccii^)i>uu1ly fJiowL^J ooiio^ntric 
lamol]iitii>iia ftnd lai^i^ tiwoUcüi nucli^i,*' were prc^nt. 

audi ruiiIinpE. Iiowcirr, Arc raro, <^^ ^' i^ Ihtt^foro ndviMiliIo 
in flook for otlj(T M^u, Awunlirjg to Ihc niithnr'n pxpericnc^, 
vhic-)i \rt Wr(T oik n dorm mrh tjisfs (iliecrviil nl norrnp^y, tho 
occurrwice of numerous fal'SJiunvI^ sphenäeg (Fctilürnckenku^ 
gdn) urc of e^pocinJ din^odic vnliic. Tlicy arc di^UuguUheil 

IVt>m TiiirfTIn mBi by th^lr dso «id tho bighlj nfractivs briU 
Ilhdi.7 of the IndMdhiA] gramilB» compouag Lhs maeM». Tliey 
are i«j probAlly dennnj from fattj-metamor^ioaed ppitbclio 
(corctnonm-TRlltf) (rig, 07). 

Id ndditioD to thti fcit-griiDulo splicTulee, pccuJiArlj foTUCil 
ofiithflia, which oth^rviM ane not met with ha th« tpuluin, ju>> of 
intirmit, Tbrj «re fnquriLÜ; ünwiunlümd in cnrciaoiria nf Üio 
tuog and nrr not mrr-ly pnvcnt m hirgn vhniK Hnmprin hu 
drawn attention 1o Uic fact that thej arc alvrmT« fico of pigm>mi 
Thfr AuU>or do» not Attribut« a« much eignificiuicc to ticm afl 
to the fat-gruralo vphemi««. 




Is nffiH'iion* tif II»? iljgmlivc apparaluB many dcmonls mny 
be found m the ilLK^bargc« per us or per iintini. Their proper 
LDtcrprctotion rcciuircs a knowledge of onaWnic tvlutiouf, aud 
«ep^inlly of th« muooea of the i>n1irc inU^tiiiiil cAnaL Thoro- 
fore A briof r&BUfne of the nr>rDail anatomy will bi? pro«on1ed. 


Tliv mnivjiJiB m^nhrarn' of thf! numlh ronnut« of liLmcUnti^l nqiiiuiioui 
rpithdiuni covcricf IW lucmbrana propria^ The latter I« piovHcd wltb 
numpfcriifc Inrgn «.nd iinnJl pn[illlir, and i* roinj>ofcpil of d^tlo flhcm awl 
il^lkala bundlp« oC ooiuiioi;tlvp tiahua. Wllhln llir^ pTfipim minmroiu 
tuW^ir [iiuvciUKi irlHiiclh nre f^iinü, MutH- uF w)ikh nii? dvcMrdf^r tianclidj. 
Thf* f'\crrlory Oiict« of thtnt ^nndt arif likPwUf! ptuvidod with pavrm^t 

i<|ilthi*hiiiii. 'i'lio ■nntr mndy nf rjäl-hA^ium nlwi pnvfiu Itio pafhilli? ftli- 
fürmef« fuDglformcJi« and tfircumviiliaUc, and in »omr plaorn in hciipod in 
njHiij' iHjrrrHh iri>L'iitXlv(l i']iilli|iUurit Eti^'uiti tml.v u|miil tlir fllifiTiii puirl!]«, 
ond is cbaTac<ii^nx4d bj^ iiltHtmr^ i>l (h^ nnfTiiii« in t!ii> inilU'idniLT lujiifitnia., 
At llic root of the töDffuc. in (he recJon of Lh« tb-ntlcd Unpm] erypt^i 
a^iiTiiiEd tiAhU« id fmiii»! twttfi^iru the |rnp1IIv clrcuiiiTiilULir *nd lliir 
cpi^olljq. At till« pomL nuincTouH l<»u?oe^lcii canMitritl}' vpiml^r In^in 
Uu? tiJen<>Ed tit^ut of llic proprla and min^e ivitfa tb« or>1 rnnr»4 an Ih«; 

The pUiiryuv po»>4i'Htiui a mi:dtlUm«Ilntod pKvomoilt c-pJthDllum 
whieb eilcnda uvcr ihr aurnvroui? pftr'Hii *=»'! irmrfiii* aUin!«- T]w 
tnacnun mi^rnbranit of TU*' naflOphnrj-njo^al i^vUy It prrivliTnl muHI' 
l/Liniimt*'Jf <'iliia*'il tjUndrfü epUhoUum, A InTije nmount of adenoid 
Ukdoir id pT?«crLl upt^u t\iV \>huiyni^-t\ totin^U and oper^ULlI; upnn tlia 
true tobtll*^ TMe tjc-^ni^ al»o prodiK'KH nitTii^roiiA «nNvary i^nrpu*f^lp<, 

Thfi lamEaaUd pavofncnt ^pJibdium of th^ plmr^'nt in cLnitisnouB 
tbroü|-botit Khv i.*^njt1ui^ue. Tliif uiucoui of tbe eflo|>bn;;U9 in f>rovld«d 
wltli papillLt and it 4iiim>iim1f>d hy ib* ■nlifniir^oiH. vhl>-h eoqialf» many 
uiui^xiH Klandfr. and by dcn--^ ninanjlar nml AlmJUM c^tU, 

Thv mumu* mnmbrani^ of thr ^tt/tiinvh is (■;iiLipom?d nf epitlielii 
nombmut pinpriA, nmsfiiilar Xnyct. ind »uhmi^ow. Th« mWn <*ompoii|] 
tbc epitbt'laum nrr of n mupii» fiimdn^p cyhndHe »iirUlJ. Tho membrftnft 




propria ^onl^liiB r|n»ft/ MTi*ii|f«] ^lunJ» hkii'ti art- dt^ienalcJ &< fanSvi 
(ppptJp) ttJiil jip/QrJe ^Jnn<b. 'Iliny aiv lUffrrcniifttHl from efcth oih« 
by lb* fiVt tUiit Ulf pylorifT |[f(inclii oonlQJn Dril<r cyUndric o«iU r««inbliif[} 
Ihv «o-ciT]cd chUf [of <mlr ji] cell« (KV^i^tcin), yrhi\.t Iho fumln» rIuthL* 

lor ocntmJj wll* are at a low cfllndrt« tyjiu aiij ooalain ft »haqjly <!*■ 
flnvJ aucku« iihUiIlIliI in ■ KntnnTnr iiriftupluniii. Viiv ]iALi(tA] (or »ciil) 
nÜir KlCrA une niitrA rmlartird rfvHhi; if«c;r4ttnn, ajijHnr in a monr 
Founded fonn. Th* chkf cdU arc grcallj doad«d and tocuvliat iwollcn 
diuin^ l)io hi-i^ltt of tliifvjiiTuiL Tliu», Lliv UixlinuL dilT«iciicv nutnl iu Lljif 
tx4tirf^ tt'>miii4i 14 wimrwimt ntmninhl, R(>th j£rmi|iH r>f ^tinil« ba^ ■ 

Hic 4nfnJrii«r mucDfi» b covpt«) bj i^llndrlc citltliclium. Inter- 
nipltd 1icn> anil Uiata by [mUMldl oral gobUt^otlU, 


Reference has wpcatedly betn mftJe to llw fwqutnt occuf- 
rencQ of oK^i^ bacUU, »piriila, UphtKivtf tad lik« rc^tation» iu 
the moutb- Uiually their prtMOQce may be coiuii}creij (rby*- 
Lologic. Tliej «ry regftNkJ n» j^JiUiolu^if^ only whrii thny occur 
in en^noifp nunilir^m, %\nh ■« are obu'TVinl in tmitiniLf^ ikn^lnrt 
of the toilet of the mouth and irhen numerous hollov, ilecayol 

Th« wor {thnieli, aphtha, or Aprae fungtu: oütiiuii olbtaitu 
— Broocb] fungua u drsTTing of mow uttontioii (tM pi^e SO), 

Thli (unp]s \ä uBualTj found In childmt and JrUlitaltJ adutt«^ li 
fcegtna tipf^n tlis mtitüw uf llu> wft Enituti-. 1<iiit:»r. i>r rlnv'kt. KtUrk'^ltr 
dffpCHtlA vQVtr'ais *^ ^'^ ^i^^ pbaiyniiv&l oarilj furm hv canliuiviiri' 
of • tmmbcr of isdividual fuDjiou> rniiitionn, The cliitriftnietii^« of 
thif fungui are tlx^ piim whif« or dirty jn^jlAliyofto^ir i^olor. and ili« 
it«4tlDM Willi wliifti tTio d^|■l1ftit onn br di^Eodjiyc) «tlhout ifijiiTy t<> Ihc 
numM. If « HPnil imiiüm (^f Uiv "pwi^Joim-JiiInuEit!" b j^uvU urnlcT 
the mlcvoaropo, a ilu|mi>»ia «»an b« reaillly madv. 

Acooni}»avvlii|f tbe iflvv fungxu la lalanii, Imt alao vlUiaul it, tjm- 
VHri^ wliitiah vn nliitiAliyrlhiM arv>* arv iiurt inrifiiurnlly mct bl Ul« 
ragiom of th« 1ianit;h pi^rjjEi^i'lH^ Thf^r arv »IM fl<vla«r'# «phfJla> 
The lUrUcv b]e«da r«adiJy wh^n Ih« rouad or oml fed (from Xve>o or l«tir 
tu ■■vUl niiUiuivt« m Jii Jjdiiitri-r i arr dl*Iiirb«l- Kninioufe may mi-iir, Aiid 
il mat#ri«l !• Bm|vil frAtn lurh ain». drl«^, unil aU1n#<l, «Uplijltyixicj 
nod frtrc|jlo'H>>:l r-<i lu^ti-fly vill Iw fuuiui. 

Thi^ gonococcuft rnr«Ov inTuili^ thi* niu<i>uii nivmhraik* of ihf 
piooth in the Dewl^ni. Thi» cooditiou hu alraacljr been 
dCAoribcd (ftp: 41). 




InnBiEcrsble boctena common to tlic oral CÄrity, in adJi- 
tton to pttft-ccrpnsclcs And falty dttriiiti, aw fouad on micro- 
»copio iixnn^iTtfttirin in Iho yolloif or w hi titih -yellow plufja of 
Bcute HJig:iTia loiiBiUarlB» A ft|>C€Llk fpoeiei has not been dis- 

YrUowisfc-gmr, olTi^nsive plus^^t wliirli can Ik* rniOitrd flal 
beneath a i?ovcr>^ljiJtf, con oikm be removed iron Ujc toDsil* ol' 
tbo^ who suRrr ^ith frrqucnt attacks of lacunar inflamma- 
tion. Micrnni^opi rally they «how, in addition to counlleaa bao- 
ti-ri«, fnltv Jefriius and fal-needlrt. 

Similar bodiaa, oceasiMnally inr-riiKtHl with lime, arr* fit|ieclo- 
nttt^ilby ttiiiny ^emm^thmix^fWhGTvoMj^hivgavhawkit]^. They 
may be frco or imlotidcd in niTifUs, and t»ftfn give rlw to much 
düc4>raf4>rt. Tbcpc liodir« arc formed cither ia the Iocuao! oF the 
tonfiil* or in the mucous folliclffl of the lateral walla of tbv 
phurynx, Thrts pturfs art tuuatly tihovi Ifie stxe of c miUttssed, 
bvt vmy he f/jaud qm large at ti brani Tlie lui'jiivt obn^rved hy 
t!ie author ^t?ro Ibe si/j? tt a »nif\l\ pfta. 

Cystformationa Ui the tonnils arc ocf3Fi<^nally «rrn in vuch 
patiimlit. J^hcy vary from the nm of a poa to that uf a ciiL<rry. 
Tha fluid cvncunlod by etipflrficinl punpliire is natt^ry or puplik« 
iti contifltpney, and rwldwh or vi^Hriwmh rod in color. In addi- 
tion to fntty liHntua and fat-nK-edl^s, the aatitor r^[>ea1f>lly found 
in SLich vjsU rhuifstcrin plairx and (»tea htiimtti'idin jiluta and 
uccdif^. In ndditicn to chulrtitiTm, ho has H'Ch Infgci, öUghtly, 
ßlistrnmg bodipi; w^hioh, to a C4-r1nin d^gn^, rcsi'mblnd n krge cggj 
with yplk. They disajtpi^arpd upon rpp&itäd addition of sihtr; 
ihe transitional stages oft*?n prrfteiil*>d slrong refifmhlnnct to a 
trfliisvers? m'^-liofi of & Irtr^f W'nshi^ll, 

In tonsillar and retrophuyngcal abscesB« nuiiir.'roua pus- 
cclU in a more or lest* adviiacvd iftjip? of fntty motamorphuniw, 
mucli frtc fat, and hir^f iMttnUvrs 'if hn'^tcria are found in the 
yoHowieli-whito puruli^nt nmttur, whidL le uüimlly i|üitn thicJ: in 
consi&teney. Smnll pigninnl gnirn!«« nnrT flukrai avo not infix*- ohHrrvi'il. 

In om- i'lMr-t whk'h hati nln^ady bi-r^n nicnlioni^d on po^e DS, 
the author obnerved nvanM« of UpMhr\;e Hbeociaied vritb namr^r* 
0110 ccfcovifnaA furmi (00a YiQ. 17). Nujiicrouft (fMinophilc^ 
were fllwi prc'jii^nh 




In tW of tfa« grot importtnc« of the ton»!!« a» a port of 
CJilrr f*r inft>ctious bftctrria, it is adrisablc to <icrott (rtvator 
AttniHon to the bAOt«riologicT oxaminatioa cf finch plug?. Tlic 
«xp«n«n<-« of Bircli-l!irschfel4 ia sofBciput pTOof of Ihift, ainoe h** 
VftA tttice aliTe to firnl lubprvle lia^iUi in Eiui'h Eiiafi»es. CaHous 
teeÜi are^nitciu "irorth; cf aLtriilivn n» \}ie lon^iUur Ijiciui;^. 

The i^Ldf^mü^i» of croupotii itnil diphtheritiü tffectiona />f t}io 
fiiucot u l^rcjilly fucilitnti^d by mJt'^^Firopic cuminntian^ c«f)o- 
ciully in tho nnrly «tagni of tlid dtiMse. 

A more or Icaa denio fibroua roticutnm (we pAg« ?07, Fig, 
S8) is foiiml til the wliJIe i1«jw>Bib of thi* lakr aüig««. Ovritig 
to the cltlficuUy In tVAung lU (he oiHtrudJun of Ihi» reticulum 
cam bu inu<Jc out odIj at ilio ptTiphrry of the fra^nrnt. On 
adUiUcin of aoc^tJc ticU\ (1 to 2 per cent,] the rmtnil C'-llfl nnd 
«^pithdiA, with tiiHr niidoi, sro distinctly oattin^ imbodd«d in 
ihn clcnr T^tiruliim. Tf th« diphth^ritJo procrtfi «xt«tirlB to tli'^ 
respiratory pa^ag^, long crou|w>us ooag)ila, whidi have alrcfidy 
been Oi'wTiUrd {fiflK«? 500), inny be r-\p*!i:lonito3. 

TukwrcnloBU of titc oral uiu) phuryn^uit catilien it TCry fcN 
dorn ol)iiLTV'o<l. 

Am ft rutp^ It llrtl apiwar* In th# form oT ptrlly lulatod, pKTtly 

' Vir'ft^'^tonffn«^ It uijutiftvt» |£ft«lFr pn-tcrrnoc, baurwr, for ihr Ulcni) 
•Ad patlt^not vtltA aI Iha pharrni. Ihc InrnTlaMn tm^fmoy 1o dUlnir- 
I^TAiiän xihimtly l«d* la ■ij|A<Hic>ml, inrKuUrlj' oiitliiioü. «iiJ ofltfn 
ttudrd ulrrtatiLiIiH Tlic batic L» gnj or vf bact^nlakp rvWr. da/ii^h- 
wlkiU. rianB|JBf*nt noJutf« mt Uie pmphorjr »f the nl':«» an ünporiunt 
in «UAjEuiitiK 

Tbtf diagncm. h^tmtr, ig titaltühvd f>n/y by i<Mon^rof 104 

Somo of tliP HCE«ti«n 1« «criprd from Itir raHOv»" 1m>^ iir Llui 
nftrgLni of tit* ii]«r. IIlcq irituntMl in a «Rlr4i-i[tAH, wiiK AHdiiii^n of 
a 0fv drop« of plkj^ialo^k mH iialutidii If ii^nurj, iiu-l roTcr glu« or 
«Hd« prrparatl'VUii iriadfi «ml sIbhiim] iu Utn iimUDvi ahuuly lUwiilapA 

[f tbl« itLcUiniJ t» iLiihiL('(i-«>fu1, [lUTtltrn» ot tliv lUsuc ftU<>uld b* muov««!, 
|iAnie»td in A^dhfil. uii<l AliiUHl En «rtfkuni. 


HlCKÜSaiPV ASD Cin:%5\hT]\\\ 


s, findinqa in d\3Bases of the *to«acm. 

UictOAcopio cxami&fttion k aelOum of decUivc valnc m Uio 
dUg&o£ia of diBturbaiic<?« of tho elociiadu Tlid j^tric coatenU 
obtairwd eitJiCP by romitiag or mechanical ii^eaiu (IaT>g9/ 
i>uckct, etc.) is iijied for tliiH putpwtv In wlilHion to raaner 
food-ivmiLaul^ fui^ign bodies, miJ aLnivnunl di»ci;bmtionA <lne 
to ädiEiixiiire of blood and !>ilL — all of which arc perceptible to 
the naki'd tje — then; arc found: — 

m iiHuuJ]; wi^n dvüiii^i], tUoiifih ofUo Aiinivwhat imlUUncl. fb-ninartfji 
or miik in iho form M eaicLii llocwiklij t^tdroptoU, «U-; MjfrfuU« ortit 
in gKAt vftTirtf. uIijüj give a dtilirtct »tarcli mtcLi^n. 

(h) «Ifuruf, uvhlrh ii rvcognii-r-rl witli ^rfnintj bjr jirjviptlAtiiMi with 
ikvotiu noirl. It in vocrctt^ |knitlir b^ tho mucoid of Ihc ftlomach «bd 
parlTj' L> thkt i>f tlm ekuptiutiu« &nd phArjux. 

i^J iJlotitJ <W'»TN in lAr^ tmaiiatd \n gatirk Ti^niorriiniE^ At tSr»L 
it » unijü]/ miKod with romntnU of foc^cl^ but In conUnii«d hcmorrliuge 
It appuiia puic; It i« «omtUiDci bilglit it^, but nwra ort^^n üaik ml, 
Wlion ffiumtn«! miproUftopU-Blly, H nJi'^w« r«l hlaod.«irpiJMol*« ■oTtiinthaC 
fthninhcn or |>ArlüilLj dCQolordd. It it 4ip|iCfiTH In a driik bn^iin, trolToO' 
grouQcI'UUc form, tht blood-corpunolu can tmuully na [on^r br rKaj(. 
DlE«d- On tbtt othar hnnd, tho blood -roloiiog cn&tlcr con ha damor^vlnUd 
by dipmk «iid inUTüucofHt ounminntion fsc« ''BWd/' |im;c« IftB i-t H'-'r,)- 

(d) Ejiltfirlift ]xti'} tKhttitit dwi/t nrf wiy nrrly nlMitrvfd In Tontlt^d 
gAftlflo 4-onE«nla, Lul thoy ato oi-caviODhlly at?^i] m Uip (htt^tibl ■0J7ar<>d 
by AilJÜdal nii-anii (ntg^biiti« ck.). Tbe cplthclU Arc jei distidct c/linilne 
forrnn fir Vvy *ifl '"riliiil," or pArlHaU Cdll« d*rtvfld fr<nn tUr» riibtilar 

These will subw^qtieiitlj br diacuwrd (»cr "CAroinoma"). 

fej ?AiaBltfie.^' 1. Vc^^i^labtc pbrANjtcB Am vunFifAuil/ prVMal 
Coed, bHi^ilIi. nnfl npirilla nre found In nil gnutrii* roiiirrt", «irn Ul 
iTiHfll nonnni- Fitft-irvt tcNtrimU aaJ ycfflwfs »re tomTuonly found Sn 
lüiffnntlon, wliNbcf free HCl Is pir^'iit tit ai>l- Tbr-y niii rtsiJily dninua- 
UTAtdii by tflklTig »omo of Ihi- gnut'ir t-ntiti-nU fmiri fbr Iv-tTtßrn of Iha 
rood vJlh (I ]H|i<^U« and cianunin^ a iwcih drr»p (nilb or wltlioul 
dihitbn witli \*'jili'i* imdrr Lli*' mU'i"»rrti»p. Tbi- irtJ ffn« rn/^rlr.'u^i (Flif, 
d^. I) U diftin^EtKhi'd by it« ElittlnoL li'imd lonn And ponkf-tlik^ drr»nj|u- 
itiCDt. If once teen It i« imposajb]« to mlatokc It. The bdivlduo] cclU 
«™ nior** or Ipm flriffJy emimUr. Oppler h^i Twnnlly dl*Un}rii1«hn1 by 
Dulli^'nli'in Am' N|*f'rK'- ->f «flri'inn, of which Iho oranffr-}/rUouf fnurimU'fJ 

nxDiycs IK Dis£AKic8 OF Tin: sruMACfi. 


jfatrina js r?hiiniH'<ris«I by iho fntt thit It grova lumrlftaU; on in 

■fid nuljicTit Tiifdium^ whfk Ihc iilbfr \iri*llM lri*Jw nn'j «pnti nlkAfin« 

Iti cArifjrfo Ibc <bar&otr>ietic bMilU taty occur In the vomit, |Wf- 
tkriUrly id Ihc mitt^ut llocouh. 

¥. AnlmiLl par»it<>ft arf aflMcm otnPTrnd in lomilii! miilt*r. WUtn 

rvlikt. ]>flE« n$)p LUtiuirFi vtjtirU hihI HjiHi^lnitumuri, u well ikJt 

Fls, fl^— <t«Htrio CunlrriT« CaltciDtli« MJcTEiicopic rirliirn. 


arllV J^ Vssnali^ bftir, 4, Etmivlii^ ft, Twit rUEi[l. f. Out'k' >luiiJ-n41i^ 

(f> PV9 may bo mixed with tomited loAttnr m e«»** of ruplart 
of onl juhl phnryngoaJ alvcstiM or in «iTci^tlonM ot llic reipUitor; UacLi 
J'u* oauiva tmni tlM »tom&ffh ll*«]f only in r^ro laaUocvb, «« in «a« 
of phlffmonouB |En«tHtit ftft«r lumuif and cnrrovlonp or in perfornÜoB 
of pua-fod ic Üie rririiin of tb« »lum«c1i, [Accunlini; lo most tnthorl' 
II», IÜO «^ntljfit «yi^iirrj^niN* ot pn« in MiJ or nonfrlid »toniMcti con^ 
iniU !■ ilUifBmiti? i»i f^rcinvraa. Ort*iilyaaX\y, howo^er, mi tli« «utbor 
fttAl4»ii, }]|j)i iruy Iv prfhtnt wlion > prii||*A(rie iüihctob iiiptnnH Into 
Um at'>iiiao]i, but in am-h itmliJifV!« mtcni« i« iitimtly ■bwnC. — Boi^ciKü] 

fifl Mor« OT Iph 4oddr<ni4l BdiDKliirrt may bt found, tudk a« 
■mill «nd UrgB ford^ bodk»; uatll itooc^ tuür. poppjaada. hmli^nA' 
n»dj^ tt4, '1 ik>]r AM rtbud by «itboF •ponlaMOtu or Induvrd romitit^ 






1, In ncntooTid chronic gLttricoaUrrhUiooinount of mucut; 
(k miirkotlly tnctr^fiAod and the number of bacteria ifl luutlly aLi|f* 

mpn!!--! ; ir llic r-hroniV fnnii j^eH^ld aiiJ surx-ifia ar^r nfti^n fruinrl ; 
roijiid cv\[» art' ouimni-m ; tzpilUeltn nri' rnri'^ In ^iphcjui-'il mntv- 
rial BeDLikiitil^sixed piecea of supcrficijü mucOMi arc ocüO^ionally 
obeeD^odi Microscojjicully it showji n vi*ry Ijcriiitiriil coiiimuoud 
kjrorof cpithclitiin w^jich nppoiire to bt* pinrrM by «i^vcrnl ;fl*ndu- 
lur mouIliJi. Snrh Invrrs are Inra off by Tii*'chflTiti'n.l tioli-nce in 
ruitlug tlifl filiiiiiftrh i^>iiti*n(» and mvjir in<»Tv r>fii»ri m ^antiTiU« 
cliroEiiL^t. By tuiljillc mxTe tlic:»e iEijuiiL« cnu be avoided^ 

S. In ectaaia tho pullK'logic manifeäUtioim are irLcro««cil. 
Saictun and yousU otwup m large nunibtra, o^pwmlly vhoD tlio 
dilalntion is not cuu^od by carcinoum, in Ibo jirwi-ni!« of malig* 
rmcl diftiisc Ü^cs.s ftmgi nro pot »o («Twlaiit, On tlnnditig fur 
ftevrnil bo«i-*t3isiim.'t fcnm^nbiliort ant\ n "mirij^" i-if the vnniilri) 
maUer oocot. 

S, Ulcer rotnndum fnrqwntly pvca riec to blootlt/ vomit 
la atiiijtmii to \i\<K**l iinjioU with reninins of Xood, piire blood luny 
be <>j:jjelU'U to Ibo amount of even one liter or more. Tt i* rarely 
bright redjbut Kumlly dark r*?d, fluid, lutd tonxiihti'd in tOtunp*. 
f)rr*ijiimijilly it »jtju^iin» in l\w fcirm of brtwn, colTi-fvgnmrid, or 
tealikc ma*«*, Micr'ffi:-if*ii:aUy partially cri-niitcd red blood- 
cor[H(&clc9 arc iieonüy fonnd, Jf thfj nn^ da-^troiTtl, tho 
ohoniio or eppctroecopic d^moriÄl ration of blooj-colorijig matkr 
ahoiild be made. Tbe vomits matter ia wanally *cid in ntaction. 

4. Tn oaroinama of the »ophn^ii and «tomach poriions of 
the nnipljiTini mjiy iJCi!*iBiulian> be torn oH mid broLi»:bt up in tliC 
^yo of the etomacb-ltibc during founding, and the dlM^^nosjii tliu& 
oatabliahcd- SpcciUc fimiiod clemcnta are very ran^ly Jouud in 
ih^ vcmiied maUrioL It Ja V[>ry difHeull to dt^eidc in n givt-ii 
COM wlietber tbe morpbolngic eb^iritml* «rt rcully dcrJTSd from a 
nt'opliiwtn or tin* iion^iJil miicnwa- There is no specific ciirrinofna* 
cr.ll Otdy truly *'ooaccntrically lamcllntcd" ccll-^onp*, or 
"canc€r*ff^iflf" can be regarded ufl of positive ai^i£canc& 

nKPUSoa m msBASES op rtts sroiucu. 


of ID ttlvQolar struuturo are ^vhoUy without dipiiric-aQci>, 

The antlior hm rarely found the «IgnlAcaDt "'cancer-pearte" 
ia CHftra of airc'iii(>iim v! Ilir- i<»i){i]m^\is or ELumttcJi. 

Til« anionnl »ut\ churncU^c nf ihc innMt^ innülcil in mrd--~^ 
noma of Lht? Moninch flc-|)ciid upnm the W^tion ckf the nr<)pliumi 
I'aroinwnnlu locuU'd in Ihtr oird^ nr fldjwvtit part« ^lurally 
CAtusg cnrly vi>miting of the ingt^tcd (am). It is cxpclkcl but 
nlighlly alh-rinl and imbrrlH'^il in thik-iis, ft prHvuw^ a BtaLc^ 
otloT, oivi, in sliniühiTig cflTi-inouia, jin oxtifiurly «iffj-'nHli'e (hlor. 

llio fü^-'t Ihflt In ^Aa4^C1' cf Ihft »tomapb tho ciptianat gnatrlo cotv- 
1<>ni« JilTuivi-* » rrpiifKier *nt"t' 'm 'it •zfAl i)iiijEiii^-*tic vjthjc OIifm-iii-« 
tum?« in «lifrh rriii.-rJiIluii,TOiiiiiriic>iiTii| [mt|iiib1e lumirrnrp nlt^pitt v^n bf 
corrvcti)' ieirrpretcd by thin odor, a> I Imvo found in HVcmt camb which 

TUe vijiuilu« in pybno oaxcinoma iA ij«ua11y vory prcfuBO 
ftnil Iiiu iiu offt^nnirü uetd oj^r It apoar* gmy or dark browaUli, 
ami ofU'ii ctmlairta targe aiurjiiiitB of fivjil iii a vtale of ^n>ftt^f or 
\vsa tmutfüniiulüin. The cahtv at Ük tumiW aialr*m1 niiigi» 
frcnn cofT^c- to cliorolflte- colored, acvonUug to the Amount of 
Uw txinc^rrliivg«. On stondinj^ etrntifioatioa occum, ihc hi>avirr 
faod-n^rnaanli: ^^tliiig to the boltom. A wnlorj', rlirty, cI<Judjrr 
nuico-foniny UyiT form« ihc toji. A "doiigliy rising" in ofton 
otiWTVoi], siTniUr t'» that which otrur« in wtni^iii. 

MicriiAc«picfiUif EorciiifL anti yv^^t^t« arc often fouinj villi 
food-romnaikte anU nurnornus bacteria, Hcd hlooJ-cctla are raivlj 
prttiout. Hi« demon strati on of blood-coloring matte^r «ruu tt^ually 
bo <lf>m' by Hicniio or sprt?it*wi\ipic mMhoiK 

y A<Bt« phltttnoAon« («JitriUs alwfty« fiftimt« ToiniUiii2> Pu* i* 
not iiKtAunly ptpimt in the x-oniilpil mjifrrtiif EpithpMn) »hnd*, hftw- 
•TOr. ar* &lvnjv obfcrr«!. I.^it« fsiinil pua, «Ithough only a Ttolant 
gMstrlti«. ^th unUKUftfly intrniK pumlral wcicUon upon thv fit« «urfac« 
of Ihc nnm^^^i^mh^vi/f pdrfJrifaf'oj nj Ittr iHAnurMd— «^it* prvBi'ikT- 


I. Testing CUclrlc &«cr«1lnii hy Chcnir Ftamtnallan of llie 
Stomach ConUnta. 

As the TOmitua i« ufiiinlly filleroil by m tnrgv amount of 
miraw i^arctod by the ihucom of UiA «opbA^ufp plur/nx» uid 
oral cuvity, Uifl /nriric content* wured irith Üi« itomacb-tnbe 



is «Imoet cxchißiroly employed for examuiAlKinH Tho odor niid 
iiiacroecopic f^nliirofi of tho eipr^eaod oont>ntH 4>btiiiQod one liour 

nftf^r n tea breakfast* or four lioiira nftor I^iibf-'* i<^t-m(MiP nve 
fitsL oli^f'rvi^i!- TfuT (ftuilrnls iirc tlirn filU»n'd ntitl Mibji-tled ti» 
cheniic euimiDJition, Tlid! rrAdian (witli litmua-papiT) attd tU« 
praacncc of frt-u UCl nrc first JcltTniincd. Thci: the qnaiitiU- 
üva dotorminatiuii of }U-l nud tbo qiifilitntivo 4ixumiiLutii>n for 
liLcrUc acid ftr« undcrt&kim; and, ßiinüy, the dot^^rmiDUtion of 
fH'pfiin sLTid ijiilk-nirdling {hh) fprrnpiif, and the drgtvir nf pn> 
tüiil and frUrch digC8tiuu. 

With very rare CAceptioDS, the gü*tric coaknU thus obtÄincd 
have nn acid Tcaclion. 'Dm is chiefly due to froo and eombißcd 
HCl twitb batüft imd prot^'id h'^Jio«) ; und ftl^o to orgonie add», 
of whkh lucliy imd It^ ofu-u bulyric and aoetic UL-ida nre of cJilof 
nn^rimiLi^ Tliuw; iiUi Jiiiij «mir in n fn-i- or imiitiiiu'd »Lute. 
FinaDj the add plio&phnte salts pariicipatc in the ucid rcncUon 
in no email degree. 

Si^iUcnnce and DemnnKlriitton ol Frcr HCL 

It is certain thnt tho function of frcv HCl, a% wta ünt 

pmphüfii^rd frntn n rJmiTiirf»-phj'tiijlngii" ntjniiljioitil, rrats rhii'Ry 
in i(e autiiteptir- jk-IIou. IU pf^-ptonij^iDg mHucDce ia of ecc^ndary 
iiiipoiiauce. The ainoiuil of HCl occurring io the stomach siif* 
fie« to kill the umjority of pttirt-facihä micro-otganiains and a 
number of iufcctioiia bacti>r]a inlroduood with the food. A« tht? 
Thjthmic perUtaltic movement of the «lomacK eonatantly bfin^ 
iirw portioris *tT tlie in^'-ela luUt iinini^diflle mnln^'t willi I-Ih? 
gUiTidular Mirfflcc, the nntiaeptic influence of the strong minrrnl 
acid coiutontly sttn^Lod con be fully exerted upon the bfKtorio 

The peptnnixing nctlon of tlic giiKiric juice \& ocrtaiiily of fiO 
small boportnnre, even thmi^^h it pun ln> whnlfy »iiipplniit^il by the 

■Tvo nipirirbluk um wlLhi>ut BUjftr ur uA\k »nil onv ilr) full, 
'tuir v)Vii\iUil*'1u\ tif grun^-miu^ «i»4htril pound ]iulUi1 iif^t. mir- tali, jvnl V«1p'b 
lEviJd-Beu Lrni'iiirnJ i Our (vtL w llbi^ul liHltci, vt twb allm vt ii*\ii l»«iitciiirila bic^cl, 
■uJ oDfl Lijil ' 4-HiJr 4^iipfu^ üf [taun of trjilvr, llamava noDliiiiia of ■brinuJi kOsroii* 

HtH|ir4r* tn fmni Ihirij (4^ i^ift^vRv« ininul«« in« lb|i«tlaa, Th* BtonkEbrh *hoal4 b« 
HtfiUvd Ed fpniiir.ivnml«n4iiii1f]iuwhiiiriiaifnKn*rUi«iuut TiUl orMltj Um>nitit$$9a 

»■ OvKnT:i,VDinBL-na'i'JKHj 


fimctiticatiRg p;inrrrpu<. On the other hnn^» Wo: ari^nuiMn <1^ui 
cot pow^ss a ^iibtititiitc for tlic actiwptic pP>pcTttf« of the odd- 
The njiKviea of the pnr* f>vloncn Kcrclce prppin only, «nd that of 
tho rimücu jH^puin And HCl. Under normal aon<.litionä tho gas- 
tric Juice rany contAm DJ5 to 0,3 pop ceni^ot fr^ HCl. 

<ir hn ial^ntis itrttU-ui initn^fuclutn in (he Inlmtido ÜDpcmU iiivt'n^.lj' 
tipou tUi^ HC'l i)JHt;itvdtui] vf lilt t'ttrl In Ihi- "ti?ii,i4j'h. It^ n'.'[iUii1i''i'rl (lie 
IfHxlHr Hf,1 by »ho jitlminUlrntidn ot Urgf dow« of Mi-nrlmnuT* c( bo'Ia 
and aluavj^ obwrfpd ■ pAiallel lucn*« of Ibe cIIicpmI tvlphalfa In Üw 
urluc {|mtf& 2i>JJ' Mulci »Uo dctiküJiiUaUri] Ihia fm-L in doici>- lie 
xviuImthI thtm abH>lut«lj "chlnin'frat" Uy f^nlin^ with rliffiliEorinntM 
m^L Ab bOOII fta thef wcTo fed wilh f>i)1i%d clilortn fprc meat iotci 
Intntiniil {JLitrcJaoMihii al t>uoA Iv^'an. Oa iho utlici Imiid. ^vlir-n 
lUiiiuftlji. in aon4u<|uunr4 ol rntaruiion of cUlorin in^kliAti. woru sbk t«j 
cl&bDr«t« free HCI> tba «niouiit of ctlmrrul HLilpliJiUfl «t fQCV Jcdinvd Ifll 
rpilc of turthiT ferdlne uith dw<jiii[i[iiwd mmU 

(i) QiralMalhr l>rmf>nftl ration of f^rre HCl. 

1. Cor|:o paper is inriK-J hUw bv /r« acVi^. Free HCl «rill 
oJoaic caQj^> a distinct corutlowcr-bluo color Laoiie acid pn>- 
^tto«» tho laH»r ^hiiili> of ooior oaly in a conoontrabon wbicli 
ncTor occurs in tJie stomach. Aft ii rule, thU («t cim bt* por- 
fnrmi^tl Lj »iuiply tlippiufc' a strip iif Tort^» prt|H"r in llwr t-lijirwj. 
Admixture of irtucuci oud fal niay ocmuiittualljr inlrrfi^re vHh the 
tart ami neceMitutc liltriitiou. The n!actioii U then )!omcnv-hat 

2. IC«tbyl-7iokt tolution U chnng^ {o a «i-^-lffu« oolcr by 
tmreg of frwT HCL 

A wnk. but dUtln^ly liluo^ WAtcry aoHitlAn U pivpATuJ. !l I« 
dlvid4<d into c.^iinl pjirCa. ^rii«#d In two iati-tAthöJt, ant] ■ fi*« drop» of 
Ihe flUiulc !■ [nldnl to vnfl of Uw titW. Ijj tbn pn^M-iwv of Itva HCl a 
«kj-bhif* mlnr i*< |>roc!ijot<l whk'li U »ttnn^lj markig on oimpirlion »Hb 
tbo roDirol ■»lution. 

3. Tropaeolui.— Thn yrthwiih-brown aUfjl4^lic aolvtioii ol 
tropn^nhu obonges irt rttfiy-rcd on addltmn of ddub^ HCl |la<^ia^ 
and nci<tic nddfl). Aocördiog to ItooSj tlila »tibitiinog can bo 
empLojrcii in Üi« followinj; raftnncr m a oCT'taiii tnt for HCI?^ 

Tlim ur 4 dri>pi of <Ofi»nlrAt«il ülfchciljc «v]titU>n uf 1rD|Me«3lfl 
find fln opial Hrn'mni of thcchfmc flJlrslp uro niitnt ifigrtlior \n a poT«^ 



Ulli illiilh On lii'jillnM jf^'ntly, wlir-n frw HO ih |>rt*nil, «iMiiKrl V\tc QT 
bhi» alrrsk« will b« vwri at tha miuviil of tbo EtLiid. T'hw klriF«k« iLrr 

never piodiiccd in a «ilmlfAi inanatr ^j or^nl«; Af'id.«^ 

4. Qunsbui^^i t»1 vith phlorogluoin-vitnillin:^» 

Tlirm 9T 4 drop* of UjIm rf«(itDt— rompoKil of S porta of phkiro- 
ghir-ln, t purl al vAnfTlin. nni .141 ptiili n1 aFi-oTioI nn AAAfA ro fhr nm« 
tiuTJiLpr oF Hm|iH of Uli- flttmlo in a pon-oUm diith. On bnÜTijf <iver % 

Irjrl.h 111 Tlii> <l(»b. thi» prp*riipe of frni* ITl.'l ia tliowTi li>' ISp jli'r#»ltjpTnpat 
of A hfiUi\ini red fvttffl'. Ctin tlLi>iiM he Uk^n nal ia bring ifa« fluU t» A 
lifiil, H.« Ll»i n^iLiiion ilrir* mii tHVp pittcr hI lwji1Jii|£ lirni, 

Tbn 1e»t wn ulun (»• mud«? with flU^rpEtTipr, pn^[mrNj with GOn» 
burn'» iobition- A ^<rip i:>f such finpr vhiih hai brcn dipped In Ihc 
KloinftrTj cri]i1>m1fc Iimiih a blight, ri'if nn bi^linj;, 

I'his tol cJin (ilwuyc be relicri upon to detnomitrntc the prm- 
rnco of früo HCl, bwauiifl tbo lOflcti'jn in n^i'ffr prAdnoed bjr 
crgflQlc Rcide, TTiifnrliJiiAt^ly QUnubnrjf'f ivngrnt U QOt pennn- 
ucnt. It flflpn n*wunic* a drf'iJ-ln^^wni^li-nit oolor, nnj Is tlicn 
iisdi*=3 for tertidj^. It b af5vif*nlili?, tliorcfort, to kwp ^r>pamtc1^ 
clcoholic BoIutioiiB of lanilliü nnd j^Iilorw^lut-'m» and, when it ia 
ncccsenr)' to make n tt%t> »dd 1 or 3^ drop« uf i^jkIl iKitution it> tho 
dieli conUiming tbe putrio conlonlB. 

Afü'r tiiiiny yp-nr* of **iprrictii^ Üjg mitlior hjia (mmd that 
Ct)ngo-rwl pjiprr w bv^tt nianpti^l for quichly demonstrating the 
pretence of free IIC1> and GiiiiJtburffe solution for more positive 

According to Ewald, Congo red ü turned blue by 0.1 pc^r 
mill*, tJie wali^rj solution of methyl -violet Ss turned »ky-b]uo by 
0,0:^4 ppr miUv, tro]iu?o]in siiIutintL !■ tiirtud browr: hy fl.SÄ jut 
mille, and (Hiii/Lurg's n^gcnl n\iovt Hit pKwniu; of I'vcn 0.09 of 
HCl per mitlc. 

As c rule, the qnalitative determintiiion of free UCi mßcos 
for practical purposes. ThU ii titprcinlty truo in nig&rd to 
tlicrapeiilip Irrstmept in llwwp rjuar« in which eotnplftt abgenc^ 
of frtn UCI ktu iecii tlt^mofvftritled. lu tlie exp*?i'ieinw of tlie 
nuUwr, aui^h iD*tjiiic<» arc by no innnns rfire. In tliia re«pect> 
Ihc fat-'t lliJit free HCl is whoUy absent in nearly all com» of 
gulrio carL-inoma [at len^t tm por cent,] is most important An 
«xcvptioD is found only in tlioee eaiieB in wbich tbe carcinonui has 




ficielopcd uptin Ibc Imm of ^tric nicer. In EiLch tiutuncca aa 
mudi M 2.S per millc of tree H<:I can be obEen-(?ct, m the aii(]ior 
lius been nblc toconGrm by iiocrnpir mTc>etigatioa. 

Vrt-r UC\ a iibKrnt in thni nirr diwMiibr atfnpktf of thr gn^rle 
miicriAti. It ii» Jiliw fll»i*iit in innny rji«i« of aniftf ifpApt^pitui ami in 
uianj/ /fhriU ajfccHifiu, 00 wcH A« in at ]ca»t hnlf of the cases of 
ehiorosi^ and in a liir^ Dumber of chr^jttic dt/ipep^ias (ulo- 
tolJsnj)> It ifi nfiftrhf aia-atfS prf^cnt m iitoor rif cho at«[iiaeh» 
sometiiues in Urge ainouiit (iip to 6 jior uiillc). scd isot Infr^ 
quentlj^ unitiiiucv tii Ütüt ivnJitK>u «tvrn wtii-n a pHrUnl IniEirifor- 
mdfioii intn laiTtiiiomn Iim OLVurn^h Tlir nfrn-ousi drspr-psijin 
|j|i7icnt IJic ni<Mt mnrkcii ikviatimiü: hyjicracklity nnd hypr^r- 
fwcn^tion. M vrcll ak clIminuHon of frc« HCl onji Iip obii(>rv4>d, and' 
not rarely botli cn^ndxtionii sro founci at dllTorcnt tini« in 11i« 
iMinu* iiulivi^liiHl. 

In the empiy (fafltlng) stomAcli cf hoji]tL/ ^ubjocU mod- 
erate amounts of i!Cl are r^iioalcdly foimJ, Only Ibe occurrtnc«. 
nf lar;^ ammmts and hi^-li HCl pcrcenlap?* ((Kö |ier milli> nnd 
oyct) Ib of pathologic rignißcnnce (oontintion* (-oatrJc How}. 

<b) QuAnlltAlNc LslSmation of HCt. 

It ü of chief important to decide whtUur oaly Uxg fn», 
pV^ilolo^'Eoally active HOI or ILat corTibii[V<0 uilh Uiuüt h (o bo 
^limiiM- nit' Itkrilure '>( U»e htti divinfft U n-jiMi.' with mor« 
or I»» vnltiAble tiicÜjndn fi>r quimtllntivc i^timntioD. A r^^rufn« 
of tlic different procedures cannot be given in thi« place A cnt- 
icoi fliinlyvic oin bo found in the admirable IrcntiM of M^rtiu« 
and I^tlke." [Ewnid and ßoju aJ^ givo in thoir trxt-booi* 
nio«t of tlL<- mdhndK in d^il. — Bk(X»)Cii.] 

Tlif> foUifvjikg ^iiHliod will bs found siüfidnnt for pmctlc^l 
piupos^: — 

J. Batlmatloit of the ToCoJ AcMlly. 

In thi* procfdiirq both tic phjwicjlo^c frei* and cotiibineil^ 
HCl arc determined. Kurlh*nnore, all the remaining 
(fieo and combined) Acidi and the ncid lalts (specially phoS' 
pbortc acid) ara Included, LacIic, bnljnc, and tetiic a^da aro 

'mwtifmJJ IflU*»; "tM ^^yttitiT* *m Mmtthtm^" fUft m. «uUpif^, 



ihc chief Off Ani< ncid«. Tlio rcactioa T>f the« ^11 be <li»ctiw«c1 
hUfj. If their prrsciir(* can be «lolndod with any d^grwt of cur* 
tainty, thi! iMtiniaUd tola! AcidJty can, in praetici), ba onaid«re(1 
n* ihr rxpr^JitiGn of the total ara/>uni cf HCl it<retfti. A high 
dt'^'v of (ii-iilit^, «Tfiti in chavk ht ulikli llie iiWuce tif tnv ITCI 
i« rccog:nJ£al Ljr ihe cobr-reacUoiit iilr&i<lj uieotiouwl. will »inli- 
cn» a nlativoly farorablo Cüiuüti<*n, becuusc it amy b*> iMtumod 
i\i%i ftotite action upon the Luctcma ati<l a t1ion>u(;b «aturutidti cf 
Ike prol^id •ubstancts occur. Tbc wiiürc of the food iiif^'ätoil 
inunt hu Ulu^i tiilo juviiiiiil m mnlciitK thi» ivfiirintiiiii in m Tnr ut 
tlifi (wcrcttisl ITCI is 6ciÄi-<l upon — for examplo, bj- tjnlk- — to n 
marked <I<Krw?, tspedilly by the phoFphoric iicrid enlta and the 
cjiaHd. In Uli* way ie ovplnincd th»^ facl that free HCl is E«ldoin 
found ID h^mUhJr suckling jafant«, I>jw porcentag« of tho 
total acidity always indirntp intnlTlripTit glandular function. 

Uf^lhod cf n E term Ina IIDIL—Thfl AlirAi« of Uio ^{4^11(0 cotiUnta L» 
titrate witli ono-tiinEh nnrnuil' nodiurn hydntTj», ii'in^ pbfrnolphthnlQin 
(or UtiiJun 1.(rEtturirt m na JiidiruWi. IV'^'iiLoTniiLf ^üctiLiin byrlmle vAu' 
tlon It altcwL-iI tc flow, drop hy cln>[>. from ft btin^tfi? into a pnrr-Mnln dith 
or lifnkur jiU'o «''uiluiiijiii: ffum S lo l<^ cuhk oi-tiliinTUTfr at llic ßllnto- 
Td Uli* 1 ur £ ilrupA cil ft L-jH-t-iviiL ilirvlinlii^ »vtutiuji of ihliniulEiltlliaUiiX 
it added. Thi> rcn^nt m tlw TuirpU«" i« mUliwI. ( lifnp nl n tiinc. lo Iha" 
fioAtiic JuiiV't ami t-oiutantlf «tirrcd» udIÜ a ditUnot «a4 pcrnrnnrut tad 
cotur apivam. Tliv Utnl lU^liliLy In L-Apres>cd, for Ihc Mkc ot simplicity, 
in portvntA^« r>f narmul hoiliiim hydr«1«- For «lampK If S mibtc Ptnli- 
nwtffia 0! TrcriJiAl AOiJium hj*!»!* ivorp u^pd lor 10 cuhii? fmtimpUm of 
thi* flllmli-, we «pi'jkk of SO-pr^'Umt. totnl Aculily. Or wp FstliDale LLc 
addiij dlTOot »a to IIU upon the ImiW lliAt 1 ^ihk cottllmcittr of tlotiuaI 
auJiiiiii lijdrM* ci^nrupoTid* to 000301 of HCl, In th* a\ta%v initUnnv 
tliee^foiv. vre vuu iwkmi Uiv ju'lUJly ojual* d)fUl lliii^ 0.00304 or OpSD 
jwr flt'iil. U(-'l. 

*By »4^rtriBl ADiutiuci t> niDkoi hdaLd wlildi wnlftkii la urm til» u nimiiy Enmiar« 
IhiAr u V]ua1b It« m^livutu wnLubL Tlfc »"IiwdIiu irelfbl uf chh>r;ii, far <>KAinf>l4 Ii 

ilimuf nn i'flfit4lfti JW,* ip^ni» i:»rflhi'ihi™«Ly j-ut* nthjAr\i\n HH i-j» Hi<r. !■ ftu tarn« 

F4ii«^1hi*iiiilan oE cmihLlEiju'buh aad im loforiD aDCULfaluLtoii^Qri In rh«n(vi|wir- 
llon of M I« HAA ai>44nllDff in ilif> fiitinulu Ktin^ na- KH + HiO. It 1» i-lii^n ibal 
»InlUV tiiluowi «T uanDBl ihiUhIuu miiI hyilrnnbUriin ■oM arpliitl'iim miul i-urUr 
fifturritiiui <«>i oUiMi TTix [^rn^iAiiUliM» uf «it^b ■i'lulivuD«vrj«ui]iaaiiuji--li Llina yarmii] 
liiitriKM^jrk ui^l Aitil if7l*««Ji»<ii hyAtat^ tea <iinaLnEi] ^ the ilnincrmihl »oIhUddi n<'<v*Ar^ 
Oir iikfdIiJitiil piifji'-n* crs (»npurv'l *HU <nini<kril upvur^y hy aiIiHtIcpIi nf 1 imri aT 
ncpFiail toliiLlnn ta9inr\Mot wtlor- l''^' n-<rv AcriiO«*] l-iPVirnintlt»», «aa r«i1-bwk* on 
rahintatrin auftly*)>. iH|i«fl«l1/ 1tf*'l1fiii\ '»UuiAinaliw nir Klt4lflliwr " OHuf^uV !■< 



2. Quuilttatlvt Grtlmntlon of Free MCI Atctttölnz ii> Matbod of 
iMurnrr and Boas. 

In thift tpjl n wfllPr/ »i>liiri<iii of r(mj(ivr<'*!, ivliirli wi- t»*i* ulrhmly 
Irvmrd 1» a viry urvicEttMo rtn^prit for <Uiiii>ii«1iiitinii of free HCi» » 
«dilrd to lliiT flUrat^ la the prcuim «f frro lijUiot^hlcirlt^ aHiJ Lbv tr^ 
color ih HmnirtTl lo blnr. T^c mlttnir I« now iiithIM wlib dnlnannnt 
«ihI&iiiti hydrato **Jutlon unli! tlio Lutigo-r«-! color i* pcj-manrntly i» 
■torcd. Tbc itutnbrr o! vuTä«: ctTiliiiirLtfrii t>t mhIiudi hyiJml« •olutJon Uiw4 
fturMpond* lo iho amount nf Ifw Hri 

Bona hfirt irfy pr^iwrlif dtu^n attcniion to tJw fact lliAl llio 
pfTwrnm of ori^iuiio «idt do« not ur»uAllj UU'ilrr« wi(ii ilii? tvnjlL fn 
t1^ff^ In whirh rflrTmnriiiV rmfunit ar Iho odor Jndlcitt^« « A^itidtrabln 
AinouTit of arganU Afldt. ht>nrot>cr, it in n^rofHjir/ to n-mare Ibi« voum 
ol «rrot b> rcp«4tcdly BhAkioi uiih vthrr Ltfuro MliinntiiiK tb« IlCt, 

3. The Auihor*« Mviliod. 

The foUowini; tnothott ap[>oars to Xhe uuUior to bo the 
ii\nii B^rdwabte: To 10 citbie iK*rktjm(^tort '>f ihv [jlt«rc<l giLstric 
jiiTft Is addei] from u biirvlt* fWinormnl «Ddium hyilratj' Mltitinii, 
r1n>f) hy ilr>p. Afkr ivu^li ;t<1f1itirii] of from A to 10 dmp9i, a ijrnji 
<»f the mixture U tÄkcn with a gloM rod nnd allo^rod to fij into 
a. dith ortntflining ^^iVh/ö (nbont Spcr-ccnL) »olntion of Coa^ 
ro<l. Ac loQg ns the HCl of tho ^ngtric jnicd u not Doutraliwd, 
Iho ^mp pm(3ii(vfi n c]r*?p-hlne color ID the reagent, SiifQeient 
•odium hydrate J*, lliprrfoi^ ailded (intil the drop no l4in(;or 
CAuactt tlie developincat of a Hue riug. When thia piiint luw 
b047n mehcd, the nuicbtr of cubic tcntimcti*» of dci^innnn^l 
podium hydntto used is mtiUipho'l li)' i),'iG5. The numhi^r tlii» 
obtftfn«d jtitt* tho perc«ntfigo of liydrodüonc acid. Thi« mpthoJ 
or ('ju inn ally UtlU in thtr pn^mi*» of orgmtri? nHdv 

In nrdi^r ti> dKrrminr ttic üti^l aruHijf the (IliM provioiuily 
litritcd for free ncid i* trftilf^ti »ith a or 3 dt»pe of a l-pcr-cenl- 
ai^holic $oMiort of phtnolphih^^H, and doctnormAl sodiuiii 
liydrato add<>d, drop by drnp^ iindi^r <t>it*tjiiit itbrring with ft fihui 
Jfod, until the prd «lor |ji*<sniim pwriiinrjil. 

(The lollovioif HiBrrpIo mathol i* •ujpBycd ly pK-f. mward Qain- 
«iird in lib« dink at ibc N?«r Votk Popi-jfri^duAU Mf^ticul School-' 

Tb* vnlmnKTli^ antly^U nf n romiHiiini I in tfir dttifTmlAatlon of tJia 
■i^anlity £>f « *Uadanl Mlulioa r*<[u«rad to mUtfy tk m«tios is & 
<^noini quanlily u( ilic c^nnpou&d. 




ord lolutloiki ftp» u*«d- A doftnit« f^Uftniitf üi t^t i^^lnc cc-ntmi« or 
ntUnU' ih litnlvd kfli-r a h-i uilln! " iiiüiivUn " hui Wa «ilded. Th« 
"Smlli'nljir" Ih a •iiI>nIiiiii''> whij<ti •^hrm« T>^T fhtTixi» ijE fiaiftt or «m«. 
oilier vi«ibfn pffcx?t Hi« cunct point at vfhirh n ^i-^u rtpvtion i» fcmplid«. 

'Hh- »lAud^iU nciluUnn u^Livt fif^ufull^' Utcd In Uu.- llttutlou oC, 
lliik |pi«T.r»* ifnifr-nU (• «TfdnftniiftI fttMliiinn hjYiratf- TPip "Indloator' 
turivt atvordin^ to (lir c|iiiilitv »I tLim xul>>1]iti<'r r<i l<v tlpl^ruiin^iU 

hi it[Jrr to obliitu a ouruiai Hitijtii>n gl any |r»rUE.'j[di aubfiiiuKTc 
il U <lf*t nÄ*fl*niFy 1o l«Brn iU tnotcculLT wrtghU TliU Iiaviög tuun 
fSftfrminodr an ri|LiivjtUMit nmount of llii htiWAiicc In gniiih u difr 
HolvtU In lfX)0 (.'ubiv ifiitirtK^lvrv of iljhiiiw n^lvr. A dwiuotniftl volxt- 
Uoq li onO't^nlh sa «Iron^ At tho »tjtndiml normiil tolulron. füT «C 
aiii|i1n. ti> ruiiki' a nürmul iKtlnLUtn of ^jiitlic acid w« Und t-b^t ih* 
mntm^Ar wi-i|;1it rir mnlii^ iirii] ill.r,0. -f- H^Oj ii \H\; litit «x It I« 
dibAmo, ihfi ntitTiial «»litFinn ^'auM ninlHin on<»-1iutf ol tlii« (1f:4 aramaj. 
Viliivh U IIjv iiuiiibrr ol ^cAma I«» Ix dittw[>c<1 In 1000 *Mv i^Kniliutivn 
aV wfvli-r jtl lA' r. tn mnk* a nnrmAl »nhirirtn- A (lA-tiiiirninl Hnlution 
i>f fixulii" iiriil i" tiivtU hy dunnldnjf «ni' t'^nlii <if H3 gmmv— If,^ 6.3 
fianiFi — is lOUO i:utiic ctnlimctcn oi di^tUtcil water. A» dUotv uxalle 
Afirl ilntftriaratM vpry Mpldlf. « fr«h >f>tut1«n should alw»}^! b* «nt 

rrvui wbiit bM bwn nld» it tv^juM nrnn tu be a vhj vimpl« UAtler 
lo rank* H iTonniil ■nJiirnin. In tai-U hrmt^vir, thU li nfll •□ oftty TMi 
is due lo thfl fact (hnt a)>fohitrl7 pure chciniealu an hftrd lo oMaip. 
TEiin i* |milk-ulAil> true» Tt|:Arda«odliink li^UiiLtL- f Nu01I>,w1iidiH"kviuK 
If: lu li^'|{rr»ui'ri|Ftr- jjn|H>t lii^^, ill vjk>'Ai*i>iir jiiih a i-f<rtjkm Ant<jitiil uf witlor. 

A ^uod ^vuy tu Limkr n Ufiiijonital tuilium liydiulo BotuUi»!! 1* aa 
fbllnwi: Tnkr i:li(^Jrilru1l/ \ii\f» «Mtiiiiii Ti)(!iHUi |M<-frk'>t. iiihd«- riiuii 
ptini »iMliimi- ChiMm^illy |niiii «Aaifii^ Jiriil in r-akon (tir <«ohlnil ti*»1. 
ThoroiiKhT^ rrliAblc oialk a-zid la bold by Morck under tbt dahic of 
"Add Omilc, lll;rhc«t I'urtiy," Th* inolwuUr weSght of AOdlum lijilmt«» 
la JÜ, KomtiinbuTlny tli« niE« tu bir |ü|]ov'«d tQ muklog up ji acirinfti 
Hihitioiit wrifli otiL 4Q jEriLrriA rtf it uid diuolvn in 1000 cubic contini«l«rf 
of diilillrd \nittr. In nnltT it irmkr a iIpHuonnal «oTiiltirit Ijikr one- 
tenth of lf> gmiDi «4 ^onif iifid dNiKilte in LIXKJ cti[>i<> wnllnielurH of 
di"[j]]i-d M'AlrT. Aa linn ftlrt^udy Li^t'ii at^tcd. ■(iJiiiut hydrntn \n hjjcrc- 
»I'lipir And aIuii>-4 mnliiiiin 4 rril-niii mnminl ol wkliT. wlairh THUVt 1)0 
coDridor^ in nakin^ il doomnrtnaE unliititin. TliU in ctbviatod 1>v dia- 
ȟEvEiJjr 4 icfnmti of viJiuni hiidintc in aWut 1>j1> ciiM<? ceiiljmrtorii of 
dli^EllInd vati^r. fJnn divigTain cif piitc oxiillc ucid i« iTirn u'ri^hod nut 
nnd dijutolvi^d iti JU <.njhjti a^rif iiiiolurx ckf Ji>1illi>d wuti-r- Thf^n add '/* 
diDp of a l-iHT-orM, n1ci>liunc wiEiitJnti nt iilnrnolplilkaldii u-v ad Indl- 
ralor I'bvnolphTlintplTi 1a m m;TiN(nnii« ulili'h Aboitt n» Lanier In add 
AolutioTiA, but whith giv«( n tvd rvactmn In alkalitu ■«iuUoDi^ Now 
titntlu ihtt ('HalJr aild »olvtloR wjtii tb« »odjtim k^dfatt^ »i^lution, Ohh 
dpt'ijj-rÄPi i>f "nAlii' aHd ih nuAi-tly n^'TitrAlto'd by Ifl.O nildr* p«"«!»!^«*^! o| 



dn-iiiuruml >odiiini hydntr lafutlan. NtutraJirATimi w'l.'LtrB liT. ih« in- 
»timt tho phtQi>lplkihal4>iii iiidUatdr thaw« tciL Nov, o* \i-f/t Ibo-n tWM 
vub^c c^Eiliiiintfi* uf Jiklillvil vv^Ut »err lijcj ti> diuglre i enn» erf 
Mxiiiim, iT i« I'rrj- |>r»hahlj- rhnl iIip i*^\ I'ulur will sppnU ton P«rlf In 
th« oiialie 4L'ici «oliition, thmt i« to mv, iK-ftitT 'i^iilr If» «iil-in coatl- 
ttvitn of KoJima b^diaic »uluUon luti» b«n aitd«d. li ihh h tkt< cut. 
add ft UllU i||jili!li<<| wAlor Jnbüut LO <^iNc iciillnictcnf la the utdium 
hydrnto «oliition unit titruL« h trfvU ditei|;ntm oF «iHli« avid Hiliilioti. 
Rii'[ieaL Llii» LiruCTwn until t-Kiu't^y lö,0 i-uUi' ■vdlimiHri? of NiMium 
bydmTo tcLiLtioD uMf*i lo I dwinnun at Mdlir nrM in nMnlion ««u«c« 
Uic [fbfnulpJtlliAlcin Udiwtor lo tun i<ed. Vklttn ttli ocotin tlw docl^ 
ovramt HduLiuu it nwly (i^ff uae, — Buooeb.) 

By limit iplyiii^ the total niiiounl (jf d^norni«! sorliiuu 
hydrate by 0.O03G4, the total ncitlity with rcfürontic to HCl ia 

The foll'iwing Uble scrrvs for crmvemon cf tiomwl «odiiuik 
hydwile into HCL 

Tahuc roA Tnn Coyvnuuuff of Xuhhai. ^^odivk ICthiutr (Crnic 





MOAA 0.1 









1 fLCtll ' tl 9 












d^j S.OC06 









a4 ' ».oami 









»ft, 3. lots 

























4- -J 














ei»! 3S485 









B.0 3.9rin 

t 1 







2 Win 

0.1 1 3.Stl^ 









0,9, 3.soeo 









3 3,3049 









« -I 3.4310 








9^ 3.4ff7ri 






S.O140 ' 7.6 


0.0 3li04a 






9.0005 7.7 


0,7 354n6 







a ^r^i) 

0^ 39770 

1,9 o-mns 




SliM TW 


11 3 illXV 

9,0 O.TJUI> J 4.0 



S.IVOU "i» 



latJi 3,0000 

Tbo hkIIickIa d^iKTib^ «ill nrnuHy rrtoet the d^mottili 
procdc«. That thpy «re not afaoolut^ exact ii dnr fT«m vhflt 



aant^ilfm^ ttni\ Üi'va Hiiiiiruiti^cl fmm tTic ««tiinntion« thn mi^iDcIs 
vtll siira informaUom in rn/trcoc« to ihc gInntJuUr fimciion of 

the Stoma eh. 

Higher jmiotiDts onn be <1otrTmin(Hi hy tbe following moth* 

Töpfur ^dimalos the fre« HCl witb OG-p^r-cont. loltt* 

tion uf (limf^tlivl-iimiilo-uzi>-lK'iiz»il Kv<m in thp pn^mc^i of 
minnfc nniounta i>f HCl the ydlow color of the raagi?ut aMamr» 
a rc»3dish tinp^, while the r»rj:ftDic ociJs altrr the color onlr whrn 
pKiBCßt in '»lortß pf 0,f> per i^nt, and protcid bodice only in »till 
higher crmceötraticn. 

For the ^stiinalion at tlie loosely coitib:rii?d HCl Tii^pfor 
ernployä suJiutn «liiurin Äiilj»h(in«l4^. TiLrnlüm hy mlclilinn of 
3 or ^ drops of l-ptj^ct-nt. vral*rj" dilution of alixciriii in cunliiimyl 
vulil the Ürsi epiK^nrmicc of a ttinlinct Wokt color- Jf the rnhie 
thue obUjiTicd ih *ubtriielnl from llio vnluo of Uio toUl nddily 
obtained by titration with phflnolplithaleir (page 25C), the 
fttanunt of tJie loowdy mrniiihiTl TIOl in fniind. 

DclcrminBtion of Lactic AciJ According |o Method ot Liffclmafiii. 

lo tö^iiog for lactic: «citl it b necewary to determine that 
vhidi has l>i.-aii iulnjdutvd with the ffiod and tbnt formed iu the 
Btomttf-h. Boas haa eflllod atteution to tho fact that oU kixidft ot 
bokory ppoduelÄ conlnlo lactie aeid. lliis ndd U also injpe«tod 
n& flarcolftctic add, ami willi smh hH»dic:ti!TÄ us wiir milk, niucr* 
ki&ul, ani^ ioiir gherKin» as fcrmcntfitivo lactic ncicl. It h, 
therofoiCt advi»abb for e^</ct aDoIy^Ls to employ a tcBt-moal froe 
from lactic acid. A fionp propaivd with Knorr^a oatmeal, eoa- 
■oned with £aJt^ ia n-ell adapted for thia purpose. 

DcmonBti^tion. — 1. A dilnti*, npnrjy e^lorlms aohitioa of 
nfutral irnn chNfnd is turned caiiai^^- or leiaua- yelhiw in tiie 
presence of laiCtk acrd in amounta txcccJing Ü<3 per millo. Z. 
An ftmcthyft-hlue eoiution of iron chlorid and carbolic acid (bMt 
prepared \yy addcUün of a few drop« of diluto Ufjuor ferri eoft- 
fjuidilomti to a S* to fi-pev-eent, kjIuIiou of carbolic acid) La 
tnrtird yalloip by ladie acid. 



The reActions are not absolutely decisive, becauee, in addi- 
tion to lactic acid and its salta, phosphoric acid salts, butyric acid, 
sugarj and alcohol produce a similar change of color in the 
reagent. The test is free from objection only when it ia made 
with a watery solution of the residue obtained by extracting the 
filtrate with etlier and then evaporating the ether. The first test 



[Fig. Ofl.— StrauH's Separating Funnel for lactic Acid Teat,] 

can be made by adding the reagent directly to the ether without 
eTaporation. After thorough ahakiug a yellowish precipitate ia 
formed if lactic acid is present. 

In liyperactdity due to TICl the lactic acid reaction may be 
obscured. According to Haas, it is advisable in such cases 
graduflHy to dilute the ßltrate with water aud tiieu make the 
above test 



In r««c« of accidental a<1miAliirv of large amount* of KAliva, 
a bronnUk coIvt niaj be obtained ni\h UfTcIinanc'fl tot, owiuiC 
lo tho |>faBanco ^f fulphocyanat«^ dalt». 

The folloviitg method for the tjväntiioUr^ tttiirntion of 
lactic aojd lia» bwn rwomin^d^ by Straus«; A »«pammg fun- 
nel {Tig. 90, wjlf) rtiArbi at .'S caljir cpntinipten and Sd cubic 
cGDti^notcffl. ift fOM to tlie fimt uiark wiUi i;utnc juice and thm 
to IKe »ocond with ether. After tborongtiljr ahahiiii;. the fluid I« 
alloved to dov out to ttie TikL mark [5 c-ubic oeDljftii<ter4), then 
fiUoil vith wiktfT to tho MWumI ttmrk (33 cubic Lvutimtiton) . 
Two dtwp* of a 10-perK*nt. lolutlofi frf iron cMorid nre then 
iidd«l. A bruutifuJ grtvn eulor nppmr* in the- pnscnc« of 
tiniounta catx^iing 0.5 per inillc In oinount» Ik-Iow (I-S5 pet 
inillc a chAtij^ of color ia BcArcciy pcroupttbk. 

f/L<;A ptrctntftgfi of tactic acid occur cvpoeially in car^noma 
of tkf> Hnm/irh^ ]rn*|HTtivc* of tho fixvl in^*tri(l. Food plnu an 
inip'irUEii ri^lr in ro tax tu^ pmiKanii'r-d Inctir ncii) frnnciitat ion 
may be induced c« tlic rebuilt of the introduction of odiTc lactic 
üdä bacilli, o^iccinll}' \Fh<m ingrtstod with eour milk, l>utt*.'rn)ilk, 
TcautTkrout, etc. Tho bacjIluB acidi laclici of lliippo w a non- 
motilu ro<l. about 1 to 1.5 /a ]nne, and 0.3 to O.-l /i thicks It 
formiL W-lit- hckI from l-uui?- htmI tmlk- vugnr. wiUi thi- liln:rulion 
nf (!(),, 

I^iiifc nc-rictf of stfttiatioa have ebovn ttut: — 

Hl.4 fier cent- «I nil ganlrlc dlt«o*CB ««onifianifrd li^v Inflle 
utid fvrmt^rttiillmi urv tvlvriiMr In t^urc-iftüini, und 

7S.A p*>r ffnX- tii all ifnnlrii; uHTFJiUiiiifltii bHow UdlW aoid 

Tntbolo^c lactic acid fcr imputation i« opparvntly favored by 
tl;^ flhwncii of tn^t HCl, motor inwiflbii'npy, and the not iQfre- 
qiipntly rf)rii)tt<'nt diminution of fiTtnrnl. *rrrction. 

AWdco of lactic acid frmicntntion doc* not contia-JnOicate 

Batty ftcidi, especially butyric «ad, oolor tTffclmarm'a 
reagent a fAwn-voUov in nmnnnU of 0^5 per rnillf'. 

Free frttty and fxretic arid* are bf*t *]elect^l by Ijieir odor 
According to Ijco. their prcvcncc can oIh) h*^ deuLoo^lrat«^ iritb 
aufiicicnt accuracy for practical purpo«« by li^ntrng 10 cubic 





ccutimetera of Üic g^tric conteuto in a test-tulie anJ watehin; 
for reddeaiiig of blue litmo^-pupcr WI<1 nl the month of ihe tuV. 

Th« prc«oDCC of flcT^iic end cnn be dcmoa^lTAtid ivh folio\4-e: 
Rome of the unfiltcrod ga^lric oontimU i* ihokcm with add-free 
elher nnd tlie latter ernjiumtcHJ. Tin* rmicluc i* Üjen diwolved in 
a few ilropü of wiitt-r ant\ ni-ntrAli/ivl uith dilute mhIa »ulution* 
If thi0 is now hcfltcd with ^]}f»huric ncicj and nlcohol, the punx^^t 
oiior of acetic acid vill be produced if thi« Acid i$ prctfnt. 

For tbo dctcctifm of Mijrtc cdd ovuporatc in tJic tunn' mnn- 
nitr with pthr-r, und thra n\h] iolHum fhlirnd lo the watifj «ilu- 
tioD of the miduc; The batyric acid prevent spparslcB in »mnll 
oil-dropIcU» vbich give oR the d^arflctcnitic odor of butyric acid. 

T<tt for P<p«ln. 

The BPCretion (pepainof^enj elaborated by the chief, or cwi- 
tf*J, cell» ia lrau»r<jr[iii"il Lj fritf HCJ idLo jMrpaiii, whii^i i* 
floential fuf the mnver^iosj of dbumiii oitil colloid into a icrluhle 
ftiitc In the preaeuoo of free IJCI any further cjEamin^tion i» 
»ii|H;rlluon)i. If fri*« acid it nbicnt, thon the follovri&ji; method 
will dcinon«tTit1e tht^ pmenci? of pf^piio: 10 cubic ctwtimetvn of 
1^lter4^[1 oliymi- nn- pliit'tNl in a tr^t*tahp und nridiilntf^ with Z 
drops of officinal hrdrochhric acid. A fragment of fibrin or 
slbuiuin if fiddcd and the Icft'tube plnccd in an incubator at a 
temperature of 37.5° C. Th^ «arly BOlulioc of tlic ulbumin coo- 
finni the prf««ni!e of pep«m. 

The following tnethot! of Hammenohlag appear» to be well 
nilnpti^ fur thU purpoH.'; Take two ln^t-luhw, i^u^h cimtnin- 
ing 10 cubic centimeter» of a l-p?r-cent. aiolntion of albm&iop 
to which 1 per mille of HCl i» nddod. To occ of them odd 5 
cubic fx-ntimcten of the fltercd giiUnc conlcnU mid t^ tl>e oth<^r 
S cobtc C4^ntJmeti*r< of iIiHtilltt) wati^r. Xow pluoft both tub« in 
an mrdintnr for c>ik< Imur. At Uie expiration rif \h\n tinv thr» 
aoiiount of nlbnmin in both tube« iü dt'termin'^d villt I'^badi'^ 
albnminometcrfl. Tbc diffcrcccc between the Ainouuta thu* 
obtained r^rprr^fnt« the quantity of dij^ted Albumin. 

The p*>ptie powrr i* i-ipn!*ml Hy tho fwre^ntage ratio of 
digttted albiiEMir to thf* amount nf albiiiuin originally praient in 
tbe niiitur«. In henltliy vubjoct« 80 to 90 per c«ut ia uvnalt/ 


Test for Renaet. 

Tlie demonstration of lab- [rennet] or milk-curdling fer- 
ment, which 18 secreted by the lab-glands and causes coagulation 
of milk, is of less importance. Place in an incubator from 5 to 
10 cubic centimeters of milk, to which 3 to 5 drops of the filtrate 
have been added, Jf the milk coagulates after from ten to fifteen 
minutee, lab- [rennet] ferment is certainly present (Ijco), 

A positive reaction indicates normal lab-gland activity, while 
a negative result points to serious degeneration of the glandular 
system, especially if the secrt^tion of pepsin is also disturbed. 

Tests to Determine Proteid Digestion. 

The following tests may be employed to determine the 
proteid digestion :— 

The abundant presence of ayntonin is ehown by a cloudiness 
on careful neutralization of the filtrate. The "neutralization 
precipitate" ia redis^solved by acid in excess. 

Propepton (hemialbumose) gives a eloudiue^s with concen- 
trated acetic acid and sodium chlorid solution. The cloudiness 
disappears on heating and reappears on cooling. 

Tf the precipitable albumin is removed by boiling (pro- 
pepton and |"'|iton do not crjügulato nn heating)^ a purple-red 
will appear m tbe presence of propepton and pepton in alkaline 
solution on adddition of copper sulphate (biuret reaction), 
Albumin and syntonin are turned violet-blue by this test. 

In order to determine positively the presence of pepton 
previous precipitation of the propepton (see page 2D8) ia neces- 
sary. Tlie biuret reaction occurring after such removal is 

Testins of Starch Digestion. 

Starch is converted into dextrose (grape-sugar) by the oetion 
of the salivary ferment (ptyalin). As intermediote products the 
dextrins — viz. : erytlirodextrin and achroödestrin and especially 
maltose — arc of importance. Only the smallest percentage of 
the starch is converted into dextrose. 

The most convenient reagent is potassium iodid (Lugor? 
solution). If on addition of this to the filtrate a blue (starch) 


er piirpl« (or violet) color (ei^tliAideilrui) ocoins ll^n »Utnh 

Aciirwiklcslriü, maItow>, ädcI dextrose are af>l a!UT*"<i hj 
ioäia. NjluiicLvr'i ta^t i£ mdicatocl for tli<* Jctection u( aUghi 
nmouiiU of Aü;iar. 

rflnff-*nyj7r ingÄltd wriUi thf food c» f^omiTlri! in Ih* 
«ioniEuh iulu ilcxtnjM: Aud Icvulcwir^ uilh or nithout \he nu\ ot 
free HC\> It » UEiually quickly abw>rbeiK 

IL T«*tlniE the Motility of the Stomach. 

!• Method of IcQb«.— Six houn ofk^r u k'ät-mcal [] 
S68] the *lomuch » washed out witli 1 litur of trdter. li &ppr»^i 
«table dtuoiiut.t of food Are u(j*ait from the iraabiogB, the uiotorj 

2. Stlol Tot o! Ewmld-SieTtrt.— This trat i» bijM?t! ui>on 
the tln^grj- thftt siii'»! cnn be convrrtcd only in thr nlkoliiio jiuoe 
of Üiü «iTuUl intestine into its componucte phc^nol luid mJicjUc 
acid, and tliat tho drtnntu^ration of the Uttrr in tho iinrn? imli* 
cfttcs t}]« pnmngB of the saliil from the ftoniach, Thr iirLiic 
loided from time to ttuie i« tested for Uic iron cMorJd reacLloa 
(rtpv pnj;o SST). Tbe ulol i» usually iidmiritaUrcd shortly aftor 
iiucnU Ol l-j^rjin eapaiUi«. A* a rulf, tlie riMic'tion m di^tioctlj' 
dioirn a» early a* frwm tlirco-fourtlw to on« or one and on^ 
fcniHh hour« nftt^r iidriiiiiMnilEoii. 

S. Oil Test of Klcmperer — An sccuratvl^ dctcniLiiied 
aiROiint of olive-oil (1^^ grnin»)» which is not nlworbcd nitd onlj^ 
^iccptionalty altrn^J b^' the eti^marh, ü «vd min interred upon obI 
«mpty ntomach through an o^pliog^fll Xvh^, l^e amoiint! 
rmainiag in the fltcmaoh after two lioiira te removed by a 
hto[naeh-td>& and hivnge. The oil and WAt«r &n w:'parHt<«d by a 
M'psniting fuiin«L The oil ia tlieii takeu up with eÜi«r, aud ufler 
«^-aporatioij of the tihfT t^e oil ÜiUB c^talued la wdghed. RJcm- 
pcrrr found a iO- i^ Sü-pram residue in ht*flhhy «ubjoct«. 

Critieal AnalyiU of th« Above Hethodt.— It should bo 
r-mpha^izLHl thjtt non^ of 1h« proiviliin^ g^^^-^ eon br rinignat^d 
aa oiact. In pmrliL"«» IjmbrV luHliod is prr-TiTabl'*, bcvaiiae ofi 
ita ^roatcr nccumcy. Usually^ however, the itomach 
obtaiiHd after a tast-brcakfaft offer «ufflcitfit informalioii. If 
ÜM tMt-bToakfa«t baa paated tba pjrlon» oft«? odd and onc-hatf 



lioun»^ Uie gflslricr niutilUy U luiunDjr nnrmaL An exiwptioD f« 
ofTurvil only hy ümo* of tytufiniij «f Ihu fttoniHcli, wUirli aro char* 
octüriGed by uther »itn^ ^^ ihac canv> uudcr cvrtAin circum- 
»tancftff nothing; um bi< {ic-tonnmnl if th<; Envaj^ir fpyoi mmiuiu 
of fooci. The oil tiiothoti of KicmporoT ii» too complicated. The 
inilol t™t i» nnt-VTfiin^ iMs-nnw Ihn wilol i« oom^ionnUy nlno con* 
\rrM hj tlu' >jM*t.ri'p Tziuriiji, ami, on t.bc otlirr haml, U»p rpadion 
may br df lo>ixl by intcftinal diAturbancCi. 

Iffifgc amounts of ro^iduc always ircllcatc a Sminaiicn of 
the motor povor. A« a rulo, inbniee eta^atioE and üccompnri- 
tioD occur. -Som^timoe there ia only moderni« Ata^fution, but 
dimtjTFCttbh iii nffrrviive odor. Accor*ltug to the nutlior^n i*»|j*Ti- 
cuc«. Uli» ia cif i^tvui value in llm early diagnogU of tyircinoma 
tf IfiC jt(?raflcA. 

III. Testing Abiorptlon. 

Testing ihe ab9'>rplion^ accoriliiig to PeuÄoldl an<l Faber: 
0.2 f^rtim of L^lifiriirnlly jiur^ [»otuitn i » m Mid U luhiiiTit^lcrcHl in 
gclntiii capgLilci ^^rl^tly lu-forc inrailtimt;. .AL intrrvnU of two to 
three minut'^ the miliva m tooled for ioilin with «Urch pupcr md 
fnming nitric acid. In honlthy nibjcct«» q violet roAction ia 
nliown aftnr froni fix nn^l ono.h;ilf to ^or^^ri mimit<A, and after 
from t!F\Tn ani3 nno-hfllf to t\1U•^?r^ niinntJ** a Mmsh ruction. 
When givfn after a ni<Ml, the ottMinvnce of the readaon fa decid- 
edly d^Iayi^dn A great delay in tlie reaction ia oUorveJ Lii all 
gnätric dma^e. Id cctasiö Zwoifel found tht^ r^adioD only after 
tvo houra. Tho delay wiw variable in i^aalnc vilecr. 

Boas nnd mnuy othore JiKj>ul(> the reliahilily of tho method, 
nJhCT Munrml pcciodft of reoi^tiou wrre hIwj ctbuTw^fl in iv1.«>iiii nnd 
thronic gflütritiw. 


IntcvtJnat dieo-harges may b« InsjsA^tod mocrcMi^pieally or 
«■immiiu'il with Ihr Tnicnwfope. TiiH|inlinn fni|iU"ntly crinflnnfl 
fL diftgnofti» bft^ed iijion oth«r dinifjil nipnn, nnd s»'mi'lini"a it i* 
the vnltf tiicitnA by which a decision con ha reached, 
Ua^iroaoopic examination ^bowa the ftillowirt;,': — 
Tho Ii.'Oi.*^ of a iwüUhy individmi are of a li»;ht- ot dark- 
brown ooloTj eyHndrie in iomi, firm in conHislenee, and ii*ünlly 



alk«]iiic m ivactioii. The color it Ei|;l)t yellow in chililren beauiüo 
of the lATg^ amount of miik compOAiD^ Ihcir diet, Jü hralth^r 
ailults. aUo, thii KUyyh may l(?<''>mG ^ark (>rowö or Dock through 
till* ng^TifV if ffiofis (tvJ wine, hucklehcrripe) and nirdicini'* 
[ imtir bi^iuth Mitinitrntf?, through the »alphiir coinpoanil* 
fornwd by tlictn). The ili^jwU an' colored yellow tftor ingevtMn 
of rhubari), oaxitoDiu, and huup, und i^i^a niter iMlomeL Th^ 
normal fccAl c^ta u«uall,v bIjot^ IcMurw ond indontuhotu. vlücb 
Indical« tlieir formiiiiüu from tndividiial «eybalfl- The alfin«? 
dixJiargtt »flm Hj>]i<-iiiy in Ui<? form nf intuwLV riwmbliii^ Hlitv|j* 
maniirü, "hrilliwit the oXT^teticr [>f nnv pntholop^ nllrnlinn of tin? 

In ditrufi of tho intrriinc the qnmtity, form, nnd color 
of tlw focoe may bo d^dodly alt^rvil. Jnflt*?ad of a -mglo fit^f\ 
usnalW itmounting ui from 100 to WO granu^, Ib^ d^jectiom may 
be ier> fra^uejil — 10 to 20 — und amount to aa muHi jib 10t>[» 
grama, TJiecyUndri*^ foniiB dmjjptar; lhe*to(il Wumfs iimaliy, 
pa|)Jikc-r or watery. Undigcöt^xt n'mrianL-i of Ukh\ { frAtrnirjil» of 
jtotato, T«gctab]c«. üte.) can hv rwo^nüi^d witli tiLC nikvyl cyo. 
ThrtM- KtooU may he lij^ht or dnrk in cf lor. " 

In bilUrj crongeiUon thi? siooTs nn- gmyinh yollou- cir eUy- 
]ik^. They arc deep brovrn or block (so-called i^rbont^ atool) 
ID obfttiiiuU' conitipation. Fri^h blood ictu) bt^ puH<d with ttu-' 
deJoeU m bemorrhag« into Uio toucr (»oriiott of thi^ intmtiDe. 
Wbtu tbe point of LU^t^mg n looatLHl hi^du^r up, tbt- «looU arv 
nviuUy »trikin^ly alii-'P«!— ilurk-brutt'n In tiir t^oluivd, Tliu ]jit- 
Irr rfiW it pnwnt [n «tfK>ls folluwiiig g/ixtric hrnuirrhHgtv In 
cboltn lice-water or wnplike evacuation« occur. In uiaoy forniF« 
of enteric oatarrb (^f^pc^ially in cbddrec) the tiooU liave a bil^ 
grem C[>lor, 

Macoua ebrfxlB or ttoeeidi fire r>Wrvtyl Ln tbeatouUof boalUiy 
ladlTidttils only nhcn tbe foe<« are xtry liard and ürin. Largd 
in«AOiM Mkmtji ATr »fli-n mixrd v lib fAin dejeeta, nr largo yrMJ- 
iwiu mftMc» of mnrijft may be eipHled with or without feet« 
{co!iti*f chok-nt, tly><-nti-rv» do.). Tciinciou*, ^[»«y Riuciu occa- 
iionatly adhfrc« to a Mingle firm nlool (witnrrb *>f lower colon 
and nefnin), or fmre mueua (pmtiitiit)« or long, ribbonllke or 
tnbntnr-frkrmNl rnticMiiii t'^mgulA arr di^^hargrd with iht »tonb 
(ms **Kntentie UfmbraiiAr<-a*'). 



SAjfolike Ejoilir«, tho nigdable ori^'n of whjL'h van he d«tcT- 
niiiied hy the icicroAcopc, may bo inlfiUken fof uua««« of miiciu. 

The mualiy ollciiJioc reaction of the fee», which oft«ti varioe 
vytm in hi^^nltJiy in^ividiiaU, may bcoDiae acid, <«p(.*cmlly m i^Uil- 
dröti suffering from atuto catarrhal cnt^ritb. The ro»<:tioii i* 
of no dmgrnwUi! *tpiifii*iuu'(\ The welt-known "fi*c?al odor" 
Ittfcomee in manj duemvLii «tinkiii^Ij jMitrid (ciLUcirr, vit;.) or dif 
appeura eutirely (djÄnttn). 

lu EkcKEiUoTi to many for^ri^ binürs ^malj aod large ffall- 
it<»nei and vonns [^«ee [^Ago 1 1t!) may Appear m tht- dejvet4i and 
ho of ^'ulunblc i3ia^Lf>&tic sigtiiflonnco- 

Bt1e-<ionor«tJoiu occur in iht hca aa tTUc AlotiCs the »k« of ft 
■■lUcuuS (!£tf uut InrgiT^ ut tn (lie form of ifravoL It b DvccwAry 
t« «ifl DDd vaflh lb« f»D«e in orilvr to «JaIvcI tho umallor ktonti. Th« 
•tciiirr liHvi« 4 polj^goDQl or a Idblrt form. Tht/ arc uiniftlly Boft and »f 
a yunvnJali. i-my-^hile. ar brown color. They «ro BomcUinH liomujfB- 
iMOUe. and on fTKoturo prcicnt a dUtinvtly or^lalltnf lurtapc.. 'i'lioy nay 
also ht ot i'D]r]]h03iU; finimtUru. |Jinwn].ifijf h t\titk nTi<:U-tj*. laJidU* 
lainHHih. VT nfU'ii nf a smor>Üi, uliilp or i^rv^i-ni^h roToT uith n rvuiElii*niH], 
ffrimnh-hlac-k cfirtiM. CholeltcMv and biUrflbln-clilolQm are tbe ohi«f 
oonfLÜliiiMiT« of ifüntt: The tqip par« oho1catl^TllI oM«ah am (uiic 
While or yellufllah wljito, uHiinlly imnoth, lmnj*luppnl, Jiiil ■omcflnir» 

trtia cfytiali. TUc niUüh miyrc common choicatcrla'blUnibüi ttcc» 
aro »oinotlmr'ii yatlow or diirk brown. iLomrLlmi4 grrcTLUh tiroATi. and 
a]«o uHuatly bam a Hfuootli KurfULV, (.'atc&um ijai-bimule oiU-uIi. os tliv 
Olbvr liand. an< oftm rouKhrnrd. 

Cnllrtoticm owiir more IroqiipntJy In women Ihnn In tnim itmir 
to fl%'c titri«), anJ tmlitularly in woinm who have bomo cbildren. Thoy 
!t!tt little i'tlur Iv 111« Ujiti-inlh yni. iiiuii^ (ti^jiiml iriiT Eli'tily, mid vny 
rtrujtifnt in ]H:>n{tlv rjv?r muty yi-vrn of Kjfr A «ff-iipJiriiHlivf- fenjiKi- 

oboUt&a it iho primary äiatnrbancv. 

Uicroscopy of tlie inle^tinnl Jiscliargea {a very repulfiT^, an« 
in «muy caaea cnn l>e fracli^^eil only with certain precaatioc«. 
Prercniive mi^aflTLrea are mdicnted at times to avoid diingvr from 
infection, and many aide arc? nfico^ary on accotmt of Uie intolor- 
abia oiJor. In the iwnmination of lliin sloola it is ndvmble in 
eovor the sppcirnea of feces in n conic glass witli a layrT of etliCT. 
The oiliir iy tliiis greatly diiiiiui&bcd. For ^xanimatioi] some* of 
the fteJimept in the bottom of a conic gbi^ nv a 'IHinJto portion 
distiDfTiiahaljlc to th<^ naked t^yo ia eckctod with a pipettv; or 



the *t<»ol may be aprcüd upoQ a pkte und examined for doßDita 

Und^T nonnal ooDrlitton« there will bo found (Fi^, 100) >- 

YmA «rHntioni. an not attm found: AiarrHrftrjnaHU, very Midom; 
mora fn^uontly. p^Anl »U» of uUa<1, spiiuich, md rralla; nlH retrtnanU 
in 0^9 tana «f >TU<iV'>Tliit« flwculi^ Ajmllj^, fit. mon vtitn in ciyaL^I- 
Hno limn tn ^InbtJlur Inrm 

S. Cryi^lB »A S&lti,— Triple phocphAt«, m coffin lid forra, and 

|n>iiirrit Aii^urrHir», Oilrtum oxaUt» In »nTi^lnp« frn-nv i« nrvr ing- 

(Parity kftor fJ<ithnapcS.) 

~^ «;Clg«trldl<iiD tiiJiTrlcaiJ A. ToMt. is Vpctubloftlli. (. Trtpt» rbsvphiU. 

I£S). lim« ulU irtiich a«o aUinvd yvUaw vritb lille-colotins niftlUv and 
fiva Uia vfiU-knnwn rrftrrtlon en uddltlun of nilric idd &r« fnquent. 
CniOlMtcrib trryvTAli an icaru. 

S. BpithclUI Cclli fiMT tiHiully «(jtrnl; but a Trw (Wlh mjiy be 
mi>rh«T]^r-Ji]t/ j1UVii1tr*^1 ^dly from Üii* fJiiininAuii-twtlri^ iviv^rmj; nf thi* 
loirtr n^^lJtm by ih*' i^vAp} of flrm fcop«. 

4. BacUrlA an alw«7B found in Urffc namh^n^ In addition Ur 
dli|itlo ireoJl'MlJ^, which arv unialijr uf a ^llow tint, and tht long, 
nuUlfl lod« uul laqfa m&Aiod of tJia 64if4tZ«d «ufifflit, triajij Comt cf 
toed and bacilli, nhirh »Urn blue when UraioJ with Lujtora »olut^on^ 
if« doiuiiim nf attmtioit. Am/tug thrm thi* olMirldlvfn bQtyrloaa. 
t&oVM|li)j IfivtatigaM bj Xothoagel, «f pfon in tho form of bnwl 




ri:ij« ttjtli raunjc-d midt or «■ vtliptäc or B|iiaEl1«-"ti4pci] bodic Tlidr 
MJM* Riul niT«Tijji>mi4it rnrljut Tlii-y ntmy oiriir «iri^y i>r In thv forrfi ■>! 
cdO^a^jk. Thvy »tain Uue er vioIoL m l'>^f or onl^ Je Uinir wiilr«! p>r 
tloiu irhii Lit>;(-r> uLfluElüii. TUl->' urv tmr^o iiuiuvrout in icRi^UUr cUirt 
l.hui In out- nf [iriktf^il. Ah Brrij^r hA« khrtwii, tb«7 flvii rlv lo liiiljrrtc 
■fHil fivnirntMlion, 

In pathologic «tat«i of tlio intestina raicroicopy ah'>irfi (Fij 

AmcI*' from llift ndmixtiirra of ur»?ig*»ttrd tofid, wbiHi arr 
nmt-ror^copically recognizable in Fcvere dUtnrbAiKi]«. liiere i» 
Dotcd in milder cftBca a considerable incrcAM (>f mu^lc-flifcr» 
und tlio üjtpctxmricii of undleaolved stnrch. which norrnitllif w 
rarfly prcjttni. t(s aburKiant occurrem-n in/tiffitan (A* «jräUi 
fftirr. tif ti'Hous catarrk. Fnrtln-'rmort*, pwHii, fal, iinil tnpk 
phittphnlt-A UTK iinw^rit in krj^ «gtinntity. ChiiTrvtj'nn nnil hi^mn- 
toi'din (■n-fltnip nrc iwiinllv rare, Fklicat*! oct*ihedrap uiorpholog- 
jonllj and ch^micnlly reecmbling Charcot- Lcj'dcn cT>«tals, aroj 
decidedly moro fraqucnt. Thcßo crrystals apc occasionally foiuiill 
iTi sloolp of pationU BiifTering from t_vphoi<I fever, «Imnt^rr, und 
jihtlitnis. and lliey apptur iilnviAl (^uEiF^funlly in »nHiylosLiTiiiajti^ 
alwAV» hl unguiMuTmitin, Uviim'jiiXy iu h^'^Hh liiitilru^iiilt-H, oxy* 
tiTiH, and iwain^ sagitinia and solium. Thcy arc f^pni'ingly found 
in trinhoi^plinlus, nnd thpy wore tnOtnlly DbeH^t in t>ic cai*e* of 
tenia Dana «o raroly obeorv^d in Oonnany (l>^LGhton9U*^n). 
Awordiag to r^icMenatern, in fvery cas^ in wliich Chsrcofs 
cryfitalfi are founil in the foL-e* tlie pri?aenL'e of wumis »houUl Iw 
iiMiuint'd nci vury probable. On llic t>Uier bacid, Uw aböttn«* of Um* 
crystals dots not pn^clude lioIrtunUjioj^ifl. 

Tlic facU thnil tlit cry^UN Ate luo^t i]iitnr<roun in thdt portian of 
llip intr<itin<^ In «hich nnohj'fn«1omiim 1« iihiulIIj toi^iitfd jiippi<r tlfitm. 
not duodcnura) : Itin-t thcy nr« very abundant In tho ilimy. UId itaEard 
hIdoIii ioduE^cd by diiulk» in AEi^uiniilintU; Itiüt ibHr fL]>|icd innre, nrrii 
though finMom, in ihn nTrtnU 4Amr Timf Bfti^r an Anthplmintiir Pfftin^ hMt 
Ijcvn punucd atAnj* poinU to tncompTctc cipultioo t*f woniid trcl^ntitra; 
of iliv |tHrlli'uliii^.v li'unL'umR iimtf HnHt^UjutiXtiuin iii M UirrwEfim bi^dli 
iitl indir^dfc ritnr IV rryAUlA Am fmimMl at Ihn H*at of tJn* pjiniiit««^ 

For tf\e dfftfiftiori 0/ infMtfttfjf purasrits U ii BICMWfy n&l 
only io aramint for dw:hvrgi^il v^rras. nio^M-M^mfufc, and 
emhrytiti, hut mcpenitlty fur the ova shotvit ift Fig. 56. 




trornifi ift ibown b^ Ihe ftet thiLt br tlii« riK^iuut it h» r«[)«AU^h' 
been ]M>BejUi' not only tn lirninnttnidi fur thi* fir*t time th« jir^ 
pncc of pamritc», hut by Üjcir OÄpiilMmi to r^-n^oT*- setcrc pnÜto* 
logic condUioDS (««e ^$t 131). Tho aütlior obscrvcd a U4y, 
a midcnt fi( St IVt<Tfcbiinr, wlio, a« a cWM, had f»ft**ti rnlc-n 
jaanfflft^mtly ffrut^kod pike \o Finlanil. and for reAr» hJid sulT^ivd 
fpom wTpn» anemTfl. She was in a conditinn of wrion» Rnemia 
Hiul debility : uuiiLiTouA ova of bt>Uin<xreplmIuH were fouud in 1Il<^ 
öloob. Expultiuo of a wi>rm eigbl mcttra in k-agüi ww fo!li>iix"<l 
bjr *fcad> improvL-mcut^ ami finiil compleltf eure wa* C4tiLbl>Abod 
iy the od minist ration o£ iron. Tho froqucncy of pnnuitc« if 
ühßwn b; thn ^tatlfitio« of HoifiJ^, who wnt sblc to dcmnn«1nit« 
p:irvitir ova in tho ^noU of 119 pereons out of 2S0 ©taminrd 
(51-? per tivaX-). 

In many inatiincca the prt^oncYr of worni« ii? ludicatuJ b> no 
domotifitrabto macroecopic alti^rations of the ötool?». Thal ohronic 
(liarrhofl^ whioli may (?^a*a after oxpubiion f>f tupL-woruiK, in op* 
fMsiniwiUy prosent hn* already 1m*^u mrulionod (*i*ö " Td-nift 
Xniin/' page J£0)- Vnrinn* tn/ujftiri/i Uavn iVHrntly orcnsiori' 
oÜy been fouud in chronic diarrta-ä in tuch lar^ numljcrs &b 
to be of si^iJicaneo. While, on the one hand, proof of the eiio- 
Infnc relation of tit« infuBorja to tho (rri^in cf tho Uji^^^j^^ oottld 
not be e»Ubluhod, on the oihetf tJiero wna no dotibt Uwl tho 
inftiMoria weh? roMponnlUi» ff«* Ihr ptrjirtuction of tha iSiarrhi'a. 
fn Addition i{i tbif mt*Kiis|imiiL<*ii(i-rir-um miviltcttirf! mi pit^i* 107. 
ccTCODioitftH, tTichomonaF, and peculiar pear-»hapcd infu^oriA 
have been found in mich con<ltt]oiia. In thia connaction tbo 
Author wmild n^ain draw attcrtion to the flj^tflcoiiee in dyM-n^ 
tiMj of tho atn^^pba roffrr^d tn ^^-n page 104, 

Qiilfipke And Rno«. vho Amt itlnwtrd atfrnilon to IhU tnbji«!. ftbo 
found uiIueaI pitmkn £a two o*fc** of dif§mtfry. In the llrtt ca», bo 
(Hfrliril fritiM Nit|ili'>. ti fvi'iii iif(-nUi:«l nUh tUi' «iHvbfi i^i^rA < p«(v 
Km vu frmnil, 1 1 fiTivluivit ';iial ilvvntf^rr In fitH In I ht Hn^'inrl r««ei, 
orifpnnthi^ in Kiel, a much !>*>« inf^iaua arnirbft «m< f>b*rrvcd- Til« 
«utljur limit obAcrrnl «niifbik In the frr^Mp dhrhatffcd. liluodj-pumlvat 
flWTuli in »WT*.[ oiiM of Lroplul «lywntorj. 

Of tli« pathoyrnU lütleria otxuzHag m tho intactioal dU- 
chargvAj tht> bt^^ilti of tubrtruluMiar typbfiid fnur, and chi>1?ra art; 




clEservirig of »p^cinl conAid^rAtion (fie© page« 4? tt wj.), Tn 
cerlain ciutPK of nriifp eni^nli» fltTeptocnc^?! occur in lar^e nitm- 
h&n in the dc^jecU. For this aud oUii^r it^usoDa lUej are to be 
rcjfardc^ a« &n otiologic factor m tlua diocao« (Eachericb), It 
may here be rcmflrkcd Uiat Kruao, bbifia, mid otbt^re [DutaU 
and Baaaotc (po^ :V76)j huvt found a »pocillo bacilluA aa t}ie 
exc}it«r of djM'ultrj, It ahould not he fflrj^ottPii thai, nm\vr oer- 
taiij ci^t■lJm^lIUu■c-*, i)ir ff/nutrucfuji jiU** mtiy Uf prrwnt. It may 
fll?o U fttntrd that the dinrrhcfll »tooU of infnnte, wpcciaJly the 
mucouB ndmixtiiws, very frequently contain spirilla the •««ircc 
of vhicti lA not crrtain. At nocrop^ca modo by E«*hcricli upon 
Micb ehildreo thcae orgflnieiDa v/ete found almost cicluflvoly in 
thd inuoüJA JeposEU in the colon and »ApT-oially Die cseiini. 

Discharge ot adniiiod mu^^iu la of great clinical atgnificane«. 
Mucus viäiMo to the nakod c>e can readily and po^iUvdy be 
idoniiliod by its chomie behavior. It aUo occura in the form of 
yffUou'ith-hrovn io dark-ifr^Gn rjr/tn^Jts, ai flmt puinlod out by 
Nr>lbmigf). If Ün^i* grminli-s nre trii^fUvd Utvieafh n Pov4^r*(^lrt**, 
ll)*^y &i|>read out into n uiuU'ttu yclUm, "ffhi!*! the jvlUiw 
Imilic^, resembling firtgo or frog-spawn, which nmally consirt of 
ircjjetrtblc rcinnonte and »rater» alwji)-» Tcninin in frat-mi^tf^ 
They are n<^ithpr disflolvnd nor etainyd by wator, othrr, iodin, or 
osmic acid- On Addition of nilrio flfld tlipy give n diaHnct ivuc^ 
tion for bile-coloring matter. Tl)ey present no special atrncliin% 
and ninnyti iiidu-iUe tüliinh of Iht- ilüuui amt upper portion of tbe 
col^n- 'I'htry deo occur m pure ilciiie. The active reaction for 
bilocolorin^ matli^r with re^^ard to tbti presence cf mucua ia of 
itwif övidcnt^f? of tbt? 4>xinttncL' of eatarrb of tlie ileum, for Uw 
reason thnt Inh'-pi^irimt w iKtrmuily fcmncl cni;/ in thr! iWnt, 
n9var in tiie colon, and can, lhcn?font, oocnr in th« fws» only 
wkeu there is very active peristal?]* of tlic ileum and colon. If 
with the coloring TimUor miiioua al^ oocnrF, proof of catarrhal 
lieilia la cstablit^hvd. 

Ct/!indnc ffithfAial eelh imhfddtd t« muais are of frequent 
or<Tirrt?nc't? in di(Ti?nnit paLb-jIngic i.'ouditioii» i>f tbi? itiltr^line. 
Tlie cell form is nnimlly altered, nttollen. or shTuutun. The pro- 
toplasm ifr ^auiilar from fatty d^f^cncrnlion, nnd the contour and 
UJcleua preserved. Unnltcrnd cpithdinl cella are found rxcUi- 
tiveJy in large mueoiis shrßda. Under the term "broken-down" 


«piUieltm Kotfana^ bn« dt^cribed Bprndlc-fomned, «Hghtlj gli»- 
tcumg bodic» wfaich have beca Altcrtd by dc«icGAtiofl. 'i'bcf 
occur mw* frf^ffueriily in dnj thttn in df^rrh^l aiof^U. 

In sdflition tn ^pithpliiil *^\h ieitcücj/tts of variable siKe are 
itianllj pmont. As ha« sliviidir bwD id«tci3, fldmiituro of ftwt 
is found in tlic feces oulj ux ulccmtire prcK^CMoe of U10 intc&UDnl 
eaoal or adjatoni parts. 


]. In Acat« Intcattna] CaUrrh Uie iiui:iber of stools is Encore 
tt IcM lacnwed nad the c^nautecicj ü poMj or liquid. Accord- 
liif lo tb« Mit ot Uu cfttatrii, «rtaiu dilT«Kfio« arc manifcvt,' — 

(c} If Ih4 ileum onry u ofFetiod, freqnont, thin «vacuatlone, 
l^unl witii mjirTTKcnpii* bilr-stUini-il mticu« {nrlnning ntimifniiui 
cylindfTc rpitiiclUI ceil«, occur; the jtlbw iitucous ^anulcti 
icrnlioncd above (NotbDogcrs) are aleo oftm ob^u^rrcdi 

fb) In caUrrh of tbc vpp^ portion of ih& c^hn, which le 
ntually aesocifltcd with estarrh of tb^ imall mti<ctifi«, tlio tbor- 
ou;*h1y ruhot), liquid, oouptike dejecta contain mucus in vtierö' 
fajfic torm vrily. 

(t) Jn <uJarrA of iht ud^m (pnclitU) purt gftatincid 
mucus i* often cxpdkd» 

(d) In cntarrh of the whch Ear^« intestittB tJie liquid, f^up- 
lik« «tools contain macroscopic mtSM« of irucm which aro not 
billets in I'd, 

^. Chronic Inteitiiial Catorrli senerallj prtecnla the follov- 
ing failure«: — 

(a) Cbroni« caiarrh cf ihe ileum doca DOt occur ttione. 
Combined with catarrh of th« f»hn it inJuct« fTCi|ucat «laily 
lii{iüd Htoolftj coutaining bili^-iUiued mucui«, yeitow mucont graii* 
uU«, etc. 

(bj Wbm lin^itod to the coW there is almost alna)^ 4 dift- 
poaitioD to ooDftipation of »cv^al day«' ditraliot], whtch mav bo 
intormplfv] at n^jlftr or qiiito inrvgukr int^^rvala by durrh<^"i. 

(€) In impliralioti of tSo rfftuin, irilh or wiihout dutiirli- 
aacm of Ifie lover coEon, Uie fpcp^ aro imbedded fn miicua. 

3, Ifarrona DUirhet h of frctjuvikt occurrvncL' in nmiiiu- 
Ihcnica^ and may )>€ attended bv from G to 8 or IQ nltcr&atoljr 



eolld and liquid atixiU daJly. Kow uuil tl^e^ fti moaUinif» (Lere 

ia fi;lt ft »iiKliliti iltt^irK I0 ilrfi^cati?. The? abtJUfl^inl biiinUM nilrkix- 

turee. whidi nre oflfn frtt[utuit, imlicatr abnunnal jitTiBlul-iis m 
the eruail juid iur^« iiiltutino. 

-t. Enuntli M«mb«nacec— In tltis nffiv^tirm lht>r<- nre lii«* 
c-lmrp*d tit infi^rvHl*, utih ur w-iUioi-it »tools ard in>t infnHjm«mllj 
iicvonij>nni<iiI by tiolrnt colicky [mine (h^m^e "miicoui colic"), 
mcmbrrtnnns ril>l>niihkc or tululer foTmalionfl (mcnibrauouA op 
bittuUr <^ntrritip|. Thcix color i& dirty wlittc and llioit length 
often cciuiid^rahlo (in a largs &m«e of caece the author found 
th«in to meaenre fTt>m six to tvenly oentünclen) ^ Tlio dia- 
charges riiaj be rHjK'alwl daily fur ^i-t-ka or only a fi'U' time* in n 
ytiif. Tliej ata extrr?iiidj rare in cliiliJren nr Tipufn*üi«iii* inrai, 
but much more frequent in ncrtiw« or h^sfrri/ v^omtn^ Not 
infrcqitentl}' a tc^idenf^y to oon»tipation coi>iütji. 

Mirntffapi rally, a doll^nte, «triat«d bAccouvit «ubctAOCO. 
ft'hich rnay hc^rc nnd t)u*r^ pTtvi'nt glUlrning, flbrinliice flbriJla- 
tiouw, h oliscrvixl in al! cjiwk Thi« la nwHally clnmM Ihrongh- 
out by aL-clic acid — an indic^lioti Uiat U ooni^iF^ra of tnat^ua. Very 
numf<roua, grL'4illy altered cylindrii: opithdjul cclU uöd K-ucfv 
c>l« are alsa ofti^n prt«eEt. Triplö ptK^jjhuto ami clioloBl^rm 
crystula ari? oecu^iJoniiHy found. The chimic heharior of thi« 
hastnienl subelaiif<^ hUowb that it is cornpost'd cliii-ily of muru^i, 
in Addition to which an albumJiLuid hotly mny oceur. Tlir cojig- 
iila fire almost entirely div<rlviKl hy caur^tie pota,-ih. Adrlition of 
acetic acid to tbc filtrate producing jnteiiiie cloudrnK, which fil 
wliolly di^apfiear« on udding an vxmsa of acetle aoid. 

It cnii fiCBTT'cly bp dotibtrd Uiiit tbi* afTrt-Lum, »liich pr^hftbly at 
Inrkfi ncrvuuti PUt>Ji?cts cA^'1Ur<lvrl/, ifl 11 ^f^nuiii? »pcrHiun nriiniHih iji 
U'^iioh Uic itorninl mucouii »trotioit Ip au^nipntcd, If in tuvL imJivjfJiinU 
IL crrUtn AlUf^fEitUiicAi of ll»< j>toolj! Willi ppuDJodic pnUtalsis of the 
r^olon h sinn iiivu'rir.. m*. IihIpi^I, U irfUii tha cote, the iiiiir-uh nmy, nn 
Marotuind rtr^t i^oinli^d outf W nuilded Iwiwimu tlie Iviifrtliidiitiil foliLx of 
tlio iuuou>a i]f iht colon into alriaE«, mftnbrnnr«, ot cvtn tidniTnr'rormpd 
miiiui>it, Ap 4 MiAttf^r aj ciuriatliy. I miy Iivtv iupdIEüii timt one of tny 
p»li<«nt«, Hiifr<iring Ifom tikis niÄlnrty. rpjkPnt«Hy »ubmitloil horvdr in 
tppcwonii ciiTt«* Liir<^i] The ndvji^i: <jf a i^uach- 

Ti. Intcittnal ulcer« üto viry nrten acranipiinitd by diarrhea, 
hnt tlie lalliT Diay ix'wisionaDy he alisout even iu pxtenaire itlccra* 
Xhiu Blood or pus mixed i^ith chronic diarrheal deject« is 


rtfoiiKly tni^^^iTe of nWratioQ. It Bhout^ be e«p«cinlly nntofl 
Ihttt viftrr af ih» ileum, the wnpilco-pwmlont t^crHion nf whirfi 
inny mA njjjM'nr in Uit- strKiIr*» nre K"^m*rii!l_\ iin^itUadeti hy (3iar- 
rben. On the ftth^'f Kniulp ulo^ration in t3ii^ lotatr poriion cf tt« 
cofivf» and rectum if< eJwiiyit nccompnni»! by diartb»- On CAre- 
f;il oxnmtn^t]<:>n of KJch dojcctn, &/(>oti cn4 pas art tfn/ mrehf 
ahsfnt if d^tfntfri^ ulcertjUan if pre^tnt. Thetj mt^ not he 
prrxfril in tubercular and tolorrhal (/oJlinilttr) u/rrni /i/inj», 
''SiuaU, gray ifili- white cluoip»/^ cor^vting of clr«cjy packed puf*- 
carpuficke, are Qüly o( occji^ionnl occurmicc. The hrtjtr nia«M> 
K » rw^itibtm}; fiiroUeii fia;-D j^ranulce, pK^iouslv meutinDfxi o^ mdica- 

tive of follicular uk'^r, eoiwiKt, aa Notlmagol fiwt oole<l, olmoftl 
ntwEiyA of purtiplf« r>f »tarrh <ir fniiL 

HistfliH blixid mid piiH, (lit? "ünut^Hihft^iln^' fDiiiid nlinml 
cxdauTclj in dj»fiitcrv, minglml with tlic diiinli<«l «tools, <re of 
tmporUnt diflanfmHc ^icnifimncc, 

A. Atrophj of tbe InUttlnil Koootn« whrtt if nlTiYU llrn^tt^d irvM 

ia itroplij of thfl mucDH of tb«? t^A^A*. Htiw^vrr, tUt- «ttnol» Qiintftin 

T^ III lotvnxi oaUrrhalls the iluoh art uiuallf olny coSorecL lUmi 
«m) mblj frtllyr TUi* ThI iq u»ii«ll> ptvxL-rit in ihr- fun» nf Itifl* or 
■hmvpt of nfvilIrLili« iryiiilit. wMrh, li^'imlinit tn Oihtvrlrin'* n>vHriiti#]t| 
probably reprctcnt limr itnj maL^nrium «uIIh of hij^drr fdtlir andii, Tb« 
rryt^UklA rpiiiflin ufiAlumI vvm after t»c1vc boun' IrAlnicnt with nil- 
phurir. tiilH^^ hycIror<h]ciTio, nnd «ivtii* txiX*. Tlifiy aUfl rp&fc><I ilia ftcllcn 
d Ainmop|4. polAviiiin, mil Vfhlium. Tlai^y IKlm JifT^r vrrj dvi:ijpj]y 

from Clmmotl*jiI''n cry*U^*. vhicli imrnnltnicly clUiipp«r on tnatnimt 
with th**e r*d]c«nl>i, 

9, In fAUy feihl amyUiU dc^enctstlon of the llrer And hoplitU 
drrhotU <|XiiiP limiltir i>ti;£(H-1in1ii' cir «rhjillc fetciol* alio onrur iiiMltrndtU 
ty Eolrrua or hWt «ttfliii-d tirlnc. 

J, In [■rtPHmimvil lat«at1nAl tubcronloila Ivhcrdc hactlll *rc nnwly 
Alvnji fitiiriEl 111 tb* frfurjCv, TliHr pii^st^ntT U dir^rily r^fiTnUlp t*> In- 
tcttlnil IvWrculi^fli«« U «hould P«t b« lorgottvn, linir**«r, tlut ■piitnm 
tuoUiP&ni; bfttUll U ttrmMov^ by pulinoniTy cojuiiTrptk«, Bod tb* 
Iwr'illl Jiiiiy «ppmr In Ihr bIduI* ulilioul thp PklMrni« nf tntcttliuil 
1«lb«mi1i»iih Thii qui^UioTi in "lill in di'itTitr^ In indtvidiiAl cii><t4 th« 
author unquAliAodly ^irim u-ith Lk'litLrlns mtd wnuld ilU^noitlcAte 
InUvUlU-l ti|t:orr*iilo«U on tt*Xvty\inJ\ of ihr ta^'Jlh In ihr fcr^t^ 

AivorJinir lo Lidifhoiiri, it ia hvU^r !'> otult »nlrn-t »Ininiiijf, far 
tbo n»»tn UmI tba iBAUUKT&bl* miiipiLi.Ui>^inr: linolifiiii pif*rtil in 111« 
«tool* {9tt pafv iWj *n fttalnod >nd rtnikr Ibr tubftmt* IacmIIi, vhlrh 



«m uxuAlljr fpiT ID numbrr, niorv diflloult t« firnt ll^na wtifn Um «implo 
"BjHviAfl" tEiL'Ehod of ftUlning Is cnplojrd (ho pAf« 49). 

Jhcnforv, dry ft&imtxiiimn ni&do from th* mucUft OT, bctUr ■till 
vhrn |>[r*rnt, miicfi piiruf^nt gidrnUUmi« iiliouH b« itwl. Tliis b «tntard 
nnlj- if! curlnil fwrWa or Ki^nEmn-riirlrt anllin-wnltT »olufiun »ml du- 
oolorrri M'llh hydfor-hlonp or nitrw odd »nd TOptr-PCot, alfnliul (m« 
|>pjc<-* 40 rf iTf'/ )' U^^<>lcrjilEon DiLut be h> t\itaoun\ily done that bH pOA- 
i^ittlllly (if t'nirfiiwcii) nllli ttni/uma \ \n¥mU-\UiW*n-]*) liAclfll in cxcluilrd. 

lU, DyMnUTj.— Tho "tnoU an? «ntmimay f;^'t[i«Ht \W, 31. »rinl 
niOfc iu l^fMj- fi^ur liuum) anil u»ii»lly ftL'-tompanicd l>j »cveit r&in «nl 
it-nf^miA». Wliil* ftnly a «n*U quantltj U dln-hifj-fd with *nrh <Jo]pu- 
tlan, Mkpii rv>l1pLTtiv«t^ thp mnnunt i» often i^OTi'i'litruliLii [LOUO In I^DQ 
cubic cFUlmicrUrB, «^fuHinK Xu ih<* Biilbur'a obeFtvitti»nt)> Tlio i1<-jvl-Ul 
prnHTVO thoir f«ro1 ranilnlrTicr* und o/ior only In tbn rarllcuiL tl«^. 
Wfirn Lha diMOikm» U fiiiJ^ «HUhLiulmJ, Ihey tkrtt compo»d outy of mifmr, 

■Itlvmu WQ d 1*1 ingu tail {juat ai with the ■ptEtinnt ■impte iniiniLtn., rntiiVk- 
|](imt>rr[iii|:iCt piir« licniurrhaficH aviil |>iiro purulent frluol», Maco furu 
lFuL-)ietuurrbfi|:m hiid i.yi\\i^t iiiUril fiiniifr hUct uto nut iiifrtijiJvnl]}' 
obMTVod, Id tha brginnrng tnunn« [iri-domindtf*. It oppMn a* « thrti, 
tramu1oti*t yvHvw jlnlm^il tdlloid wliidi dlUer iriolo»* particlt« «f imx 
■tin prrWiit' in tlift varly ntujfi'H or h niHril viliii Ehrm in liir'iji^ iiiHHitfJi. 
KrofD th« very bi^gmniiig ihn miir»« i< tpoLI«d »nd itrt'iitvfi with blood. 
"Muctjii« iiliri'dfi" ill ihxi fonn oT Hat im»ieu1«, ^hli-li ixiv«r tbo uLaoK ora 

Thr hcmorthagk dciacnt« Jo tho boginning may b« 4iniply on Indi 
culiifii of IiyjiairpiiA «J tbu niiliiUtiH iiii'nibLAun iJ Uiit I'ulmi; in lliir laUr 
*in^*t thi-M» «iliitiifurp-i. A<]ivi-i4lly ihiiwii of m ptirfly br>niorrhMgirT lyp*, 
brp dorWcd, like the pitn, from the rxihluij;- uTcafntinno, Fn in'>rv ex- 
li'jLaivv «nJ di^^-p <tr>UiiuU<jii üf Ütc InUaliiiMl muc^ato. unqmnllanjiblc 
ttuut-frtLgfriütit* appear in th# putrii, »linking, dSrtf'lmjwlfcli-nJ or 
lilarUixh Atf>o9h.' 

'I'hv mJcrctioope Jiwlily n^vi'bli mui-un nnil \'\\* i>y mon^liologk pnd 
iiiicici'hcutic fuL-ftttc Aold rvuetti^fx ot lb« miicuil dukmclohatici. Frcth 
IflcKhJ i» rmif^-ni/^d hj iti« prc^r^e uf ivd tlooJcflb. Old 1jloi>d In otXtn 
dNnonHtmblf« only liy jnitnim i.if chfTiik and «p^KTroFiMvpir propvdiir«A fvo 
p0{fo IVO]. Tho Mnndy-inftLtrjjLtvd miicou« thiiD]A often contain Iho 
apurtiB ilrii(:iiLt[| a» tlic caiwc uf djncalcrj' (*« paj^o lO-l, I'lg. 53}, [A 
hncÜhi» diMCftvpTi'jl by Mii;jrt, of ToVin. *nfl mnllTinHl hy V\PXnfT qnd 
other«) lia< rcvcciTly }küü d?H<ril<cd nB«n clidrrgiic foMor w trnpienl form« 
of djtfvnLfrj. H U alao clnimeLl thai Ihis ntlcro-orciLniBin is the chlvf 
i>Uotogifr «gj-nt In th« Biinimpr dyirnfcry of children-— ItniKFKti- J 

11. Tim ftnn «nd fürnird hIcoU pic^rit iu lha mrly -lugfl of typhoid 
fci;<I, imni'ly tiJWJiid i\n- rml of tUr fliAl wrrK "I llif? dihrn-e, bcfJire 
Ihkn And Hiitj-ry nnd hUll hn^-i* n tlullni'l. lt'ou-»|pib r-riW>r. TEir diarrli4?a, 
which then begins anil continuon dvting nluioHt the ^]io\i> porit>d of (he 
fpver. U niniilfcnlcU by flvc^ tu, Liid ni«rc tlghthcüvn. palcydTow. iiiiil 


|^lo<r-tlng*d it^olt. »hkli ii^i^uritU lata two l»7«r* oa itAniliug. Tho 
iowvt cui i.-ui]Uiri4 fl»i'ciLliiLt miJ ItLiripy yptlvv mamei bom wliEch tbc 
npp»r mrtw or Ii-** fflnu-ly. |LrnwniMli-j-»nnrt-[^ili>rrrt, witlrrr Mmtum h»Ji 
«DpuntKil Tlu« "fmi-^bf-'tiw" Mnel tr>*ri> it« li^it-^mji'h -yellow ?ot<?r 
o\i\y towftril Ibc «nd ol the di>wi»r. daHDn tbc gri^d^uit decline o( llw 
Uvn. It lhr<n bMoPiM brovalnh «nd gntduilly mora :trm uniil i>1 □omiikl 

In lljr ■cement of llic pcB-BODp'Oolorrd itool there uiq found, ia 
A-ldiuoii to patriBfiu.-livD liBctortft, % vatrytng numbar ol räuad «tl«, do- 
penJiTif njiuEi ilie *iiiount ul tnunu, and inAiiy cr/*!«!» ((rliilc pbo* 
liliMlr), «buiiilitnl ^itn-tili/rumt^ okwin ni;a;iiLi. suil lliv iipriHc LJülhotfraic 
liiph<44 ÜtjrilH (p»^ «JJ. TAr« ar* rrm^fl^anNr rmJj^ bj/ truUurt ittfthnifjt. 

lit iiilrvlirjpU iLriJiortbijti*, nlikb. it« ia kii»vrti, ocL'^ur from Ihc cii«l 
uf 111« HM^iind ti:^ thu fmirlh w(*^k lu frorii <l (o 7 ]i^r ivnt- uf tKv rui^4, 
pur^ blwid or thicle or tli^-htly coi^Utcd dark blood m«/ bo «omelirnoa 
dih-liuitji-U ia luriic i|iiuriUi^. If t!ii^ hcmuirliat;«' h lUKht ur a U<ifc 
»troKur, of \i}'«i\\ huH hi*Ptt m-\a\»M l<ir ntiUic liuiti in ih« InituUn», Ui* 

i^Hi/ht admtttKn-t of bttiod K\lh the stvols tmi iitfrc^v^Ht}]/ gtt« 
learning ttf an (nipmitttiff neffrr hcmi'Tthüjjf. dtQir^iii'r] Ity lU*«o tttmkit 
<^ liland or blE>(ri|-otniiit>Lj miKt^JM HbrrÜM riviliTfi to tho njkki^ ayo «ih^iilj 
bo fttU'iilUelf »»tcUcd fvr and gfnu iiiott carvful i^ntUtTiitioii, 

In Ibo fttoöli dtachnrtroil nKh unvote hf^morrbig«*. Iho rtd blood- 
cotlii art tkflrn »(ill m'cjiEniuUl«, Id iho UlooJ which ha« hr^o oiuch 
B^tcred in color, v^vu. iTiu "ichueU" uf Ihv rrd Uuvd-<iurpU"^lL<q a» ab- 
huL Leader inch rlrpumitonm blno<J'.-olr>nug niftitrr niu<t ba domon- 
atralnl by TrjtlnrmiLU't hrmin tett ur by uintn« E^f l>ic up^rotc^pr. Bf 
thv lattT iTCtlKHl iL riiiiHt In* rrnii^nilifrnil that ih# uiybaiiiagloUii taaf 
bar« b^n trnnvf^rmad ialo inj^thmuiglobLn 1pA|E* W)- 

I'J, Cholert— Tiie diamderitüc "rica-water" or "ottlnjcal* 
foup-lik«*' «toole ure uauall/ very Tn^^uent And profti»:. Owing 
to the obftGOoe of bilo-pit^incni, Utoy tin liquiJ, jerayUh vhite, 
mixfid vith LijEbt-coIorüd flocculi n^Mmblinj; cnobcii rice» ftnd 
c|[?voij| af fortl rtdor 

Micnacojtic ejvmination of a flmpli?, t]nstfiiii«*(] "«^raftli** 
prf!-paratioD, luado from one of Ihe LigUt-colorcnl inucu^ia Jlocculii 
fthov^ tliflt they uro oompoeed of do«e!y airtinged, 0iroII«ii cylin- 
dric epithelial <e\h and luucufl^ Among which an tiumcroua ^c* 
itria of all varielifs, 

Ck>nv«iutn1t]r lit« jprdfi" iufrrLioM« mp-nl c«n Tatrly la («co^janl 
Ed a ilHpd aiirl aljihiFil ■prrtrnm. t uUitüUim U r*m*M\al. Ko'^h and 
mimtrou« «thc-r ]ihi<*1i^HlDn ob*«TV4d on Immtf onatlgas and ala* in 
Ifao BtTctc epidoink at Hanibuf^, In iMtt. a aurnbci of i;a>n Ut u'hicb 


the commB. badlli (pa^ 70J were present in atained preparatioiu in 

almoat pure cultun-» and noted especlellj the characteriBtk grouping 
of the baciUi in the mucous Hoceuli. In eome of these chbcs the diagnoeiH 
can be made vith ^eat probability without cultivation» because the 
comma bacilJi are diatingulehed from other comma speciea hy their 
ehorter, thicker, and more curved form and their eharacteristic arrange- 
ment in c^umpfl. 

13. In lyphllii of the lectnin mucuA and blood are not infrequcDtly 
discharged with the feces. 

14. Iq oanoer of the reotun frequent, nonfeculent discbarge of 
blood and mucus accompanied by tenesmus is particuliirly choracteriBtic. 
When the seat of cancer la higher up, putrid, Htinkiug dejecta» Tery 
rarely containing pa ncer-f ragmen t>, may support a diognoais. On the 
other hand» tapelike or aheep-manure-like atoola are of no differential 
diagnoatie signiflcanee. 

15. Intnunsecptlons of the intestine lead to bloody-mucold de- 
jecta; more rarely to expulsion of necrotic portions of intestine. Era- 
buiism of the mesenteric artery, severe congestion of the portal vein» and 
scorbutus aliHJ cause bloody stoola. 

IM.iTK I. 


jhim.VflEUT tylfJ «^? 


Li^ht Yello^v- 



If^^ish Yellow: 

Yellowish Hed^ 

BrQ}9-nish Red. 

Reddish Brotfu. 

Ikv^fiish Blacks 




Examination of the urine reveals valuable information, 
with reforonce not only to general metabolism, but also to the con- 
dition of all those organs concerned in the elaboration and dis-^ 
charge of this iniportant secretion. A high estimate has, thcrc- 
fore^ been plnccd upon careful examination of the urine since 
olden times. Examination is directed chiefly to the chemic and 
microscopic characteristics. Before describing the methods of 
examination and the conclusions to be drawn from them, the 
properties of normal urine will be briefly conpidcred. 

The total quantity of urine voided in twenty-four hours by 
the healthy male averages from 1500 to SOOO cubic centimeters^ 
and by the female, from 1000 to 1500 cubic ecntiuielers. It may 
be temporarily diminished or increased by bodily exercise, exccs- 
Bive ingestion of fluids, etc., without the existence of pathologic 

Urine is usually perfectly olear and transparent, and on 
shaking shows a whitish foam, which quickly disappears. After 
long standing there forms at the bottoju of the vessel a deliente, 
whitish cloud (ncbecula), which is composed of isolated mucous 
corpuscles (leucocytes), squamous epitltelia, and salts. On cool- 
ing a reddish sediment composed of sodium urate is not infre- 
quently deposited, which disappears on lieating. In faintly acid 
urine a wliitish deposit is formed which is composed of earthy 
phopjihates iiud dofs not disappear on heating. Indeed, tJie phos- 
phates are stuneltiiu-s preiipititted finly nfter heating. 

The oobr of tlie urine may vary from ptraw-yellow to brick- 
j'cl[ow-re<l. The more acid tlie urine, the diirker the color. 

Tlie aln^o:^t constant acid reaction of hcntthy urine is due 
principally to tlie presence of acid sodium phosplmte. Under 
phvj^iologic conditions — e.g., during prepondcnmt-e of vegetable 
diet and ahuud;int cunsnitiption of alkaline carlK)nftt«?s, and less 
often sliortly after the principal meal — it may be faintly acid or 



even alkaline. The earthy phosphates and earthy carbonates 
precipitated from such urine spontaneously or only after heating 
arc at once dissolved by addition of acid. Amphoteric reaction, 
in which the urine turns blue litmus-paper red and red litmus- 
paper blue, is rare. 

The Bpeoific gravity usually varios between 1-012 and 1-024- 
It may be decidedly lowered by ingostion of large amounts of 
water and increased after profuse sweating. It is determined 
by means of the uHnotneter (Fig. 101) — an araeometer, gauged 
at 15" C, and graduoted from 1.000 to 1.050 or higher. 

Fig- 101,— Urinometer. 

Tlie apparatus is immersed in the urine contained in the 
cylinder, and tlie specific gravity read off from the lower menis- 
cus. The urine must be absolutely clear, and the urinometer 
must move frrdy in tlie fluid and touch neither the bottom nor 
sides of the cylinder. The layer of foam which is often present 
on the top of the fluid and interferes with correct reading should 
be removed with a glass rod, [For very small amounts of urino, 
the so-called specific gravity heads are very useful in estimating 
approsimately the specific gravity- — BnooKS.] 


TJJO aromfttic odor of tht tuine preicni undrr or<liiiAty dr* 
comfltoaott muy bo mlluciiccd or incrcEU^d by ccrtnin food», mcb 
&a esparnj^iu nnd tliu like. A violdliko odor h produced by 
bityiUuii^ ml (it InqM-ntine (*^J-, aflrr polishing of panquH 

Amon^ the oreuUc constituent« ejicrdttd daily witli tliv 
tirinc urea aseiunc?» tho firet place. Tbo averago unounl du- 
ch8Tg«d ifi 30 grama per diertt. Ürio aold is daily €JCCfd4yl in 
flinotints of 0.75 gram. Atnon^ tb« Inorgfint« ooi^ftUtiu^Dti üodiuic 
cblorid In pnr».til in Urgt^^L amount, »veru^ing 14 gntim. RuN 
pburic and pliio»pboric acida ate eicietcd in juuüLLnts of Z.S ^ramfi 
each per day. 


Uoder pathologic condition« tho vriat h ofton do€id«dtjf 
a1t«re3. Same cbongM can b« rccognirnd with the naked cyv; 
as a luir, bowFVct, cAfcful cbrmlc and micrnKopic pxamination » 

The fc)]k>wni^ deviation« may bo obstrved witli tbo naked 
oyo: Increofle in quantity in diabetM ine^pidna ftnd mollitna, con- 
tracted kidney, pyeUlf», etc. Blminntlon in ft'brüo di»eai^, 
Tnlwtur K<ftiotii uf Uic> ht^urt. many ForrTi« of tic-jilinii«, in utv- 
mi«, choTera, rtc. Alteiationt in appeaianoe and color: Tbc 
urine n)ay be cloudy or quite opnqur, and inatood of a liitbt* 
yellow fane oEfiumc n dark rc^d to tnky bla^k or even a nulky- 
«hitoabade. The preaoncc of bl<»d' and büc- coloring raottor^ 
indScan, meluniD, and admbcture of poi, a« vtM as a itrong 
pmipilalo of umiL'it, c«n »Jini-tiimi* be »urmiM-'iI with (jreciter 
ttr tiru ccrtuinly without furlbcr t^iantination. 

It niny be mentioned be« that the npe<:ißc (nMvity may jtTt- 
ipnt i^^Tit vanntionn between 1.000 and K060. Abnomiully low 
fi[H.vliic grnTtty ia obiortcd prineipiUy in dinbclisi innipiduji and 
emilrnrtnl kidney; vrry high »jH^eillr; grtvily h Mvn ebirfly in 
diabctc« TiiHlitns. 

Tbo acid raaction is subject to many variationa Jn dUvoic, 
o»peciall>' in cnUrrh of th« bibddfrr {siX be]ow)> It should here 
be Eiien(ioii«d lliat after E^«re t^miting, after lavage of iht 
itomacfa, and in brp^rcblor^t^ria tbe urtn« maj bc<«iT>o alkaline^ 


owing cither to lose or to too profuse elaboration of hydroebloric 


A few remarks upon the molecular concentration of the 
blood have already been given [page 147]. From the state- 
ments there made it is plain that in defective renal function 
and consequent retention in the blood of Bubstances whicli 
should be excreted in the urine, a diminution of the molecules 
in the urine must occur in the same ratio. In other words, in 
disturbed renal function the freezing-point of the urine (A) ri^ea 
above the normal. 

It has been shown that in healthy kidneys this varies be- 
tween 0.87° and S.43° C, according to the conditions of metab- 
olism. In order to obtain an approximate idea of the actual 
amount of molecules escreted, the daily amount of urine must, 
of course, be considered. In order to obtain standard values, 
the product of A and the amount of urine = -^' (valence 
number) has been calculated. The figures given by different 
authorities vary between 7GG and 3770, While the practical 
value of the molecular determination of the urine in internal 
medicine is limited (because the limits of the normal value, 
which among other things are decidedly influenced by solid 
and liquid food, are very variable), the researches of Kümmel 
and Rumpel have shown that cryoscopy is of the greatest ad- 
vantage in the diagnosis of unilateral renal affectious. For this 
purpose it is necessary to collect the urine of both kidneys 
separately by ureteral cathetorism. The urine of each kidney is 
then examined in regard to its freezing-point and also its urea 
and sodium chloride content. If A of one kidney shows a 
normal value, while A of the other kidney is under 0,87, this 
indicates an afFoition of the latter. 

The method of dclcrmining the freezing-point of the urine 
is the same as that for the blood [pce page 147]. 

■ Fmia icpUt « Ua 





Ure*.— The urine ia evap£*rate[l to a Hick *ynip niiil 
«xfracttxl wKli alc>>lkoL It ia iht'u filtcnil, the filtrato craporotcH, 
und the rcfiduc diä»}lircd in ^^Icr and Iroated vLth con<?cQtnitc<l 
uitrio acid. On coolinj'f tulrato ci xxnto. eoparat« afUT & tünd 
in rhombic or hi^u^goit^] y»lAtM. 

A limjili?, although not vi*ry ifisrt, niclhofi nf ^t-tifrinSning 
the nmounl of ur^'Ji ha« brcn offcrt'd by »I'lich, of I'lirU. S> 
i&T u thff dctcniiiuatton of approiimalc value» or oblaininjE 
comparative Cgnrca in urmo eecured ftfrparalcly tv ur^^tcrAl 
catlicti^nzattoD n ooaceriit*d. 111« netbod muj' be recommended, 
and h therefore inferred to in thia |>laec. 

[Om- i>f tK- mkh! iTiipfirtjiiit iinrcrJurt?* in uriitary eiamlna- 
ti'jus i» tlie qQ&ntitfttive efttixniition uf itrea. .Mnnjr mciliod]« lUld 
ApparntLis have boon dcvm^d for thi« piirpoflr^ nil of wh:ch ;irc 
mere or k^^^ prarlicnl And corivi^niont. \Vc have found, hoivcvcr, 
UiiJ the iXinniiufi unfom^^l^r, E«jK>eial1y tbo roofnt nuidilicralion 
of this inMrtimcnl, givi's rwulte mfflciVntly niviimt^ for all prne- 
1icj)l pLiqio8e8. Tho coQ^tntotir^n of the two foniD? of Appanbtiu 
iä showü in Pig». IÜÄ and 103. Tiie tc*t ih based upon tie 
«mount of nitro^n-j!«« Ubemtod from ft £iven quonlity of unia. 
Jii thia twt Iht* solution u^od to decompose the urr?» u fhv hypo- 
ttomitüof ]*odo. The meUjod of proceduTC it os fullo«-»:^^ 

Mill»' n 1(J-[H'r-*r»t, »vntrrj Riilution of WKliiim hyilmU- (pniv 
Mickn). Tbl? fodium hy^mlromilc tn-i vohit^on i» made by add* 
ing pure bromin to the »odiimi hydrate iK>Iution in the proportion 
of 1 pari of th« formrf to lo pjirU of live Inttrr The broinin 
and RoiliuEn hydmttf» »olutioc should bo miiwi ftwh for each te*t. 
It 19 moM convi-nirnt to pour üEiflii^irnt sodium hydmte aoluliOB 
into iW long anu of the apparatu« to rc^juh ia the rtiark ^= and 
ihcn add enough water completely to fill the long jria aud hcod 
of tJie tube. Tbo t«h(* »bould bo ?ulli<^i<<aitly fnii to Avoid eiitranei* 
of air into the \nng arm wh^o th^ instrument it lilted tu a 
direction tow»n) thi* huSh. an «hould bo the aua when mukini» 
the U»\, Tlie IhuiLb ia lu« placed oi«r tlie optütiug of th« tub« 



and the Golution shaken until thoroughly mixed. Now add 1 
cubic centimeter of bromin with the cubic centimeter pipette 
which accompanies the apparatus. The bromin can be made to 
mix witli the dilute sodium hydrate solution by pressing rapidly 
a number of times upon the rubber bulb of the pipette while the 
latter is immersed in the solution with the tip directed toward the 
top of the closed tube. When the bromiu is disaorvedj again 



Fig- lOS-^Doremus'a Ureometer. 

place the thumb over the opening of the tube and shake well as 
before, to insure thorough mixture. Now allow all air to escape 
from the tube and then slowly and carefully add exactly 1 cubic 
centimeter of fresh urine with the pipette (if old form of appa- 
ratus ia used)j the point of the pipette directed upward toward 
the top of the dosed tube. Ab soon as the urine comes in con- 
tact with the hypobromite solution nitrogen and carboD dioxid 



gaB are set free and tbe fcrmer collects at the top of the tube. 
The COj gas is at once absorbed by the excess of sodiuin hydrate, 
forming sodium carbonate, and therefore does not interfere with 
the test. The introduction of the pipette containing the urine 
requires no sraali amount of dexterity to avoid lose of gaa. Some 
gas will always be lost, but if the pipette is quickly, but care- 
fully, introduced this loss »ill not materially interfere with 
the result. With the modified instrument (Fig. 103), which is 
to be preferred, this source of error is avoided. In this appa- 
ratus the urine is placed in the graduated small, straight tube 
and the flow controlled by the stopcock. The reading is the 
same in both apparatus. 








A "■ 


Fig. 103, — DoreDLUft'a Ureometer, Improved. 

Each mark upon the scale rcpresonCs 1 milligram of urea 
per cubic centimeter, or 0.1 per cent. Upon the graduated closed 
tube to tlie left of the scale are the marks — , N, and -|-, which 
represent minus, normal, and excess, rcspcctively. The instru- 
ment is al^o made with graduations showing the number of grains 
of urea to the ounce of urine. If the nunihiT of cubic cenli- 
iiictcrs of urino passed in twenty-four lionrs is multiplied by the 
percentage ohtiiinod with the apparatus, the total amount of urea 
for twenty-four hours will bo secured. 

The solution of hypobroniiie in the tube will indicate 6 per 
cent, of urea; bo that, if a Bpecimen in which not more than 3 


per cent, of urea is indicated by the ecalo waa first uaed, the 
solution may be uBcd again for a second specimen containing a 
like amount or less of urea. All that ia necessary is to allow 
the accumulated gas to escape and then proceed as with the first 
teat. — Brooks,] 

Urea is diminished in chronic hepatic and renal diseases, 
principally, however, in acute yoliöw atrophy of the liver, in 
which, under certain circumstances, the urea excretion may be 
wholly suspended and leucin and tyrosin (which see) appear in 
its place. 

Urea is increased by augmented proteid destruction in fever, 
and also in diabetes mellitus, in which affection most abundant 
eicretion occurs. 

^ <h 

[Fig. I03a.— Colorleas Uric Acid CryslalB. X 350, (A'tcr Sinion^)] 

Uric Acid, — A portion of the sediment, to which a few drops 
of nitric acid have been added, is slowly evaporated to dryness 
upon a porcelain dish. The orange-colored spot thus formed 
turns a purplish red on addition of ammonia, and bJue on sub- 
sequent addition of potassium hydrate (murexid test). 

Decided increase is observed in gout, leukemia, etc. 

[duantitative Estimation of Uric Acid. — Quite recently 
Ruhemann presented to the Berlin Medical Society a new 
method for the quantitaHie estimation of uric acid in the urine, 
whicli is based upon the principle of the union of uric ocid with 
iodin and is carried out in the following manner: — 

The author has constructed a burette, 25 centimeters in 
length, with the following divisions: The lowest mark fS) 
shows the height to which the indicator, sulphid of carbon. 


ehouH icach. Then ff>lloir0, to tho rDDrk /, ft 
t^tiOQ of S cubic c^ntiiceler«* oon(«nt üit'> which 
iodln solution is pour^. Tho lalCpr itohitinn is 
iHiit]|KJhvri1 nf iudiri, I.Jj: [NflflHiitUii luiliil. 1^; al- 
cohol, 15.0 ; water, 18S.0. Abore tlie nurk /, at 
a,ö, bf.piift an vmptnc bcüIc which, al dUtaiioi>i of 
OJ cubic ctülimüter, pivc* Iho urk» a^t*i vaUic 
pro miiii. It niiiM from $.45 tr> 0.1T5 ^raiu« /irc 
mill* (*r*t? Fiji(, 101), Afh»r Uu? »utpliul nf ^■llHl^»:^ 
and io<iin solution hn\c Wen pluci?d in th.' 
burette, olwcrnngthc prcc^nutions luM diwn hr 
ÜühWaiiii, the unna ia »lovjy added Qj;d th« mix- 
tnri* vignroviEly ahakcn after oach addition- Th<< 
uritiP ifi flddrd until the pHrnnty lirown co]nT give* 
pEftca to a vldU one, at whidi uometil the ]fvr- 
oentagc of uric add i« rcud off b> tho aid of th« 
flgurcs at tbo tcp of the column of tiuid. If tht 
orine oonlainfi leea uric arid than tho apparvtUh 
will iiidicale, add the iudin ify lb«? mark itiidwnv 
ttt-lHceu I »Jcd S Timl rrail firi//-^«lm-fc, Alkuliur 
urinCA should h^ AciduluU'U vrith acrtic acid, ard, 
if abundont «oduncnt of oodium urate i* prct^cat, 
tha «pi-'oiinaii «liould fimt ha wt^W lihakcn. Tracts 
of Ku^r and albumin tla not intrrff^r«', hut if 
large amount« of nibumju and trtco» of fixn or 
blood ar« prcscnt, tltf^o should he coagulated l^ 
hcci and then rcmorcd by filtTotion. The pro- 
podur« reqniree, on an arera^, about from thirty 
to forty-flvd minulra, ftuheinann cisime for liU 
method rapidit) aud an accuraci eijunl to tlijit 
obtained hy (h« weight anah^ia iii«lWl. 

Clinical Eitimation of the Qnanttty of Faria 
in the Urin« by Htana of the Purinomctftr — Vhv 
litTm "puHa hoditfa" includes all combinations 
whiuh cozit^iia th« nudr^tui C,N^, The pnnripil 
wvm ara hypoxonthin, uric arid, ^mnia. ami 
moihylxanthin- Thopurinbodie«cr>[itainedb tht? 
urino arc most ffomrmirntly diridtsd into ''croij- 
eDoiuA" and "«ndo^nou»." Tho former ar« 



rig. 104.— 



derircr] from the pann boiics of the fooä«, ond thdr uuoimt 
Ib in (Ürnct pr{)portir>n tothn qiiantity af food ukcn; tho EaUor 
are vor/ probably derived from dwntttgrnlion of th^ body- 
itiirlpiriK during mpfjtlioiUni. 

According to ITull, B*»r<liiig &vd otlcr» hare n-trntlj as* 
aortcd tlifll «mplc dctcruxi nut loos of uric acid arc of no prac- 
iic«] cliQical value, cicvpt aa ov aid in tho diagnods of aciiU 
attftckfi of j^out and for tho danonetratiMi oJ the prv^^no« of 
loukcnLla. Wboii the relation exi»tiDg butu-ecn the purin bodf«!« 
cif Lbc f(HKlK and of thft urint; isi ui^niraMy diTtfinriin^d, Uits HtK 
%^iiiiiii^s of n fyttomatic drfcnninntinn of ih^ indiiiriunl re- 
o^cnous Aud cndi>gGitouB purine under aormal and abnormil 
cocditiors will be more npparoiiti 

On £n avornE^Of about ^t> per oont of tho pHTllL takaa vrith 
Ihe food is excreted in the urine during tha follorlnjr tlWftty- 
four hcmrKr althrmgh in certain iikdividuals ilm amount varJa« 
up to 10 per curtt. A knovrlcdgu of the lUiLociiit of iriu1i>;c(^nouii 
piirin and repented deti^rmination of the pnrin ju the urine of 
patiente (tt>gctbor viththo use of tabloa which giro the quan- 
litatfve purin cr»nt(nit of ordinary foods) permiis «xact regula- 
tion of the daily activity of metabolism in the }}f^Ay. 

The procedure ia bsspd upon Caiijeiwr'K rm-Lh<id f«*r tli4? 
determination of the total amount of purin bodies in the nnn<x 
For this purpose two solutions arc required: — 

?fOf t-TTan I. 
Ludwi^V rnngnf^in miictm'aV . r- 100 ciihic c«ntiniotfir«i 
Amaionla (So pi^r L-pnt.i .100 cubic »uhirwtur». 

Talcum lU ^niiiH. 

IkfLtrmir« IL 
E^;|v4-r nitmlp,, .,,,...,,...^,.... 1 grjinip 

AmnionU (Urong) 100 uuImc crtiUumtc;!. 

TaWim -,----. . a gninu. 

DixlilW wntnr, .-- 100 cubic cent imctcriy 

Thif purin Oil] e tor conelata chiefly of a graduated cylinder 
clivided into twci wjual parts by a }n?iTurutL'd cuck. 

The iTiiicd urinu for the twent.v-four linnnt U frrrd of 
atbuiuin and, with closed cock, DO cubic ccntimctcra of urine 

I (MBfniHiBAfiturld [c^TvvUl*!. 100 Ennui miar. l«Kinj|ii<i 0riit1ni«rjtTii ; »i&mnli^ 
f. a. laftTAtliPW^IaUinikatrunBlnulOlilEdLOdor; ■mnoDluiu cLloria t-t toll^ahtUHt 



a&d SO cubic ccntimetera of Solution I are poured into the tube» 
The phoephates are at once thrown down, and the cock is then 
opened. In ten minutes the phoephatcs have subsided into the 
lower part of the tube, when the cock is again closed and Solu- 
tion II added to the mark 100, The precipitate which now 
forma ia a mixture of silver chlorid and silver-purin. The 
former Bubstauce dissolves in the excess of the ammonia pres- 
ent. Shaking the purinometer hastens this process. If the 
yellow silver-purin contains a few white fiocculi, a few drops of 
ammonia are added. The purinometer is then placed in a closet 

Tig. KMfl. — Purinomctrr. 

projected from light. The whole procedure takes no more than 
ton minutes. After one hour all the precipitate is thrown down, 
but it is better to woit for twenty-four hours before the result 
is read off. 

The amount of precipitate in cubic ccntiuiotors mulliplied 
by 1.5 (percentape) and an empiric vnluc (about 0.0010, which 
is especially determined for each apparatus) gives the percent- 
age of nitrogen. If this value is mulliplied by the daily amount 
of urine expressed in cubic centimeters and divided by 100, 
the total daily amount of purin-nitro-jen is obtained. 



Example.— The precipitate amounts to 22 cubic centi- 

22 X 1.5 X 0,0011 = 0.0363 per cent, purin-nitrogen. 

0.0363 per cent. X 1000 cubic centimeters (total twenty- 
four hours' urine) = 0,363 (total puriu-ni trogen). 

The nitrogen factors in the precipitate are to be found in 
cubic centimeters in the table which accompanies each puri- 

The followiug table shows the nitrogen percentage yielded 
by each cubic centimeter of the precipitate- Multiply this 
factor by the number of cubic centimeters contained in the 
twenty-four hours' urine and then by 100. 

4 oubic ceDlimeterB OOOTS 

C cubic centiincterfi. . . , - ..,,,. 0,0097 

6 cubic ccntimeterB OjOW 

7 cubic centime Lerfi 0,0136 

a cubic centimctcrtf 0.0150 

9 cubic centimetcre 0,0175 

10 cubic ccntimcterB 0-ÖfS5 

11 cubic centimeters 0.0195 

12 cubic ceatJiDetcrB 0-0205 

13 cubic cebtimeterH O^OSIS 

U cutrtc centimeter» .... 0.0225 

15 cubic centimetcrH 00234 

le cubic ccntitnvtera 0.0240 

17 cubic centimeters 0-0200 

18 cubic Cflntimetcra 0.0205 

10 cubic centimeter», , . . , 0,0270 

20 cubic centintet«ra 0.0275 

21 cubic centimeter» 0,O2S3 

22 cubic centimeters 0.0285 

23 cubic ccntimeteis 0.0299 

24 cubic centimeters 0.0312 

25 cubic cebtimetera 0,0325 

The most accurate results are obtainud when the spccißc 
gravity of the urine is about 1.015 to 1,025. Abo^e and below 
these limits deviations occur, but the diffoi-enccs cau readily be 
estimated. When the precipitate is less than 10 cubic centi- 
meters, the number of cubic centimeters must be multiplied hy 
0.0015; when over 10 cubic centimeters by 0.0012, and when 
over 22 cubic centimeters by 0.0010. 



BuriDg tltc c»UT»c of til« cjtnminjiHun ndtli^r tea Dor 
coff« should be dmnk. For the dotcmiijioticn of the amomit 
of eiwiog^^iifjiis f «rin, a (Jict of f^i:^;^, milk, chocur, rice, polotoM. 
brva(^, und butt&r «hould tic ordered ^ for the amouct of cx^j;- 
ptioQA pnrin any quantity of meftt riay be emplnyoti and tho 
pttrtn content delermiiit'd by [he La1j|e. 

It ia dear tlint thcr dUI nn^tlKidä tjf cfitiinating the excr«tif>n 
of uric acid mnat be replaced by new dcterminalion^ of the hM 
ea:<Trti<>n of piirin, and that it i* unncceRSÄty lo MK'k new pro- 
codure* for the det^rriinntion of oric nHd nlono. — BnooKä.] 

Creatinin, — A few drops of frmhly prc*pan*d diluti* «idltim 
nitroprnidiil Hotution And stjtme Vit&k Aodinm ii^drato are addrd 
to & freah aample of uriiie. Tlie luby-ntd color at fir*l pro«nl 
iKually »oon boconiea etratv-^^Uow. On addition of acolic add 
anri lioilms a htai^h-f/rfcn ccbr appAam. 

Hippuri« acid is beet demonetretod by prcvi pita lion of tha 
cry&tfllH cl<vcrib<^ bMow 

Of the inorgaric conatitueiltl^ ioditiiD chlorid [lesfrvm r^jio- 
cial <M)[iniiItTriitiQn, It is tnoat CDHvenSently deniou.-'l rated ly 
addition, a drop at a time, of n sßlution of ülver nitrate to the 
urine ociditlntcd vith nitric acid. (*hlnnd of «iLvcr i« prmpi- 
tated m dtim^ milky-vhit« floceulmt and »ibredUke oongula. 

ProDounctk] diminQtion of the ohloridi» which ia obaerved 
in acute febrile discH^t'fi, pnrlicul.irly LTüupotii pneiirnonla, la 
mAmr<<:(trf] by the mcurrrjiee of only a fnint cloudim^i«, vrhÜe an 
lAoreaae of clilonda. oa occurs capccinlly in the ab«orptioa of 
lar^ exudate, ia cbara<:1cTi£cd by an unuaually intcnde pncipa* 
tation of bl]v4t chloride. {The niodiflcation in the amount of 
cbbridB haa been aitritruicx] to the diet, ThU vbev ia unquM- 
tioiiahty intorwel, to vtniw tixUnit at htat, «iiicc it b coBtmdict^ 
by thr Rhundant dbuhnrgi? of thc^rr i^ulwlnnct^ nt the pmod of 
contalcsconcCi It ia also knovn tliat> if chlorids arc admini«* 
tcred to pncuDitciiia patkaitf^ the« «"ubatancca accumalate in the 
orpaniem and art eliminated only at tho lime of the cri^ia 
(Uoger). Llkewiftc the phnt^phalca and aulphatn incrcai« wheo 
mn^lmreoi» ia «aUibliilied, altlu>uj{h ia a )eu notable di^rBe.— 


Thoaphatei of lime and HapneaU.— 1. On heating arinrr to 
irhich a f?v drop« of pDtA»ium hydmtc have been add<xl, Uie 



"cflrthy phosphal««*' arc throwD domi &i a HifihtW flocculeot, 
whitiiüi prccipitfttOn In faintly «cid or iWnWrt iirioc the Addi- 
tion of jKJtiu^ium hylnit^ it unnixi^arv, 

2, On addUion of silver nitrate solution the phnnphnnc aeid 
of the phogphikliw b ]jr€<fi[>iUled ba u'hlliBli, fli>i:inj1i>nL itHver 

3. Addition of nminoninctil mAjnt<^iin ttolutton t^ ft »iim|>Ii! 
of urintT c-miH*ft n procJ|>itnlt' of inpW ph^tsphnt*', whidi in chnrnc- 
tvritod hy thf' to-tnlM "toiUn-lid*" cryi^tnl* (*oo holnw). 

Sulphuric «Old nrrtirr at n niilplmte (ao-c»IU^ prvformod 
Ki](ihTine rtcid) or as ('*i*tiTnliic«d") nmmatic ot^c-ri'rtl mulphfiti*. 
The ili*t ift deriveO priucipally from the a]1»iiuuii. The "com- 
bined" IB dependent upon the amount of Atoniutic bodioi orig- 
inated fJuring pruttvil piirwhutioD, which unite with a\\ the 
flTiilnblo mitphurk' atud i>f Ui<.' Iiody and appear in the urlnct 
iM iimmatin i*thi-n'jil auljihtihs. An inrnuiiu* tr thrsi? i« nWrv«v1 
lliii ^?«tj*r ihe nmoiitit of [^hiiiol nnd iiiLlicni] — -in oli^itinsle 
obfin^dion, iln»*, etc> — ^prr^f^nt in the urine; their augiticnied 
oxoretion indicate« ineTee^ed protoin (Je^tmction, oe|>eoially in 
forer (Baunienn, Kaet, and othere). 

DsiiONSTKATioK. — 1 If (he urine ta firet treated with acetifi 
or hyilriK'Mfiric tun] nut] liif'n wtUi hnrii^in nhturid, n nhiliMh pns 
eipitatc of barium F^ilphato is formr-d, vhirh in injioliihln in nctd, 

9. Tbc* dhetcal sulphates combined vitli phenol, ore^o], 
indoxyl, and ekatol edn bo doinonetratcd moet eonvenientl^ as 
JoUowfl : The urine sliphlly aoididated wilh aoetio or hjiilrochiorio 
ieid h treated with a large anoitnt of bnrium ehlorid and filtered. 
After U*.-^! «Jdiliim of tiuiirtntralHl hvdrucliWic nciU IJwr fiitrata 
is boiW fur from twi^nly to Uiirty miuuit«p until bfirium f^utphato 
IS prtcipitatL^d frnm tho decomposed etht'rmil Mjlpb^itai. The 
ivRLOunt: of thie preoipiUte indicntt« th^ quantity of flthorcal gtil- 



The norma! acid raitiion of Ihe urintv which i« faintly aciti 
or alkulmt! only under the exceptitmnl eircum^tances already 
mentioned, is fn:c^m*ntly ur cnuptiintly alltiillnü in mnny diitea»«, 
Thm i* Into I'jspt'inally of the? aTinnoniactil fermentation shawn by 
pathologic urine, ev^^n on miding or shortly thrrpflftrr. To prove 




ttiat Uit atrojig ftlkatine reAction of Ute uriue iu ^ticli C4»» äa not 
due to "ßxcd" olkolitit», but to aminomum carboitdtc, all tJiat 14 
nvcowtty » lo hold oyer th« urine u gUßo ro<i nnfi^-li-iiod with 
hydroclüonc neid^ whvu t)ie (?harm:ti<rit1io nil arnnioiiiac fuiue« 
ire «Ji^vobpi-il, vliü'li nIht'nrisMT are rtliwiit, 

Occurrence of Altiumin In Ihr LTrfnc (Albuminuria). 

In additJoa to Gcntiu-albunno, the mMt important lortn, 
an^ »orun^-globulin, which u^aall^ a»?oziipiuiiee it, propcfiion 
(liemiailium<Hc) and pt^pion, übrin, beiiLo^lobin, ond mucin an 
ti^til witb jji the iirlDLV 

ThfoniQunt of oUtamtn ncrrbvl vnnnt nithin wJda limilflL 
Wc epcak of alight, moderate, and ^-vcr« albumJauna, According 
aa the doily qaautity amouota to OJ, 0,5, or 1.0 gram or moro per 


Id the great njajortty of ea*« ev«ry pertisteni alLmniiauril 
la an indienüon or dtuHue of the kidvu?}- imd 1«« often of the 
nrinnn' IrjuH, rrcnAiiüf^ cicrdinn of nlbiimiQ witliout renal 
Lotion occur« in fever, Tcnoua congeattOD» nervoua diftturbaticca 
(dcliritiT» trcj]itMW> epilepsy, corcbral concuseion)« etc.; a1so> id 
a number of chronic confltitutional and infectioua diffeaMS (eetcre 
blood aOFctioDS, diabetea mellrtiia. 1tiborcnlo«is, eta) ; flnallT, na 
a ivsult of obitruetion lo the flow of urine due to pr^aore of 
atonm, iKvpljisint;. Ha, u^ton the uMt^r. 

The di^^i^ation phyaiolocio albununuiiA ia crrp^jcd to 
indivat« an occaAJonaUy npidly tmniiitory «^ic^Mi^n of albumin, 
(«Idom lasting for month« or \tar¥, oiion p»?nodioally int«t- 
ntitlpiit and alirfly* slight (just demnn«tmMi*) , in wlili^h the mo*l 
earvfiil mi<-fosiijpic examtiiatten of the tirJoe reveala not Uie 
alightwt dt-viatii>Dfl and in vbich clinic»! tigw of an acute or 
chronic diaeaac of the kidacj'ä art ab«>eiit. lliia form ü nom^ 
Ihnat obaer\'eU m the abfi-nco of anj antiwedcnt cau» (atiion^ 
oihtn, in llie u^^bom); more freqii^tly, hoirever, only after 
arvrre iHxiily raertion, wry h«nrty ititviK raid hnlh», tnpnial 
alrAin, violent i^motionnl rii^itniK^iit, etc. Ft>r iiKam|de, among 
119 healthy »oldirr^, l^viibe found unqtievtionabl^ dbuminurift in 
19 — ü$,f in 16 por c«oL — aftor long n^nrche«. 

If the albiiininiiria oo^ttr« pm^iiVui/^, a d«ßnit«ly ngttkf 
4iyd« ia nfU'U uniftJAliikiihlc, Surh nw« hi« dwignalcd ■■ 



''cyclic albuminurm" (I'ltvy), U»uiilljr Ibe victims iir«^ouf^/uJ 

individiinin in whom tha cictrtion of olfcminin iff im!ucw3 by 
chnnx«^ /mm tJi*! rv-ctimbcnt to Ihc u{>n^ht position, Injccd^ tho 
ftlbumiaiirm Ü gcmer&lly mofft mt«n«« T^ry »oon aJt^r riemg or 
dlif^rlly nff^T long niJircliee^ Re^t cau«^s it to dtüoppnar *ntifiTly, 
'Plic div iJodly (iri-irtoüin-eii cycVtv l-Iyähh^Iit of tht yunvliou ooi-ur- 
riug under ordmary mod«» üf life can at any timo be ituitlc whulLy 
it} disdppeur by dc\-ernl daya' rv^it in bed. f^or f/tff rxoft oh*erua- 
tiora of ilm form of Mumiituna. classed as phffmoh^c (Pavy, 
K. Wagn^Fj reydeOp and otli^re), U « nf^f^^ary to mtjkt txamina- 
iions of (he vririe rei/uförfi/ Every one or two hours, and to rv>te 
Iht röufjrr af Ihd üVmminnriii under rrrdtrt'iry and varivmtj/ 
oUiir^d in'JtifJi of life (body laovciiiiuite» rest in bed, aientai 
flcti^ly, ftc). 

Ae to tlie juatilicatidn for assuming the onftbmcc o£ phj^io- 
logic albuminuria and of this Gdlxinlin^tc form, opiDion i^ 
fJividctl. TUl- jiutiior wmild doss hiiTiwlf wilb thos* who, from 
u prad.ic'ttl ibUEuljmLnt, view pliy>-iol(igJc a^ well ha cyclic albu- 
miuuiia with much »kcpticient, Not that lie wculi^ deny the 
occurrcDco of pliysiologic exoretion of albumin. ff>r thia Iiaa bocn 
poeitively d on lonal rated by reliable pli^'Hit'ians {[>oübo. üraiB;;er- 
Stewart, and (>tlier3)j una he himseU Iiae made tbis dia^osis in 
tbrue ciisi^s under «liArrvuLinL for a long period. Bui he amsidtTr* 
it Rxtremcly ijiflk^ult to make a pO!-iilive clingiroäis of phy^nlogic 
albuminuria in iiidiviilunl ca*<^. In fact, many e^arapl«« of 
physiologic flibiiinimirin Imvo £ubsfrqin>ntly proved to be coeoa of 
Brjght's ditieaw. It mii?t alw be remembered that many caaea 
of (rtrtrficlod Vidney at IJn™ %}\n\x no trace of forrried «'lomenta 
and Hint tliti uüier rliiiioul phiriumi-'im tuny be olnfctia'il. Jn 
hiich infllnnces i^oti^ideraliou of the apeclGf^ gravity will, nnd^r 
rrrbiia coiulifii^ufl, decide the question. Senator, howovi^r jiwtly 
wunui R^iiiiii^l doclarifi^ as phy&jologjo evea an iiifignificnnt 
cyclic album in urin oecurrttigiii pt^rsuTie at or beyond middl« ngo\ 
\t\ yi«ing indiviilinil^ hr "»n*ider*fin aihum'm rrtntrrtt ftf 0,4 to 0,5 
per fnillii ok Iht limit bfyond which itu nlbiimtnuria cart no 
longer he recognised as phimolo^icf If the qiinntJlativo oetiiiu- 
tion i» made with the P^bach method, ©apecial care mu&t be 
obwrvcd (*cc pa^iu '^^Z). 

ghkuk: kxamixation of tug umsa 


<)iJBntat1ve TffBli f«r AllittmlR. 

The tirinf; to be examined rnuft be pure ond free fnon 
^trftQooL^f admixliir««. Jf i« algo cdvüahU tc tat the unn« 
voided at difftrtnt Um6i of the tiny. Tha nrino formi^ At night 
^'iierally give« the leaaL information of ejnsljDg disturbAnctv ; 
the uriuQ voided during Uie day. eepeckU^ after tlie Erat meal, is 
to be preferred. Cloudy or high^ conccatruted urine sbouli) 
alwAja b<^ fiUertd Wfon.' tivlin^;. 

Bemonttntioii of >erum-albainin, wlkh is u«uall> accom- 
p^uiicd bj sfln]m-^l'>t»ulin: — 

1. Heller's Nitric Acid Teat,- — Eqiutl pAiH^ of iinnir And [niTt 
nitric aud are ^u placoU m a k?!t<titl>c that tlio uriD>;, Iv careful 
«dditiou, forme a Javer chove the add vlthout adinixturo- Id 
tho preMiu» af albumin (ail>umoAo and mucmi Üi^iv t£ forTned 
at tho pc^nt of couUict a diNlim^rlly i>ut]ini.Hl, vbile rin^ wbieh, 
uhcn ftmall nmonnta of albumin nro pn^cont» can aomt^times le 
reco^iiz/'d nidy nf(4-r M'v^^rol rniinit«« and occjujonall^ onljr vlu^n 
tbc tc«t-tLbc is Jicid a^ninfit a dark tiadcgroimd. 

It id beet to dilute highly co[ic«nLrated uriao rtck in i;Eratce 
»itb watoFf olliorwiöo procipitaliona with mtric aeid may be pro- 
duced ^ tiivMC pn^dpitaleii, hi»wevcr, can be dUtlngultbed froin 
ilbjmiu by tlinir color na v/eW na Ibü hiijhcf pomiion nf Uic ring 
aod alan £iy iheir disapptamnee on application nf fftntU heat. 

An opale*ccnce may alfo occur afttr u»c of tiirpontinf and 
baiMm of copoibo and l>>in (Öommcibrodt'a copi^ulc«), Thi^, 
bowoTcr. ifl di&^lred by aliakjng wLtb alcobol. T^ie ui^i^iolly faint 
nn^ product by murm generally diEnppvare on iboking. If 
tbtta pruvautiou* are obnrnwl; thv t«iL i* ftrircmWy reliabl*-. It 
is tarn vi-ry drltcalr, iiiict 0.0£ per millr of Albumin 15 di«linct1y 
ahown by it 

[A very har»<3y jind unrful inntniim-iit for tbc dctcctj^wi cf 
antall <tuAiitiiicfl of albumin in tbo urine ia tbo albDmotoopa 
(boriamawope), ahovn in tbp accompcinying lllustrallon (Fig. 
lors). ItobviaU« tile» itheof tlie pippüo. Till» urine \i firvt plaeed 
in the LirgtT cyli>idi?r, oud nitric d(:iU then (lourf^d iuto ttic futiu«! 
of the ainaller tube uttlil tlie level of the odd Kucrhca about the 
eaater of the bUek bnek^roand in the iai^'r tub«, Jly looking 
through Die fluid agnitiat tho blaeie lurfaee^ faint Incoa of 


incBoecopv and cucmistby. 

iklbumin OD readily be Dwde out When the Albumia ii t«7 
tttmll in amount, it U bc#t to Act tlic in«tn]mcnt A«idc for from 
fifteen U> twenty mimjt« br'ft>r(> iiip|v>cticii, — ßuooice»] 

2. Nitric Acid und Heut Tttt. — The ^imjit^ Heat Ifv^ fiiifln*« 
fi« flU alLimiin rengfiil oiAy Jii süch urinGS n» have & di^tJiictl/ 
£ni} reaction, bccauee. in fainÜjr acid or aUdltnc uriti«, eorlbv 
fi!ii>^phntee. ju vdl a« the albuminp is precipitAtvd by boiliof;. 
it iff. üicrefore, »ilvieubl« firit to add nitric acid, wtiicb ui pref- 
erable to acetic aeiJ» becauo« tbe Utti^r^ t^nni in »light oxcc*^ dk- 
luilvfv »light Aziioitnte of ullrumiji. For tlii» nv^j^n kh Hirmnnt 
of njlric. flpitl Mjual to nbtiul uno-u/lh of Uic bulk of iht nrinc is 
added and Üio uii^lurc licuUil to bojlin^'. Ttic white prcdpitato 

Wjf. 105.— AlUumcöcope. 

which ci once begma to form, oni! which is «sunlly bTownifih if 
bloc»d i* prviont, indicates Uit? (Jit^^ncv of ulbuiiitn, Tht ilu<», 
KHndlikp prt'cipiljiti^ Mist-rvod nfti*r il time in high!j cnnwulrnWd 
lirjiu' n\iit,i not lie iniKtrikriL for ull^iimiu. The ti'^^t i» quit«? deli* 
Cfltc, but it i* cxcdled by others in crrtnioty nmi conTcniencc. 

d. Acetic AcU'Potassinm Fcrrocyanid IcBt. — 1'hc urino %» 
firel etron^'Iv ociilulotcd with noelic «cid nnd ih^n 5- to 10-por- 
cenl, potait^lütü ferrocj'flnid eolutinn forefnlly added deop by 
drop- In UieprpHenr^ of albuiniu a JenKs wliit** prtreipitate geri- 
«rally AppcuntnL once, or. if di^litamoiiDtadn- j^h.'HL-nt, a dbliiaei. 
oloudineu it Aeon onlj aHv-t scvcrtd minutrA, If u cloudy pre- 
cipitate apprnrs nt the lime of ac-idvilation (dte to precipjUtion 




of mucin), it i* n-w«*arv to fiHtr thi.' urmc; it i* bot firs! lo 
dilute \eij cDiK^ul fated uriLo«. The roacttou i« extrcnttltf deO' 
€^U anti terttiin, aruJ, eince boiling ü oinittcdt it is \cry eoa- 
voitient, ^or a/fiat tt^rh it unju^dun^ify dfstrvtt lo ht ffircn 
the preftrfinc». 

4. Tf«1 with Acptio Add and Conoentrated Cointnon 8aH or 
Sodium Sul;ihatc Solution.— Tii:; urirm I» Ur^t lautixl with acdic 
add and then vitli aiuturiilocl »oliitiozi of comuicm mlU or eodiam 
«uiphfltc and bojbd. Thr pnvipitiLtc, which w at <inc« fomiod, 
i« ft wy poitittvo indicntion of the prcwnco of iklbumiih Wh^m 
ierg^ amounts of albumin (and nlhumoÄ«) nn* |in«-iit, u prtv 
cipitate app(^r& «ven IWnre hp«t is apjj!lr<l< Tli-jviing diiiwln» 
the aibu[ikoe4TA ; faint trace« of albumin i^n then be rc-cD^ni^. 

6. T»t with Mctaphoaphoric Add,— Thifi test, Üni rccom- 
mended by Hmüt-'utmi^'. pije^^.-^cos ihn followia;- juliantago«: The 
pbytjefis onii (^»ilv curry «iit- mi^>ut «bout »ilh bim, aad an 
rxEinniiiition for alburriJu ciui i|uii'kfy be mado. A »malt f^iece 
of tlic whitv^ «tick, dirl]i|uu»ci'iLt in the nir« i» plnoed in a iH>rtioil 
of the unne to be rxnniincd nntt thc<n f^hnken. A di^tin^t nhitü 
procipitfltc indicale« tl^c prr#cncc of alburnin, A oattirnled i^oiu- 
tion, added a drop at n time, alto ptxkduoi>ii a pwcipiut© of 
albnmin (a«ordinglnHnppp-Si»j!rr, prjUrJii it not pm-ipitatsvl). 
The tmt is very comv^nient, hot is \est dellcale and positive than 
the metboda Ünt uentloneij. It should, Uieicforo, be xtäcd only 
oa a DDeaaa of orientalioB, Triehloraitlic iicid tnptnls may bo 
n^oommcDdod for rhe »anie |fiirpoeo. 

^ Pkilo Acid Tart, — A^ luaeh of tbe erwtjiU u* can ho Md 
upon thfT pi>int <if a pjinknifr* i^ luldml in ihv urxm and »hakcn. 
A diitintt yellow ItntcuEtnl prvcjpiUte is pradiu-i.<i1 in Uic pit*- 
oncc of albumin. Tlii? k-^t i» more marked wiurn made with a 
aatumtcd (aqu4-oi») ^lutioD, addend a drop at a tinux Tba twt 
16 nliablo, delicate, and convL^rient. It mny bo naaarkcd Ihat» 
ao^^rding to JaJTp, rrrNiinin is jiIbo pmi'ipJUitt^ by pfrric acJd. 
Tlw yellov color ofUn di»turta tho test. 

7. TatauiDiD SalphocyanAtf-Acetio Acid Teat (Zovchloa)- 
— The Krtgiiu r<«ii-i»-lii fif Jim jiiirt^ of l<>j>er-e4nt. pütmvium 
farrocyaiuta aolution and $0 j>arU of scelJc acid- When added 
a drop at a t)fn<?, ir pri>diirf^ ■ d^tinct el^^ndin«« in tlie pTOwnoa 
of albmiiiu. The U?l ia aluAi^t im iJnUeatv and n|ually a« oon- 


MICIHKeOl'y AS't> i'H£MIi>TRy. 

v^ient OB Na 3, and, aecording to von Jalueh, iiidi<mt«a 0.007 

per f^^ut. 'jf iilbuniin. 

8^ Spic^ler'K TuL^To n Mimpl« 4)f nrinn wliich hiu b«wii 
fr^ of mucin by «tron^ ftcidaUiion with aoriic acid tre caro-l 
fiillyndiJi'da fi-w rfropi of the following frwM> prq>arcd rcng^'iit: 
Hydmrg^ri bichbridi corroai^si, 8; ocidi tnrtarici, 4; filywnm, 
W\ aquic dojitilUtas £00. Jq tho pr«K«iice of ruinate amounU 
of BlfidrriiTi a wbitThli riii^ i(|"|."'tir* 

QuMler'a albumin icu^trut pajier [itM StuU'fl ^IVumin re- 
agent oapsulea jiom^c?« no ftdvuntagre so far a% canTcnicnce is 
(Ti>nccTf)td. Un tlic oUicr hand, both nre higMy urrcUabk. The 
lirsl toGt U bflpcd upon Iha feet that a procipilnt^ is prodxiwrd in 
n]lii]iTiiaoi;fi unn« by ftoliitions of citric aoid and iodoAubltmAta. 
I'he ciipftulre coiitftin citric soid, feoJiuiu dilond, and corro^iv* 
Hul)iiti4tu, aud wlieu mldn] to urine ü]äo pjodHCti pret^ipitjition 
of albumin. 

i^'or th« di?t«ctior of tht^ n^ii^utc traccä of nlbumin present 
even in norma/ urinG (in tlie latter ^n^tnu^e wry probnbl^ 
dcTJvi'd fn>m the vc^els ot llie glomeruli), fosripr roonrnmondt 
tbr following^ A pi^-ipltAt« iä fDrmi>d by »filling to titft urino 
three Uinea lis \-^Atime uf alc^liol or coia-cntruteU wutery «olulion 
of tannin. The pa'cipilale b tlicn ira^liird in water and dia- 
solvi'i in noetic ac^d. The toete Nob^ 3> 4, ttnd 7 then rJiow Irttcc« 
of albumin. 

Detectian of Globulin.— To <3pmon?itrrite the prwk^iicv of 
^IrkbuliD, vhii-U ifi usuully associated wJth «^enim-iilbumiii, the 
folLowiug mvtbod ia convenient: About from 30 to 50 cubic 
ccntimetcTB of nrinu arc filtered and diluted vith ten timea its 
volomo of diblilleU water. If a cIouclmtsÄ or ductruk^ut precipi- 
tate ia gradually prodtiood on addition of ditutü acetic or boric 
acid, then more or iods globnlm k prcsr-nt. 

Detection of Fropepton (Hemiiübumoic). — Tf TTpIWfi nitric 
ncid tc«t or the acetic acid-potflssinm fcrrocyanid test produce» a 
difttinct precipitate wliieh dir?^ppcara on hcatine and reappears 
on cooling, tliis is indicative of th« pro«oneo of albumose. 

If in addition to albnTno^ies albuniin also is preaenC, the ht- 
li>r munt h^ pri^Hpilnt^'d by I'arcfirl nddilion of atretic o^id to 
lolling iiriTi** mid removed by filUjfciJnn. The flltrntc i* ren- 
dered strongly Llkalinc with pota««ium hydrate, and 10-per- 

cnßiür examtkatiou or the otink. 


ccutp copper «ulphal« Added dnp hi/ dr&p, Ihv iid or Uni^b- 
rrd color (biitrct rta^thnj indicutcn tlic prctwuce uf albumosc^ 
AlbiimoKcr! occnir liitt «cldom m the uriric, und ovido Crom 

(Bnton'i Uf^thod for Bence*Jonei Albanosc. — Frcin 15 
tf> $0 tuliic ri-^iilinietorK uf thi^ flltiTnl (inin' jijv |»1hit.^ in a 
tcAMijbe, aud to it au ei^uul E^uuntit) <jf a TalLirnti^J ^oliition of 
«odium chlorid i* added, ami ih*: tult shakiwi to citicl u perfect 
mütuit-. Bottlou'c din^ütiond an ua follüW£: — 

" Two or threo cubic c&ntimct«r« of a SO-p^r-cent, ftoLution 
of <'im*lic fiivlii nro now addi'd, choking vi^poij*ly. 

"TJi? Upper nne-fourlli of this colnmn of ]\(\\i\^ is grjid- 
ualljr b^uted over a flaine to [he boiling-point, when a solution 
of kad acetate (tO per cent.) "J* atfded, drop by drop, boiliȀ 
ihü upper previouftJy heated stratum of lw]utd ftft*r eaeh addi- 
tional drop. 

"When the drop of lend acvtafa soliitton eonu^a In coiv* 
tart wiih the liquid a c^piona pearljr or er<?:*mj' t;loud Appt^nm 
at ih« eurface, which becornes 1«6S dcnae as the botling-point it 
neared^ aod when ebulUlion ia prolooged for from one-half to 
one minute Ihc opper utratnm »how» a »light browning, which 
doupeii* lo a didl blaelc. The lower portiwi of the heati>d liquid 
«liowi lewi marki'd blnckin^j, a«d below thin point for some 
diF<1anee ihi-n?- i« »i^en n rarinhhi dt'grce of brovniag, dtnrdiD)^ 
inlenptifieA the reaction; but if Ibi» be prt>lonjKcd for several 
hoMT« the bbelc precipitate falh through itio clear ^trattim of 
liquid, coUectinf; ti a coarsely ^Tannlar pigment in thf* bottom 
of the tnbe." — Brooks] 

Detection of Pepton. — Our knowledf^e of peptonuria Is dnf* 
lo Uaisiut^r, \on JaWh. and ulhen. It appe^ira i^deptndmlly 
of albumtnuTiA, and cKcunt cfiiffiy i?n enttyinct into ike blood of 
pfpUn dtriüed from ditint^grcUd Icttcocyics and pu»-c^rp^i*dt9. 

l^optontttb 1* iro«t frcquenttj cbteiv^l %% n pj/ot^enic /orm 
in «appi^rntiix^ plmml c^mtd/itn and citlmr Mipporatinng within 
the body, a» well a« in eronpons pnmnionia at the time of reso- 
lution: i\e., when the eonditiona for the difinlegtation of tha 
Icucoejtea and the atworplion of tlnnr producta ntv particularly 
fatorablo. The demon^l ration of [«pton in the iiriue di>M not, in 
eierjr imtaiiee, Jnstify the concluojon that interna) auppuralioa 



Dud the likf axiti. Ajadc from llic occurrcnoe of pejiton in 111« 
rwolntiun tit^ of pntumonin, nhich ha» alrcaily been referred, 
to, it h ftlfto oWrvuJ in liciilthy puorjjontl vQinv^n. NL«v«rtlie1«iAi 
fJie (IniiDni&lnitiaii «f pepfon riiHy In* nt din^nmli«- vnlxi<» in mniij 
IIhIjuicui. Vnr cj:rir[»plr, Hrcortiiog to von Jiik*fb, Üic alAfttrr 
of peptonuria m th<; presence of mcnin^itic phooomcaiA m&y 
bu docwivo fi>r (liagnoem of tho tiilcrculär foroi. 

For th<i detection of pepton the urine U ftrei ron^^^wd 
UiirAy free of albumin, AI}diU &0 cnbio centimelfrs of concpn- 
trätj*4 »odium accUte «olutkm are aildeil lo COO cubic ceittimettrr« 
of urlu^. and theo ae many drups of coacfutrttted eotuÜ^m o£, 
iron chloric! a« yriW give tlio tluid a decidedly rtddiBh color* 
'rbjdn «oilmm or potueaiuni hjdrHto l* <^ar(.'fuUy added, drop by 
drop, uoUl tbü add ryactiuu is niHitruliaed or tiic fluid juat red- 
dr.nH IdiiR liLinuü'pujier. 'i'lic fluid \* lliKii lutib-i], mjd^ wlirii 
cool, filtered. The filtrate, which mnat not äivc the !tH|:htc«t 
doudinciid with apelic aoid nnd potA.-<»:um fcrrocvanid, 1* now 
tcet*vl witli tlio ubovc-mon tinned biurül ttsit If pL'pton ia prcft- 
ent n distinct red or viokt cohr i« prndiicod (nofmitrnttT), 

Deteotion of Fibrin. — Fibrin rniigiJa »w bnt «c'ldnm fnnnd 
iij UiL- uiiuL\ Fur di."tcdioa, ibcy arc separattd by Gllratiou and 
wftnlicd rop<:«teJly in S-por-ccnt. wlution of eodium cblorid uiiUl 
tho wuehiu^ no lon^r p^'*^ tho albumin lest. If the reaidue 
upon tho filtor ia now ti'vuk-d with l-per-oont soda iolutlon and 
bnilfsj, rampK'lv Hnlnliuii 04.-(rurH, AppltcHtion r>f tbi' Heller or 
(lie iiti'iic iH'iil-piilnwinin fiTnicvftuui Icst after Ibe Kilniiim ha» 
cooled will now »how tlii.- alUtTittn reaction, 

Deteolion of Hgoih- — In ntnny diE^L^ufoo of the kninevj, atlO 
eepocinlly of the urinary hlnddtr, the amount of mudn in oftvn 
constd^rflbly incrcaHed. It ifi'very pnibabln fhut in tlda inM&noe 
we liave to deal with nucleo-nlhuniiii, which will be *iK>krn of 

To determine lis proscrtce the urine ia flret diluted with 
vator, fillered^ and acetic acid in f^xcei°« fldd«d to tbi? nitrate. In 
the praienee of murus a dialjn^^t prpcipitnte i» fonn*^J, which 
dixappeant on addition of jtolawitiin hydrate, but reapfear» on 
furtlt<rr nOditioiu of acetie add* 



Qiuntitmtlve Eattmalfon of Albumin. 

For the quantitative estimation of the amoant of albumin 

excreted in twenty^four hours^ if it is not desired to make an 





Fit'- 100-— l-^wbot'h'a 

Fig. 107- — Improved Kalmch 

exact analysis, tlte test with Esback's albuminometer suiUccsi 
(Figs. 106 and 107). This i^implc aod cheap instnimont con- 
eists of a test-tube upon which are etched the marks R and U, 
and a finolv grndufited scale for distinctly determining the h^'ight 
of the column of precipitated alhumin. 



It is absolutely Ä*^ntiiil to observe the MlcwinR pflTnl«^— 

I. Tilt* uriue mniit bnc »n acid re;idioii. Nmitrfll nnci 
oIlculiUL' nun<^ nw, thcrpfnri?, to be flcidiJot^i] with sccHc acid, 

a, Th<( dcnf!!^ of the «rinc must nol G»ccd 1.006 or 1.0C9;j 
it muni, ther^foro, bn dihitcii orr^pondicgly, 

,1, Thp t™t miiBt nlwny* he made at room Untptfuimft, llll4 
rlifTcn'Ticfi» of h-inpcrdlure influence deciiSedly the helf^M of tli« 

Tbc follow ing reagtiit is cmplüyoii: 10 gninin of pure picrtG 
acid an<l VO graitm of uir-dricil, cbt^minnlly pure oUnc acid Are 
dif»i>lvi>d in 800 cubic ceütimcter« of wntc-r jTn<3 tho total volume 
bmiigl^t In 1000 ci\h\Q c^Titimet4.'ra hy ftdditmn ot water at 15'C. 
(60* FO- 

In pcrfonning tho tr«l ibo Efrbach c>'linlcr is filled with 
urine to the mark V and the re-a^nt nddcd to tlie m»rk ß. Tlie 
tube ifl thon oloecd with a rubber oork aod inserted «Jowly about 
fifteen tliau. The tube is tticiL allowed to Atoiul at r^t for 
tuenty^foiir hnuis nt hr iMiifonu \\ If-mpi-riifuN' nü pnitKiblt?. At 
ÜJf did of Ihin time fA« hvüjhi uf ihr prfriiiitufr^ tts »hoien hy 
the graduated ictils, givf^ iht nur/iher of ^fiMtns vf alltttnin con- 
iaintd in ont tittr <if IKß urine ejximincd. 

Tbt* mothod ia attendod by many eoiirec« of error, and is 
nd&pteil only for apprciimnte estifnaiton of the albumin losa^ 
In this rffipwt, it la, however^ far inferior to the formerly 
cmployi'd nalhrkd of dHermmation of t!ie 'Solmuetrit percent- 
age/' which w«a hjwod upün the cstinuitce of the auiount of albu- 
min frt^m the lucight of preoipttnto obtained in ft teat-tube vritli 
tbr nitnc ncid-hoat test. If, howovor, the d*tt»rmiimtion* aj 
cnndTirti'd with slnel obsenntiori of the nlMive-mc»nlicjfir'd imintw, 
quite Accursfar information iu rpgnrd to the jiHTea*(<i imd dpcn^njw 
of tbe aibuijiia excretion will be obtained» Tlie method ia, thcro- 
fore, of di'oiilod valuo, evon in the diagnonie of ^'physiologio and 
cyclic albuminuria " 

The polariEation method of eglimatln^ llii^ amount of alli^- 
mifi cxcrc'l<'d Is Imf^d upon Uic far-L IIihL ii\] ulbumin hüdiiTs turn 
thp plftiir of poLnrized light to the IcfL The tefit can readily and 
eaeJly be madet but it also gives imly approximate values, because 
men nonalbuminouE urine oleo tum^ tJm plane of light alightly tc 
the left [ftoopage 3V1). 




Tjit sumetimct occurs m tlit* iirme In ilropVls, unrnvimv* la 
cn>tjil]iri<j form. It \e seldom obftcrrpd, nnd iJicn nlmc^t only in 
prcpi.^nt iri>irrn, in caw* of " Inrirc, whit« kidntf^j'/' nnd in phnn- 
phorus pojgoiiing, Thf^ whitish -yd low, clotidy urine cicare on 
fhaJcing with oihcr. Fat occu« somewhat mor© frw^iKoitlj in 
llie urifie of i^ers^ins ftulTering from chylurin, ^vho i?»erpt^ » ff^^^Jf 
iiuJ alhuminints urme. Tliiti (»itneiiU fi ilisliiit-tly iiiilXr nppear- 
iincc and not rarely conlrtin» loo*L-]y aTranguJ, whitiaJi or trrtiia- 
?>nr<'nt grlatinous coo^la ((ibriD). 'i'hu whole of tJw! urine 
Tiwiy occfLBLon^lly coAgu[iite into & very ti>ongy ina£i?, which 
ftifiume« the form of the vassal oontttining it. 

The iirmp loe/% (he milky fLppc^^tmncv no addition of iionno 
ftnlium liydnte aüiI bliakiag witli ether. The '" ciiml&iricfl" fat 
Ü dtBAolvct], hut perfect clearing; ie tiflually not ot>tauied. In 
addition to the very variable amount of fat, from 0^ to S por 
ecnt- or more of albumin )B alwaj-s pre^ool, If^ oe is not 
infn'cjm'ntlj Uie <^iw*, t)w nriun nUo pontairjs blond fhtviaio^ 
fhiflurui), it hnis n rlw^ry-nn! «ilor^ nnJ (iHHimrs the yi-llowish- 
wbit*?, milkliko charnctcr only after ihc blood hat »cttlcd to 
the bottom. The urine jurtt dracribod i« ob^ned almost &icla- 
firely in inhabitant» of tho tropics {««p^ciolly in China, JapaD, 
Eg}~pt, Brasil, ^to.), or siich who formerly li^fld there (lee page 
2U), Briej^er and others ha^e olwrved oliyhiDa In Eurrtpenua 
whri h:it1 never been in the tropiod- Th«e^ howevtar, arc «• 
tn:m<:ly rare exceptio na, 

I1«m«iuria AitJ Hcmoilobinurio. 

Btoo^r-TcH urine contain» dther par« blood from the kid- 
ii*»yfl and urinary pa«!^ or dUnilvod and otherwise altorad 
blood-coloring matter. In tho ßrrt inAtnnoo the condition b 
knovn oa hnnattirias In the second aa htrmt^iuhinvnt; or mtMrm- 

In hi-matnria \he urine U bright or dark ml, diFUm-tfy 
btoody. dichroic, and aomctimc» rontain« broad, somewhat 
ragged blood -clump« (vcaicol blooding) or oarthwonnlUcc blood 
«oogQla (renal peine bleeding^ which aro roided a« auch, or 
eoignUtfoD dooa not oc^mr until af1«r urinatton. 


Fmiwlli' fw^ilcve tli'trnninatMJn tif ilw t^eiii of Iho liPinoT- 
rhäf^ie rjia \)c \na'\a titily wiÜj ihr. mütxjM-opir. IIi-iiinluriA m^cun 
in (EonirrhriL, neuter ontitK cnlciiH «n^l nlcrMlionv in the blAilJer 
nnd ir^ the pAy[t of tht? kirlniy, find in tubcrculo::!» «nd nco- 
plujji« cf the urmitry apparMu«. 

Ch«nilc Dclcdlon of Blood -Col Attn ji Metier. 

1. He1t«r'fl Tfil.— TiiL* iirmt- is rui<!L*rt*rl idrongh" nlkalme 
mih iKiiuniiiMii \i\iin\ir imil IwiiUil, On rtwliiig, llip MfkhN 
colorirg matter it cnrriwl down with Uie prccipitotcd ft»rthy 
phci[iph;iUs nnil ting«« the lalW (which othcrwi«: appear Ai 
wliitö Ii*K*ni[i) brownish or gnrnd-rcd. 

S. Almen'i Teet. — K(|iid] volumoa of froth tiDCtiiT« at p:aftiAC 
AUcT old oil of lijrpL'iitiiii.^ are pluci^il lu u Ii^L-IilIj« nuc! ilialcL^ 
uutil on irriJuI-HJi-Mi i& fonnei.1. Tu Ihm Ihi? urinr i* rnn^fuUy 
added- In the preftCDcc of b]'>od ihtrt at first appcure a bliiüh* 
green, w)iiKHm<^j light- or flftrk- blue ring, and, on ahnking, the 
whoU mixture nesiimre fl dlJTiist* hlup color. The unne lo be 
tMled mtiet t»& distinctly n^cf. and if al):a1irie in reaction it mUfct 
be ttdUülötod with atelii? adO. The prcsent'*! of pun wiLhuut 
tilood ^vcJi Ihf iLAJiip tL'iirlion with Ihis ti>ät, 

While the diftgnof^is of hemntann can often be inad*> with 
nlmosft abeohitP cnrtmnty from the npponrniicc of tbe nrint onri 
thö chcniic exam innt ion, tho din^oei!; of hirmojj^lobinnria, «hidi 
oocurt as a rcünlt of h^^moglohincmia (q, v.}, can usually be 
drtefmired nnly by inü-rL>iMi|ii<" und ftpi>ri rn^eopJc aaalyftia (uv 
lidow) . 

ßil c>Cul u I ill ^ Mat t era. 

ThT'>!r nrrur in ihr Hriin? it^ bilirubin, tht? oxidatinti ptrMliK^bi 
i)f which are hiUt^h-din. bUifauin, and &th~j7nMin, or a« urobiliti a. 
hf^drohitinibin, which n formnrl by nsduelion fn>m bilo< and 
blood- coloring mattor. Urine oontnining bile-oolonng matter« 
oppeara light- or dark- bwr brown, and on ah&kuig «bowa u 
yullow or jdlowi&h-fc'iecn foaui. 

Deteotign of Bilimbin.— 1» Chloroform T«t.— About 10 
drops of cKloroWm arc^ atUKd lu ImU n li-t.-EHbL^'ul of urine, and 
tbo solution thomufthly «hak4.>ii. Tho finely divided C!bloroforin 
bringB down tlio coloring ntaUorj and ap|M?nr& sa a d<inA«, canary- 




jellovr prccii^itnte. If the chloroform cxtnct ia dow mhad with 
OBOnaU'd oil of turpentine and torn« dilute potoeaium bydi^to» & 
di*tmc'l tinviiit^ ti:>hT will 1m? ol»«iT«d in wntory «ojuüon. 

2, Gmdin'ft Te»t, — A fnv riiliic cf.ntimi'li»ni n! purp nitric 
Bciii^ tj> wliicli J or S (imp« nf fuming wifl Imvc l»n"ß addcil, urc* 
carefully overlaid with urine hy mca&A of a pip^tft» At the 
point <}( cDQtnot tbcrc ft^riiie a gTMXi, blue, TJolot, or radish* 
jellov ring. Only the ^retn hug i« poeJtivo. ßluo and r^ 
coTcre may be pn>dii*»d by iivlicaii or urobilin. 

8> Omeliu-BoMnbftuh Filter Teat. — AIUt tlti? urmti hm boeu 
Jtltcntl 1lin>u;;]i a nmnU paptrr filter, vr1i«reby tbc Ialti*r w colored 
a decided y<?]lnurt tbc inner nurfnco of the ültcT'papcr 10 touched 
with tho Jibnvc-nic'-atioiifld nitric acid misiturc. in the prcconco 
of bilo-coloring mattpr « di^tinc^ play of color» from gn>im to rod 
will Bomntimps hp (ibfiprvrd, Thifi t«d ifl pitremHjr deltcat« and 
liighly io tie n'OoiHiuendeJ- 

4- BoKnbacJi hua proj><»(^ the u»e of G-pcr-cent, »iclutiou of 
«hrenmc acid m&kod of nitric acid» with whkJi a pure in^reu 
color *xolufii^«ly ia obtuined. Only 1 drop, Iioift-vt-r» mtut tu* 
cttnfully od<led. Tbc^ filter twl ü aluo well ndnplfd her*?. 

Detection of Urobilin. — Tvo to A dm[u <if n lO-prr-ivnt 
•olntjon of zinc cblorid nrc mixed with i\vf urine and then 
ammonift added nntil the pi^ipitstcd xidc oTid a rcdisaohrod. 
If IL grociiiäb fluore&ccnco can be detected in II1« tlitrKd aolotion 
vhen lield against a dark bnckgrotind, the prv>«eiie« of mobilin 
ia demonstrated (Fr. Mblli?r). 

Bilirabin is vwni&l in th« uHue in every cuae »f iHfiniR 
after ab^rption of bile into ihe blood vlien the flov of bile into 
the int«etiiiG i» obatrudod by any oauae. 

Urobilin ii not conn«vted with icteriu f^tr ne. On tbo con< 
trsxy, it ia formal in tbi> inii^tinn by tlic ndinn of putrvfnctiw 
boi-lrm hy n-^Wtiiiti ikf bilinibia. Tt Lc, tlim-fonii, untally 
aWikt wbr-a the flow of bile into Ihc intestine is eu^pended aa 
tho rcf^lt of chronic oerln^ion of the ductua cholcdocbuA by 
ncoplo^mü, cftIt'*t'^nM, nnd tho liko. Thin vic«% wbich » adTo- 
oat^d particTiUrly by Fr. MulW, in tiifporlod hy the faet tlint 
the inttfUne find urinr f{ ihf nttt'hom, in wlmm the action of 
putnrfactivQ bicieria i» out of the ^ueetjon, arv aUayü fuiuul Id 
bo free fron ur'>bilin, and, furthermore, ihal, after r«<«atflb* 



liahmcnt of Ütc flow oi btl« mto the intceiini^ vcrjr large nmotinU 
of hj^rabilirubic at oilg>c Jippc-ar. lo Addilior to it« occur* 
renc« in icterus it is observed «tpacially in arm« of fobrJt« 
patientfl. It is oftpn formei [n voided utioc from nrrtbilhkogmi.^ 
ou eijmwure Icj flie air. 

Biliaij Acida. — In nJililion lo the bUo-coloring injt(t«rt9> 
bilkrj ucidn il^o occur in tlic urine (iHomit). 

Iktntion by PcttenJcorer'i Tctt.^A fow diopA of urine-, to 
whJdx 1 grain of tuut.'-su^';» r liiu ln'on adJwi, aro urnpijrulLvl with 
n drop of mnrrntrntrd tiiljilmrii: nrid «imn ji pnrrrlnin Hi*b, hy 
iiid of grntic hrrfti. In thrt prrw^ncp of bilinrj nci^l* % (iUtinct 
purple color ift prfjduccd which mny chrnicc to b purplii^ 
violet. (Ae eimiiar reactions are occMeioriflllv coueod by other 
■ubet^DcCB, a morG c^iinplicatod mothod for tho äliminAtioQ ot 
lodtcan, albumin, fat, etc.« U n^Gss&ry for eiAct det<<rminat{ona. 
For (lireirtiona for sut-li ji pritiwlurc Lb« naulijr In itJürred lo 
larger tuit-book«.) 


Tndif^n, whicb is a prorlnct cf prot^d putrcfaclioa in Üio 
intefitine and ifl filwayn pn-^nt evni in tiOTnml nrino, may b* 
greatly increasetl in pHtlioIu^'ii? process« ia Uie gaatto-iQtffitlnal 
conal, capccially in thoeo wliitb give ri« to decided prot^id 
putrefaction in the intestine (ilcus^ stranguLntion, etc), 
BB veil as in putrid enpfmratious in otlier parts of tho body. 
Although the eicrelino cS imlifjin ia very ^tirlnbla i>vtm tn niclr 
ctisturtmnres, a vi^ry »(r»ng renelitm pt^rmij« tbr luaunipllnti af 
the oxiMcncc of nbnormnlly intense pr«leid cl<icompo»itioD in 
the inl^tino or other pnrtn of the body. 

In the Iflttrr prorcw intiol w first formed. After nb»o:*p- 
tion the indol is oxidi3:pd into mdntyl, snd, combined with the 
Hidphuric acid of Ibe uriue, is exerplod ne Indoxyl-potassiuin 

I In tliif connection it uiny be etatctl that It nc»w nppenrfl to 
t>o quite well e^tntlinhed that gnatro-intiistinal dbtturbBnoo« 
charactprizcd by oicee&ive fttrmentnlian and pntrtrfaetion indueo 
degenerative arterial HiaTigea. There la nmple fcninddUon f-^e 
the Itflief iliat tlie iiitlTience of syphilis in the pmduetiou of 
Bcleroe^B has beea e.iag^erated, and that many arterioscUrotio 




oonditioiiB Attributed ta this ^autl-c arc in i^ftlity due to the 
ff6katgfiA couL&vious uLtlucuce of icj'ms abaorbod from th« 
Inte^tiiial trftet Indeed^ Houbncr and Lano^reaux dony to 
■yjiliili« nil inßuffrtco In ihn |irndu cation of arli-rlmdirroAia 
(Ifogrr), Tho prt)rct» m inict^linBl disturbftticc» of thff lyp^i 
aboTo mentioitcd ü a true mt^^xication of tbo organism. AI- 
though the liver is us\iallr tho crfan most inarkodly invotrcd 
(ficl«rofiif), the tdtitie soocer or later pa^fl Ibo barrier oppoflod 
hy this giand artd act upon other organa. eapooiatly the ariem'a 
of fh(* principal em »nc to nee., namelj : the kiilnE^js, In Ihr 
latter organs tL<^ pnn^udiyma (thtr cpitluiliat cells) ie grnduiiltj 
And insidiou&ly dc!^iroj«d and equally «lowly and inaidi^^UfJy 
aucc«cd«d by iibrouf lieiao. IndividuaJ» sufforin^ from this dU- 
tiirl'iinoe iienaUy pA£& a urine but elighüy deviating from Ui« 
noriTi»! afl rpgard» speHflr gravit/, color, and ammmt, Chem- 
irull^, liiiwevLT, lur^t aiMuuiilH ot indtcaii acifl üccjifüi dually Iraecr» 
of albumin are found. Uicroi^copic oxaitiination pKowei occa- 
atonaUy email hyaline and dclirjitc, f^raiLular cajittf; rarely cpi- 
thdiatod cnKtfl; very fn^guftntly cnlcicim oxalate; and often 
tirio acid: indicalionfl of tuboiiidatJon and dUturbancc in gco- 
«ral mctnlKilifm, Many giiHi ntM-K nrn flingnofitiralrd im 
"gocly" or ^'rlicTJiiiatiu'* aod treated accordingly. — nitoom.] 

Detection of Indican by Jaffe'i Icit.— Vrvt tho nrinc of 
TanoQS anbetoiLcc« intcrfcnn^ with the? t^t by tho addition of 
ODO-foUTfli Ob volumo of J^i^jx'r'Ofat «olution of lead ncctati?, 
find then ftttratin^. To the Ültrate add an equal amonnt of 
«ijiii^eulraled liyjrtjcjilünc atJ«! ^fiplittiug) ntid X to 2 iWp» of a 
saturated »olution of cakium chlorid dilutiMl one-half with 
vat^r, or S or 1 Avapa of 0.£>p»-ccnt. Mtuticn potojoium pct- 
mangnnato (ojtfktiou). On further addition of Ihiw f^lulinri 
tbrn? nppnan, vh^n iudican i* |jrtHi-nl, fint a bluiih-gronn tini, 
Uli^ a dinUnct bfno color Tf a littlü rhlrimfnrm V* nntr Arldrd 
nnd tho wholo thoicugbly shabm, the indigo ii tiirawn dowu aa 
a blue precipitate. 

Tho amount of indican normally prc«cnt in tho tirino fiflvfd 
vlth thia t«st only a rose or faint-violot color 

In rare Enfltancf« a deep Moct ct>/omii«n of the nnno ii 
imluivd bj iitdioan; k» tliut eoufgkMin with mclnnin, vhioh vrill 
Dezt be oon»iii«r«dp may occur. 



lo tench cases Lhu urine At tho ttmc of voicliog i«, bm ib 
j:t-uutu& mi'l?jiio*is^ oiilv dark rcddivh or hrr^nninh in color, vtn<\ 
ltL'<i]im<r( blm-ki>h nnl;^ ciii «handing, nr nrt Koiting mv\ ^AAitmn 
of nitric ncid. The dark c>loratioD cad ain perriist or W intcu^i- 
fcH bv «ililitioD of cbiomic acid» eulpliunc acid, chloroform, an^ 
with Jatlo'fl ijidij^o test If, however, tbe indiain ia pr^cipitatcd' 
bj milk of lim@ and t)ie black color do longer remaüUr then t)i« 
cause i>f tbe laUi^r i* indifunuHii (S?iiat*ir). 

Ill riirf ir*iljimtrn indiifa (nrlnc-blue, Viirhow) n|iprjin& r« 
fiuch in Uic urine und may then cither color all of the iirin« 
blur oTf what leii rdativcly more fr^iifut, «ink to the bi>ttom a« 
blue Hnkc» vbidi «liow tbc dcUorat^^ indi;r<^-b]uc Docdim arranged 
io sU^llntrt fnrm. The urin^ in n«ualty voided clear und pal*, and 
pffltrrfff \h« blur» cnlnr ooJ^ af<pr wiin»? tidip (Virt^hotf). A 
deep-bliic urjui' ui^y. how(^>fr. Iai fn^lily vuidt-d (LilUji). In 
»uch cjmf« nonpifftntnUii corciuonid of tlie Momach luid liver u» 
uBUüIly ptwent. 

In mfilanorU, nbo, tbc uriuc i» pule yollcw, ycllowiab bnjwn, 
und ptjrfcctly drar. imd b*>GoniCft divp bluok and optique only on 
fttiinding nr after addition of oxidhiu;; agtMit«. It oct;«* ion ally 
pnsrtitu AH inky npjH'Rrani'c irvp-n ivhi'n Vifiilrri. Tn Hin firsl 
iDBtiiiU'e tbc coU'Tiik^ matlrr i» rÄrrrb-d jw meldHO^en^ in the 
second as mflantn. Mclnnogcn h a colorlc» cliromog*!! which 
bwomcft doi]p black only on ojtidfltion, Brom io- water, chromic 
AciJ, nitric acid, and iron chlrrrid, ^moni; olhorf, at once chuhc 
tlie mflanin to develop. Corfiition n-ith indleanuria con he 
avoided hy previous prtn-ipilittinr lA indican {spc page -lOrt), 

(iriiiiliic nudanurU is of high seiiiciotiL- eiguifii-nTur in tlr 
dift^osie of mcUnolic tumorä lo<?itod in internal oTgnn?, pnr- 
tionlarly in the liver, Exrcptione nrc *o raro (Litt<^n, 8cmntOT) 
tlmt tlioy ö<?arcely need b© coneidered in din^osiö. 


The uHUally rare ttUtaptonnrift ip chflrÄrIcriaed hy the fn't 
(liiit Llu^ LiriiH* iin ^aiicliii^- r\p.ihnl tti tlie air, rtnrl slill more on 
Drciitrvtrnv of umiiioulatfil fcrrnrnintiniij nwumr» n hron^n nr 
even hhdish color, Trommcr't eu^r tcet (sec pop? 31S) giroaa 



ft pfwitirc rcuction, but, on the other ham)^ Kjlamler's (bismuth} 
tot do« not. Tt© urine ruuialiw oplicaUj iiiat-live, waO wUcc* 
aniiEiiMiincal ^iK^r soluiiou ih tlic cold, ßy the« f«atur«a it ctn 
btf difttiu^iiaheti fr»m dmbelic uruic. 

Whether nlkaptoii^ ivliich ocvunt witliout dUturbunc« of 
hesJtl! aniJ w ü/^p^j otmcri^rd in hrnthcn and mUn, in oniiH^ Uy 
ftliQoruiiil fvniLCiilatiDti in tlic iiiti^tjiial rJiiml (Bnunjfiiul AUfl 
Woikoir) bo« not loen duttrrxuiii«d. Tlie fact Ihnt Jilkapton ha« 
nvTcr bocn found in ihc stoole even nftcr free a^ImiDUtration 
cf cathnrticA flpoake a^oet Gueh an aB^umption. Allcnpton 
mny be coa^den?d a« a derivative of tyroain. Eiubden foiuiAl 
tliflt ilie i^U'Mion uf urie aeid waa doctiledty dimiutihed in aub- 
jecta of alka^tuiium. 



Id pentoaurid. also, ibe ixxuw i« cliaraLd-ri^Hl by strung 
reduciu^ projurtlm. Tri/mmtff, yrhlinyfi, nnj ^t/htnier'^ teat* 
give |XMiUve mciiona ; Uwro it, Jiowcvetj only fiLight power of 
dofltfctiuD of puluristL'd Iij^hl, und lie fc-rmtMitattun tt>£t Clivca 
UüKalhi' rcjijjll*. 'I'lillm'» ri^jirtioTi i* rhjimctf-rUtir iif |irhtiu««. 

I'd 5 or G cubic centimeters of fnoiing hyi^roeltloric acid ia 
added enfHcieDt phloro^Iuein lo leave some undif^olfcd. The 
«olutioa i£ nov diiidod into two equal parts, and to one half ia 
added half a ciihic contimeter of the nrlne lo bo examined aiid 
to the otbtrr lialf tlie aauie ainouDt of norinul uriti^. If tlie tmru- 
pW hv now 1i0al«d >» u glaH uiUi Wliii^ wnkr, thi? pi-iiliKw 
»rine quickly nNii]mr.-< n tn^^iqn^rrii tvlor, ivhich rutcnds from 
ohoTC downvard, wiiiit; th« control urine rcmaina unaltcrrd. (It 
ü odvienhlo piwioualy to dtvrtlor botli »nniplcii of ixnno vith 
animal cbarcoal.) 

The follonini; ti«t \f^ rTka rdiabln and cnnvrnicnL- A» miuch 
orcem aa can bo held upon tJic point of a pmknifo and S eobi« 
caittin*^ler? of hydriu^Mone arid (^j^ee. gfav,, 1,1^) art addr^ to 
5 oubic tvntiiDetere of urino in a t^i^t-tnbe and heat^ to boding 
In the pmu-nee of pento*p a distinct bluiah-^rttn coloration 
npp<-ari. Ti*e i^Uiriui- inalTer may be eitraeted by ahakiog with 
oiftjl iüfH>liol» and wbeji lieweil with the ap«ciruw»|ia thtrtm nn 
ab>OT|>tioii Uand in r«d ( BlamiMttliftl). 




1. By (icJuiiiLiMtralion cf fhubBxb irnil ««Alia tliA urine \a 
üolortnl iIltt^h■(oU ydlow, owing to Ihc» pn?«rrici^ nl H[pvw>ji}iiuiiL* 
acid. It 101:1] n nrmn i» tn^tcd villi )K)1«Näuiii hjilntt«^ a 
brilluint-rtd i^br dcr^lopH, wbich diuppcare on addition of 
ocid {üüo "Sflnlonin'^]. 

S. Aft<ir nntoniii n HmilAr yellow color ü obwrved which 
ip transfomipd iut'> a rast-nd on addiUcn of potassium hydrate- 
ir elhirr is fclidkcD uillt the uriiie, tlie oilier ri-^iimiiis colorlev«, 
while OD ahalcui^' witli rliubdrb or aemiü urine it LeomcA ^rvUovr, 
and addititiu of t^otii^iuTQ bydntto to tho yi:1 low -colored eUivre&l 
ffrtrat*l t'flUiL^ a dialmct tv<\ colorution nt llie point of cnuüict 

3. Urioc i<4mlj]iriiug Unnia iu (nlntvjT ffrnj/hih tjrrrn to 
bldcleüh hlas ou adi^iUnn nf diSiit« Kilrjlion of iron chlond. 

4. Uriuc coiüuiuuii^ balaftm of copaiba -^«TH-ifinaily p7e8.oa. 
boiling and additiou oi lk)'droditonc acid, n di^tmut cloudinEu«. 
wlkich, unlike albumiQ precipitAto, ia di^eolvcd by alcohol. Addi* 
rioD of 113 d roch lor 1c acid colore the urino a beautiful f$d, and 
when lii^Ei:'d at tlii? vmint'. time it jiKiitini^ u muUt hue, 

5. The tight to dark blood-nhJ ui'iiie of^rurrjiig after free 
odmiaiBtration of antipyrin, and which not iofroqucntlv mcni- 
fofltfi dichroiem^ bi^oon^i« n ^cep-br^wnM-rcd on ndiltlion ef 
dilate (<ohitioD of irf«i chlorid. 

6. Afler udminiiTrATion of naphtalln the iirJn^ Aä8iimea 
li dftik i:oloi-. On jidditiou vt a fL'w urups uf jjmmoiua a htae 
fluvracünfc la obaerved, 

7. In llie pfTni^TK-o of (alUyli* aoid in tlic unuc Uxc «ddi* 
lion ol inm clilond llrst prodm^ia n yvUowifk prcoijjitatc of 
earthy phonpSnt^, find on further addition a hj\i^\Uvi^>ltt-htnc 
rnloraHoii. Tf very Bmiill nmoiiiilH am (n V dH<Ttixl, it in fiect^s- 
8Uf/, aftor jirc^iuiia acidulation of the iiriiic ivith ttiiau sul- 
phuric acid» to add to the nrinc an equal volume of ether and 
extract the ealii-V^ic acid by ehnkin^, Tho lattor i^ tahtn up by 
the ellier, vhich is then poured off and trt^alod with iron chlorid 



& Alter the cnlTniicc of oarbolio tcid by ]n£<tit]oc, inspira- 
Imd^ or ftbttorpliocL from wound and ulcer fiurfncott tUo urini) 
ap|Mtn hr^wniih grfcn^ ami n Mill drtri'Cr ffrean on IrMij; tUntU 
iiig. If A Nunpic r>f Kijcix urfrp ia pljirriT in a Irvt-ti^br iini3 joints 
broniia-naUrr a(I<1ci1, a hriffht-yMm' procJpiUU is pruclncctl, in 
vhicb, After a time, gli^lcumg crjftaU in the form of acc«il<« Aod 
Aüftloe 4ro foand. 

9l PotnuiuQ^ io^id urJaG lE^atod mih & few drops of fuming 
ritrlo add And »LKinE ocMhfrd iU volume of (^liloi>>fi>nu give»« & 
l)uiutiful iiwie-\ loM iulor to tlie npp[iriiU'<l rlilomforni an wlink' 
iug. laslead of dilorofoim, ciuIkid Iwulphül ciui W employed, 
tbc odor of «hicli, howovcr, is very ivpuUive. The fojlowiug 
toot is BtiLI moro dclicnto: A few drop« of tiUk.v^h poeto am tbor- 
oiEglily ma<d with the eamplo of urine iu ft tc«9t-ti^1>o and thun 
EDme fuoiiog nitric add added. At ihe point of union therre 
«ecim, GTCOi in the pre^uee of but C.tiOl per nent of todin, a 
<it4fhllu€ riftfT, ^htclu however, b tronctitory. Or the urioa A 
mixe^l vJlb ou cquiU tolume of coaceatmted liydrocltlonc acid 
in n luit-tubc; ftniä overhiid with 3 or S drop« of veuk chlorin* 
vdt«r. A Iftm^mth-yeticv «tfiilum u forrn£.<J upon tho HurfneOr. 
whiith hiwim*"* hltif nil ii<7illlfim uf stan-h wliititm (Ji>llw), 

10. Fotauium broiaid ta detected hy adding chlorjn-iFatcr 
to tlie urinr^» in order to liborAte the bron^m, and afterward chak- 
iag with chloroform. When the latter sottlcfi, it appear? dark 
ftdhw in color, owing to X\vs prewnce of bn>Eiiii. Or tl^« urin« 
11 treaited vith ehtonn-water and then ahülren with ethi>r. Th«< 
XmLUt U colon-il jfflfov by Ibe liljenited briruiu, ntid, nflrr deoAat* 
iug and addition of poU^^iuin hydrate, can ajfain be dttolored. 


Tbe iogar piv«etit in human urin« U gr«p««-«ugar (glura^e).' 
Ths qocrtfoci wT)«thi'T i)\i^ aulifilnnn* tn Enmll atnonnls mxy b« 
TOUiikred tu » uuminl i-uii-tituen; of the nrine appear« 1o be «a 
vsMlTcd prohlf^m even st the prewnt day, A# glucofte is eon- 
itftoUj preaeut in the blood, in luncuuta of 0>( to 1 per tuillet 
its appoaraneo in the urine «x^uld c priori be expected, up 
tlio prccont time, liowevi^ff Uie opinions of dif^liiifcui'dw^ inTOrti*] 
^lor« are at varlanre in thi* rrsprct. WhiJi» RHi4<.k«, Meimncr» 
andotliereclaiui tobai^ di^miknj^r4teil tlic constant oocuiTtiKie of 



fcugar In the vrltw, Maly, Sc-^'K^'Or Küli, and otUen, upon Ih« 
btflie of GjüiauAtiTe reaenrchu ii|K>n a gri>nt Quinlror of uriiuef. 
oppose the «rivdu*^ of audi mi ftwuiapiion. 

A d^ieiooQ cf tiu& qucAlion, irhjiii is of e^junl imporUmco in 
fhyviotosy and practio&l nu'tlieinc, U rf>jiüujvü dSißciüt by Ui^ 
fuHbeT rMean*h«v mnAa «illi r^f<rrtic^ to ivduciiig »ub^Uni** 
had tliOMc! whicli ilrHrHrL the |i)finc of polnriKcrl liK^^t to the ri^it. 
il ftüS hfen firüitd iJutt the urine of hralihy individuals possemet 
a distinct ;^ifff cf rfductwn, thiefltf btf Wr^jjtf cf iht uric ücid^ 
tuatinin^ and the i^ampoundo of fflycurornc flrtj which tt con~ 
tainsj Ihflt gljciironir acid, which very probahly is an intor- 
niediati* prcxluct of ciieUliol L8rii nfu<r bntli meat anil ctithohj^mis 
diet, m&aireate ilextracircumpolarimtion ; oiid that, firuilltf, ths 
tsrrriifm tif ffidt/cing srtb'iianc4S is incrtrastd bif Uhemi m^t diet, 
and ffirlii^ularlt/ 6y feuf'f- 

When E. Fi&cher d^monetrat^d a« a charactcrislic projwrly 
nf phrnylhvdrn^in — tliw^vurfld hy him — Ibat tlu* bndv form*, 
with i^iJ^'ar, ycUuwisli, cntlalün? c<>ni[KHindft diatinguislied hy 
high mol ting-point. — the fo-called aaonoi,. — an eepetiallr delicate 
inc'tltod for the detcttii>o of minLit^ qmmtitiia of ftugur, and one 
mwJiaturbed by oLhor rtduL^mf- bodiofl prtteiit in ILo iirin<% 
njjpnuruii to have b^en offered. Tdii^ hupe, Uowftver, was eTrnt- 
tirril wIjvii Tliii-r Miliar provtH thiil glycuiuiiic arid also ft^rmrd 
tlic mtnr oryKiaWirur (-nmpDundA with ph^njlh^drn^iu. Uoncvett 
tlicro sppoAr" 1o be an important point id distinction, in so far ofi 
Ibeec cr^etalß havö a much htfcr mci ling-point. 

With regard to thi« diffcrpr«, 31critt found in pCTfectif 
boalthy individuaU Ihoorinsiant formallor of p]u^nyl^luco«acon6 
crjtilaüw, whidip a\iu\v. all eW\ xiL-re tliarai'Ltn/i'il bj Ihi^ir liigU 
irolting-potDt: l)ctwc%n l^fi" und 2O0' 0. [^81* and 40Ü* 1\]. 
With the ftrmt-nffltion mHh™!, nltto, whicU will riiltM"r|ut*ntly bo 
dlficnpi^^d, MorJLx mippoodt'd in ubt^inin;; dixljnvt^ p^^rtly intirniin 
rwinlt»! in thn^c iiiftanct» in six liealtliy mim vTio, along with 
fnli niflfllE, injjj'fiird bjrge aninunU t^t sttii'ti«, ict-ä, and «kt, whiln 
XvlaudtT^fi iL^al ff/. tj piivtr po&ilivc result* four liiiiw- Bj t1]ia 
udik'Ttiment ihe po^ibility of transitory alimcDtary gtyoosum 
( Cj- afimflntotfv of Cländo Bfirnard) , U again demou^l railed, and 
un<3cf pneh oiroumsliinceB us ver>" often occur in ordmary life. 
Further invt-tlipitiona In ibU dlretrlioa are needed. 



Trao^iiory g1>co«iina b occaflion&lty obecrvcd after admini»- 
tnticw of druj^ (e,^,, thyroid tablets), mid inicrmitt^nt ^ly- 
<f}§una in paccKalic oolic. |A1^ atier chloroform and @th(?r 
Anesthefin, after c^iileptic and hy^toric paroiy^nift, and violent 
eniotional eicEtement Under thote t^irL^umntano^a il h uauall/ 

slight IP ninn^Juf.^TlMOOKJl.] 

In diabete» mdlitns the clinical fcntuiv« on* decidedly dif* 
fcrcnt. Here vc have to deal with a cl^ronic diaewc in whidi 
innro or lc«s largo quantitios of sugar aro confltaotly cxcrclod, 
and can iimiNlly \w rfsdily dcnHiiiMmt^ by m^hods givpn lx'I»w. 
Tht or^nitm is no lonygr capahU of cowmming Iht ^l\tco8% 
Jerived frtjm the t^rhitlt^dmUii. on</. ctcn upon ar» erthmtt meal 
iiielt pcmf*aen the patMogu alitity to form mg*if in qitantiiies 
wticb could not poaaibly be dwivod from the *U>rhl amount of 
mrbohyijrutea of t!ie m^t, and wLicli öJtiui o>nitanlly liKrcuas 
on eulurited mcjil di*?L The mlmimliliT r^inTiminbi of TOit 
Mf^rin^ and MinkoHi^ki [aitd Ojii«] have brilliaiUly dumon- 
ciraUd the clinical and patliologico-anatomic obfr«rTat>'>n thai 
the pancreaa occasionally play» on importAnt tüIl' in diabetes. 
U«numc <lio1ic1eä invanably occurs aft<tr removal of th« pan- 

/ft tiiahrtßf an übnormalltf imU, dr^r, djid aHd urina ü 
vi^idfd. Th^ ^itatitiijf IT ujmall^ inn^üienxhly itu^tratir-d, nmt maf/ 
rary betatttt 1.6 and 10 hters. Th^ *ptci/if. ^raviiy i* clai'ayii 
intrfAif^l, t-arying Mirffn 1.03V and 1.000. TA« odor is iM«tdi/y 
Komrirhat xtcle vr rfjitPtblta ihni c/ fruit. Tht cmottnt ßf twjar 
titfiUd mA\f rary froft\ quarAtiiUs ühieh art jtut dimoiutrM* up 
iü to prr ttnL It U I'ertf d^idtiUp in/titvne^ bj^ dirt, the ojn- 
»umpticiTi of earUilLvdrjitf-i iEirrrA#iri;{ the ainctint nf miifar, 
and f^trii^t meat diet caunn^ it vrh^liy to diHApprar {mitd form) ; 
or it porftisu undtrr osctii&ion of carbohydrntca and ia increased 
l>y augmented ni4-sl diot ifff^vr form). 

Ai-lETr walking and otW hcidily rirrri«^ nlM>, iMiaUy 
dimiDi»}! the cxcrHion of fngar; «q tbo other hand, cjüiaoatittg 
bodily ordi'^n (KtiU) and criiotional excitement may tDcrenw.' it. 

In the diagno^i« of the «^called "mild form'' tho fact that 
ITw arin« »Dtaina cugar only at certain tim«» of the day anri at 
otber tfnws i« fr«^ from f^ignr Ia nf iiTiportniife. Very often, 
hcpvererp aiagar U found vhen Üjo urine ia voddLnl from ooe-lintf 


lo one hour oftgr Vu fnt "nAV* brrnkfaxt, btiaituf. ihg 
vnQTß rp'itiiljj jiasse^ into the unne v^knn the C4irhf>h^Jr^ta 4irt 
taken upon en empty stomach (Ivijlz, VTonn-MtÜIcr). If it ii 
dcdrod t» i<-M n portion cf the urine, core «hodii be tAliin tliAt 
at lout the "hrt^akfast" ■aTiaa i& ssciirnl. Otherwie^ it ia aäviA- 
flllfl to »JCftmin^ n snmplo Ukon from the Mixl quantity voided 
in tventy-four ^ou^^, HJtu-e in lliiu v&y iiiformattnii a» to the 
total «XQOuui of BU^r excrütcd iu livent>-fuiii lour» can ale« bv 
otltainfidp for, neiJti^ from tli« fact that roMiy ^Dgle »ftmi>l«a ma.j 
cOLtaiD much nu^ur eukI otiien mtxy bo vboJly freo from it, tbo 
piTTCciitiLgc of sugar iu t\ts former is veiy TRrinblc. Aftor cöd- 
»idörutilti L'ip(>rient^, hised upon n hirge eeriis of «üximiiimtioTu, 
an. np proximale percpntnge e&tiiiijitioa can he rnn<1c, prg^idcrl 
Üie total quantiiy pft?**^ id tw^iil3'f()ur hours and üio Fpccific 
gruvity nrc Isnowti, 


iHilun 1.030 Aboul 1 Iv 2 |H-t irnL 

3 " I.IWS AtuQt a U 4 ■* ■* 

OLvd " hOA) ir*uall.va1iuve6 '' '* 

If only «light amounts of eugnr are fouTid with the sugar 
b*v\M now to bo dc^Tibed, n dingnotis of diabt^tvü indhtus should 
bo mndo with caution, unii the po^ibilJtj of the pnaseTice of n 
ph_v*;oTogic or Irnnsitory nlimentary glycosuria onnetjintly kepi 
In niin-l. In eucli i'UMs ri'iTflkd trsting of tfiü urine for augjir 
ia uecfssary. It tliLJuId be learuod whether cr not in^'<:^tion of 
carboh virales, especially canc-sugar (KÜlz), iftpidly increase» 
the pcrcontüs'* of ^luooeo in the num. 

Id many »ev^rc casea allatiiinuric coexifits^ Tlio latter 
sometimes follow* n slrirtly t-nffuvwl Cantnni m&at cure iiTidor- 
takrn for tlic purpose of quickly stippi-es^ing tlie glyciouuria. 
WhcnCTCr it exists, it i^ nl^solutdy necessary to rpmuve the «Ibtt* 
niin from the «rinc b<*fcifr the t^?Bt for sugar ie mmie. 

For this purpona t]in uriitc is boiU>d and thu bctgi:uiing 
oloudineai tranefnriTifld into a procäpitate hy curcful nddition of 
iicfitic aoid, drop by drop, Aficr lioiling fnr n nhort time lli€ 
urinc! h filtered, If the flltratc ic perfectly clear, llica all tlic 
slbuiLiiu has been precipitated. 



QaalUatlve and QtianlTtalivo TtaU for Sufar. 

Thtw* dqwini oiinn tlip folloiring priijH^nim of nugur: — 
1. In alkaline solution it reduce« various metallic oxid^^ 

FUcJi A» Dipper and bi«niuth oxid» 

9. It ia doranipoäod in liot s<»lütions by potoniura lijdivtd 

vith th« formation of a yellow or rejiliah-brown preoipitato. 

3. With p}t«m'lhydraiia it f i>rm» yvllowiib, cry»iaUSao cora- 

4. It 1% dt^compfMcd into alcohol and cnrbonic ucid Uirou^li 
llie ageiw*y of ycofll. 

b. It tunui ttif! plnnc of jiolarisu'd li^ht to tli<^ ri^ht. 

Suitar Tctli. 

1. Trominer'i T«it. — Thn uriu« k rcndorod ulkulino with 
polfliuiuin or e<i^iuio liydnil? (fi\im nrr-fnurili to ono-tliird iU 
volume), HTLd tfjfn» tind^^r co;i&Unt aliaklng, as much 10-pi'r-<T'Ul- 
ooppet fculphate >o]utiou adde45, drop by dr*>p, aa vill bo di*- 
aolKcd. The uppor portion of tho iiüxturo ia Ihtn boiled tuilJ a 
yi>]lowüib-bTOwii ]>recipitole a|>ptai«. Furtlier doTobpnitnt oS 
tho preoipiute i» nllowwl ia Utkc jjlaco «poatauwüsly. TIil» 
ivdiirlEoti now ikIvhmxv-k inl» tin? n^mniuiiig blutM^ilummir 1i(|uid. 
The jcIlowWi-rvd pnx^ipiUte h duo to cuprous bydroiid and Um 
reddish prL\:ipitAtc to euproo« oiid. 

A ftimpl« yeJIuw eoloration is not dooifliic, nod the «ame » 
Iru« of a pn>cipitatc occurring after K/iae time. 

If a diHtinot yi?]lofffsh-r€d precipitate formt hefor* boJIInjr. 
it ivry prubublt Ibüt tlie iiriiie t^rHiUio* mi^ir It riiUf»t mil 
]te for;^ittcu. hoH'e^t'r, llmt uormal urine contain» a ntimlicT uf 
rudncirfi mbfltanc« (uric a<id, Creatinin» (riycuronic acid [al- 
kaptonj), whi*:h» n^ider certain circumMuiccj^, may jfi^o * con- 
futing roddUh Golctmtion, and tbat^ on th« other haiid, eves in 
the preienee of unali qiianHtir'« of sngar the cnprous o^ld 
furmi'd may be be]d jn solution b) cri*aliüiii aad the appearaute 
of the duinickrbliü color thuA be prerented (aee a]»a "Alkaji- 
toaufia^ and "Pentosuria"). 

Sn^r in amounts Im« tlmn 0.5 per eeDt in not diiCinctly 
abown br tbin teat. 



2. Teat with Feliliiie'B SoIqUoil^-^Ab lauch of thia eolutioc 
mt wiU n-mnin die^lvnd U added to Uic urine» drop by drop. 
Tho top of tlm wiluma of lU]md in now lu'citj^tl nin! the rezLCtioD 
niUjwnä furfhrr in drvHriji ju: tV^TJWd in H^i Nti. I, 

fF^hliiiK*! wl^tlitm in iiiiiili a* fuMoif*: — 

1 . DiKniihr M 0A£ umniK of pure tTj^üUllizod rup|wr hiilphair In £09 
gTffmi of dmlüivd water. 

Z. DiMLilvr ITJI grncnv of chfrntkMiUy pLirv cijttala «f nciilnt tmdic 
tjirl rftti- in *sa pnti^n flf lir|iJor nftila* — *pi>L4no eravilj, 1-14- 

To this orH tlic cnpppr EiJuUon, % titilc ut » lime- thi-n dilute Ih« 
iniAtifii: with Jiiltllfid water to lUOO ^«uu.— Bhodiu.1 

ThiB t'^&t 10 convenient in »u frir as nddition of only ouv win- 
Con U n€<!ewftary ; thifi atlvautu;??, however, is ofTsot bj tJw ioata- 
Litily oX tho ioluticn- ITtirthofuiore, it nUo pctfäi^stes Üie defoctd 
nipnlMMfil uiuIlt list No, 1, 

3. Hoorc*! Teit. — Thii unnp in rcnt^rtrij »fron^ly nlknlinc 
vt'dh potiwwium hydrolc ond IJoiW. The prwcncc of »ugar ii 
ninnifwtfd by o distinct canimol odor ond a more or less ^ntoneo 
browni*h diBcok^ration. The t<*st i» tiiore d^Hcate wht-u tlie urLnj> 
is opirr/dVfJ with pntasfiirtm hydrate and healed on}y at the point of 
cimUti. Tlw'H-' Ihiii foniLB ü ilisltui't hmwuish-rvi! ring. 
Alihrnigh thiF U^t \» not vtTv ddicatc, it can he locottimendei) 
for purpo^rf of orientation. Distinct naciion m not ^hown with 
cmovnf» of aiif/or less thnrx 0.ü per cfrtL 

4. Büttger'i Test, — -\fter strong biricnlinis^titinn und adt^lLIon 
nf iifimnch hade bisit) lit h »uhnitnitc an pan hi^hrtjd iipan the point 
of a pi'iikuifK-, the urine i» Wilixl. In the preeeoce of f^rvpe- 
eiigar a d^cp-black precipitate of t)i^niuth oTLld occunt 

Aa TCfc'ardß tho delicacy and TcltabLlity of Uiia teat, tl« 
remark« made nndt>r test No, 1 are applicabla h^ro, 

9- Nylander'a Tastp — Tliia i« h ui^int vnhriihle mudirii^ntiun 
of th*' fiinin*r (NV 4)- Tl«? T»ij|ulion h eomjuK-.<'d of 2,0 his^ 
nmth nuWlrftlc, 4.0 lioclielle enlt«, and 100.0 of an fi-prr-cert. 
euluiion oi ^fMUum hydrate. Ose pjirt of thi^ jiohiMrjn ia added 
to !) partn liy vohinie oi tiie urine, and th<.' mixtiirr boiled tor a 
tiiut*. The rpBctioß begins H9 a iirjuiBh-hlfli-k t'jiloration of tli9 
whole iriixture, whi<rh 8(K>n leeciiuw* a det'ij hhick> 

■lutnl Kn n, 


The Ust is far more delicate than those already menfioned, 
and it reveals sugar in ordinary urines in amounts of 0.05 per 
vent, but in concentrated urines only in amounts of 0.1 per 
cent, upward. 

A faint reaction may be pro<?uced even in nonsacchario 
urines, eepecially when drugE, euoh as rhubarb and senna, anti- 
pyrin, Balicylic acid, camphor, chloroform, chloral hydrate, 
Eaccharin, and turpentine have been ingested. All of thcee 
Gubelances may reduce cupric and biemuth oxid to a certain 

With due consideration of these eircumstaaces, Nylandcr*» 
test can be strongly recommended for the nee of the practitioner. 
It is easily performed and the solution keeps perfectly for many 

6. Von Jakflcli'i PhenyUiydnEiii T«»t, — The urine is dilutth) 
with an equal volume of water, 2 penknife^pointfule of Phenyl- 
hydrazin hydrochlorate and 4 penknife-point fuls of eodium ace- 
tate added, and boiled for twenty minute in a water-bath. After 
cooling in water either a precipitate is at once produced which 
microscopically is composed of yellow needles or the crystals are 
found only in the sediment. 

While the test is quite delicate, it is not always decr^ire for 
sugar, becauee, as has already been stated (page 312),^ycuronic 
acid also gives with it similar cryiftalline formations which are 
distinguishable only by their lower melting-point. In practice 
onJy an abundant precipitate of yellow crj-etals can be considered 
c-onelufive, since a flight reaction occurs in almost every normal 
urine. Therefore, in reliability and convenience^ it is far inferior 
to the Sylander test, 

7. Hoppe-Seyl«r"l Mcthod^^The reagent« employefl arc 0.5- 
p^T-cent. N>lution of nitn'>ph*'nol propionic acid in Mwliuni 
hydrat'.'. T^tj dr'iji*^ of urine are boik-d for one-fourth minute 
with 't cu*>if; c*'ritiiii*'t^Tp of this n'a;,«7nt, Tli** ap]>earancf; of & 
d^rk-blue cdor t^li'iws r^lucing ^ulw^tanc** fu'vl Ws than 0.5 [*<rr 
<-<^nt- of hiji!ar). The priiwncc of albumin d'K« not int^Tfi-r*' 
with th'; t-T^l. I'rine fr^^e frrun sugar giv<* a preeni*fi <si]or <inly 
afUfr tht,' a-Miijon of I cubic wntim-'t^'r; di^tim.-t blue (■'dor onlv 
on addili-'i» of mwh lar;.'<'r am'^uiiti^, and «'v^-n thfai not a*" with 



B. The FenncnUtion Test ü itnquesiionabli/ tl« tnn^i rfUuhtn 
nt^thcd for the ilr^tectwn of xiigar in ihe urine, and thonlti he 
tmploytd in nrry avtt- m a-hich aitTf daubt ctt^U, It iiivarial>iy 
»bows gltioo90 in nmouDta of 0.1 pdr t^nt, and upward, and c^n 
«AAJIy nni^ cnnrmkntly he applied. Its boIo JlEadvantflg^p hcvr- 
ffter, iff that, ivhen 8ma11 omounU of 9u>;ar ae^ prwi^at^ a dadiiou 
£s obtainet] oulj aftL>r from eigl^Uvu io twvaty tioure. 

yop porforniauoo of the Uvt tlie iio-ciillod fcrmrntotion tubo 
ia Qmploj'ed» A'ln^j^m'j apparatus (Fi^. IC'S) i« the moät prLtc- 

FiC' lOSi^Kiahotti's J^cinitiilAÜuij Skix-lnkiunicUr. 

tical, because b; its uec a quruititatne cetuiiattciu can alw Irn 
made with flp]>rr^ximAto nccurfjey. The bulb is filled with tlw 
urifle wbicb haß bwn thorrtiighlj miii^d wiUi n plec« of rr«h 
prwft^d yoaat [onu-fliilpenth of a cake of Flpiw^bmaiin"« *tiin- 
prwBi'i! ^citbi. Tbe occompaiiyiDg tube is filled up to tbe mark 
— . whidi iuilicilea 10 cubic ccntimptrts. The jonrt is then 
nddod fljid Ibofotiirldy mixed wilh the utino with ft glosa n>dj 
ftfid tho mixture tbue obtained poured into the appftratiw- — 
Btiookf'^] Ky careful tilling of th& apparatus the mixture E» 
silovi^il f^ flcjw mln and mmpUUl^ fill the n^rif^hl arm, vrliich 



<um easily be done. N^) >ir »hould rv^mnin At the cloved top ot \hii 
tube. The npporntiijf is how set itfidc for from fiftf^n to twenty 
hou«, nt ft tomporfltur« of U* C («0" F.), ift^r which timo the 
vnliTiTir, if any, of rftrbonlc ftcid gaa formed and the percentage 
of «LEgAf (^quivrilrnt lliereto (!aE be read off from the Bcala etcfaoil 
upon the upright arm, [By placing tlie appHmtua la au iociiba- 
tor, bottor r^Ma are obüuncd. — Bhooks.] 

Aa Eiiüionk'8 npparatuft done not thov HLore thiin 1 per cent, 
of «ii^r, uricee coQtaining more Ihau this nntotint tnu^t b^ 
dilül4^<U Qivi^a a uriiw? with « spm-ific- grnvily cf l,01fi (^ 1.022, 
it b a(lTJ:fable (o dilutv two time»; one witli a epcciflc gmiily of 
l.OifS to ].OSS, tivc tirac«; ODd» above thi«, teo tim<«. The per- 
eenCii^ mdicntcd by th€ scale luuet thoD bo moIUpliod by 2, If or 
10, according to dilation, vhich will give the perceatafifo of »lU^ar 
pn^HHit in tlie Tindilntpd nrmp 

iStciu'a Uhut^lucoBOtueter» — Tbi« upparnUi« (Vt^'. 109) 
cDiisiGta of one atiiall (B) aud one Inrge ginsa lube (A) niiilcd 
at their ho^ea to form a U- The large tube is ^n^d to 100 
eubie cuntiiiLCterK and the email tui>o to 50 cubie centinictetfl. 
Both tubt^a aro proi'ided u'ith porforat^ motal capa (^B, a/ 
Fifty rnbi<> rrntimefrr^ nf urine »re placed in the smaller (nbo 
and the latter tightly closed with the rtibbt-r *to|nnT (g). 
Place 3 or 4 gr^nia of co!iipre4«ed yeut into the larger tulic and 
then add urine to the mark too €.c. Insert the nrmomctcrrs 
cover the tub^* with the metal L*apf, and »t the npparatue aaido 
atalemporaturoof S0° F. for f rum twehe to fifteen hour«. Aftor 
thii^ timr? remo^t! thn mi'tal nap fmnt tbr liirgirr tube and atlr 
the urine to liberate the CO^ JCcplace the cup and allow Ike 
cloud to ftubitdc. When the flor.cnll hare »^tllcd the cpeoific 
gravity of the urine in both tnbea ta determined by readijag the 
K-ale on thd urinometera from the flat top of tbo raetat eop». 
As «aeh degree of ipecifle grnriiy loat e-jnali 0.?ID6 gram of 
glucose per 100 cubic c«Dti]iittt'iH t^f urine, i\iv tiiffcTfiure iu tbo 
■peclGc gravity of tho conteute of both tubes ttiultiplied by 
0.2195 equal» the percental of migar present. For example, 
if tha speeifii? f^vity of ihe urine in the Mimll tubo (tinfer- 
Bi«nt4d) ia 1.036 and that in the largo tulHt (fermented) U 
1.020, tho di(Ti*Tt^tcr i» la. U X 0.2196 = X\rM gramt per 
100 cubic (entimcton, or 3,lß3i! par oni^-^BiooKs.j 

Thi> method of Moritz U v^rj practknL An ortTinnr^ 
tulpo m il]l'.i\ i\\n}\il thjv-i>fi>Lirt1m HJtIi a minturo of yesst and' 
urin« anil llion tiiiLtli- t^ ov(?rflow Itj HtlUJtitin of mercury. It >i< 
Üjcn trlowd with a pcrforaJcJ rubber cork Uirough wdich &< 
U-ttlmpcü glaee tube U poäaod. Tlie viriuo iilU the U-nt tube^ 
The air-free apparatUB ia Ihen iovertol, »o tlmt th« mercury oecn- 
pi<w the lowt^r part of llie luiUtiili« «in! r*lulH>. The nn'rciiry i* 
(orcril out hy tlic curliuuic odd gas ttliii;b accuiinjInUiJ «t tlic 

(Hk- l09,-^ttfrn'> Uiitiuiflucirpoiiititir.l 

closed end of thr (ufic- itni] Ihn» tiITitk po^itivr rvirli<ni<c of 
prv«enc« of Augar. The addition of ^ per cent« of ycwt «loEAeoir 
for the lest. 

ifi Mio fennentnlion test "apantonwua fermentation of Üi« 
_jeast" miiy be miatakcn forminwi« quantities of sugar. In pra^ 
tip«, howi^vur, UiU jniiat caa uliiLo^t nlvuftjtt be l^iiuu-d. If, how- 
ever, it is i]r-*irnble to be nbeolutely i:t"rtai(i, a »I'ofnid tubr sli'HilO 
be filled with a miitnrc of ycMt wid perfectly nimiai urine for 
oontroJi If thifi tube prcecnte do tni<» of fertnontritionf thoiL th«j 
CO) derolop^d in th« othrr tiibo cnn b« accepted ai; abPoLuto ovj- 



dcDce of tbe prwGBoa «f npir. This dficcpUve i3crelopi»<:nt of 
pt« con qIbo be atiDoet cntirtl; ttvoided t>y prcrvi^u^ly boiling tbo 
urifc (iM^förc a<!<liiioc of tli« ycut) for Uni minutoi, 

A rnlidKßi i]f ihr* tni'lhiMl will bu fnuml tindff tnetn Tfoa^ 
10 and 1 1 (pagv« 323 iui<l 4*12.^. 

9. Dcteotion with the Foiarüoop«.— N>?^t U> the fermciiüi- 
lioQ t^ut, tlK |Jolnjij^oo[Kr tR <>f chjci iiikporüuicc in dclcrmiiiing 

Hc^ lllK— t'ulttrifiiÜDn AppArmtiu. 

th<? protmcQ of glucoM in the ahne, Tbo wo-o4U«d 'Hialf- 
■hndov^ ftppsntu« i» u^xiiüIt emploT^, ty iumiu of whkh tbo 
■pfidflc *'d»ilrorotfltory" nMirtu nf gluoow? «n Ti-adiU Im* rvco^ 
nixcd ; 0.1 por tvat can bo poduüvdj d<^rraiificd. 

Polariution pouraecs tLe adviDUgc over dl oüicr prcTioa^ly 
IBOiUocied nettioda m (btt it alio pcnaita i|ii«ntiUtm ottaa- 


boo. It ehould be r«meiubcT<<d, bowe^cr, tlmt Uic uriae miut be 
perftcti^ (lent, «irce any oloudin«* absorb* lii^ht ClariCcaHon 
is TDO*t easily Boourod by AdJittou of oiit'^tojilh vüHiiuo of lead 
ax-'trliitL», wliirli must hv n>Tisic?iim] in Uji? fninl iinTi'ijlUiori. Fur* 
theriüon% iilburnin, whirb li Miinutimp* prn^rni, m\iftt be ii-movrai 
by (hy mctliod nUövc mrrntiontrti. 

Kor thiT purformnnop of thui motbod, Ibo bilf-^bodow rifrw 
nppurntm U'"?- "^) n»nniif"dTtrc<J by Schmidt BDd H*i»niich, of 
livHiri, i* jirt^fi-ndilf. This appnmtiTP, unlike that af Mit*rh'>r- 
lich, doc« Dot r(?qi^ir<* aodium lighl» but vmx bu vucpliiml wtOi 
tliC ordinary vhit« light of a gaa or p^^trxjlimm flame. 'Hie 
apparatus fihowe ^luooac (and albunjin) in diuouEitit »f 0,1 [H^r 

Fncodiirc— i3it liimp aliotilU ba pin^^rd iituiit lliirlj cvJiUnioimi 
UlUUkinAillt^ «y<T(irn cf thp nppimlita. U'lir-n the obficrvcr [oolci tlirougl 

<■ ■ « « H 



Kr. in. 

thft WintniTiifrf, hcfnrr tbc lube ff i« jilnn^d in jv}ntl)iin, a cl<>ar> HrvuUr 
lldU, dividod icto tv-D tqiinl parts by a distinct ctntiftt iiurpincücutar 
line, murt bo fltL'H. I( tlie Ikla !■ lijuy. tU« tclPMüvc ^Oi »bvuäd b» 
dnwn ciul or pmhM in tinlil fhU drvhfon lin» of tlio ■ImdoffKiilf nlffkol 
fP; in pPrtrclly 4rflrn*d, Rmdintf of llir in.'jtlt f*^> >■ *[«iifl Vj lufAiii of 
Uio Icutt r^A wlikh &i» tlrttwti uut or iuKrilt'd uiittf iW hijjIi' huo bv din 
tlDi^lly TTco^nizoil If Ihv Tor» potdt of tliQ ttniior it r-cucUy upLin tbe 
*rfo puint «f tUt afaIc (9i} jn 'Uoh a mflnneT tlint bctli bncn form a 
Htniifljt hn<^, fr]ii>T> Tlir nji^nirntiH Sh rmclly Sn llai> O jmnil Uju anil liolh 
hulvc^t of the fti?td Dn* niniklly illiimmulPil If llic pirimn /h'J in (iimoiL 
»lifbtty from Lfft lo ti^hi, tic Icit hnlf of Uio Held bccomoa daTh, the 
ri|:1it IIUiiTilnalctl: If ui^ Hu' iitlmr hmid, Uh» [i1rii«Mi Ih LiiniiMl friiiii tlm 
O point aliplitly from rlglit to kn, iho rl^ht half boootnoa iUrLc mid tli« 
Ipft tlliiiiitimtL-T|. 

n the ikb«t<TV4linn tub« /'ffj It now flllnl wUh ■ujr^r uHrA «ad 
fjIiLord in tho «ppnr«lif* i»<]jiiiiKi<d In thu (J jiolnt, tliL> r^'ld no lonjtiv 
Hp[H'nrH i^lt^nj; ll b, llitivfüiit al)>^(»)iJtvty nt^iftauiy fiv»\ Iv irttOTV tLe 
roriri(*r htinrpiiffftii by Ipnjrthj^ninff or »horten in a tJir |[>!eKc<iji'". Orif-liiiJI af 
Iho flcM win Ihun Im dark and llm other WitrM, In ftrt!rr fo dr^rrm*!»? 
IAet txiHmni of euQar\ it U nccr^tanr fo 'urn fhr «trrvui iK/ nnfii br/tk 



kutir* tff tftc itciil apitr-ttf ejncttt/ tkf tamr. A tiigUi Itirn to (li* Wl or 
right miiirt llun tiTi>i3iifitf th« vuim< HifTrrrDfi-H m ihif iWld «n irficn Uie 
app«r»li])* VM* tn iKr ^ ptihitjon, minus tub« «ml llbid, 

TAr »nir thru tirf/r* J^nrfJp *hc inTTTpWTJf of yHic mpnr. TTic 
»niliiitf fi''« t'ljE. Nil U dcno ■■ tollow«! — 

HarU ^uli-rv«! ai Ibe «ciJo nqunlf Oü ]itf rent, ol urliM nuxnr; 

AuiiiDivi th^i Iho fti^mum of Xhv «Tfll« vith ihv ««mi»r ^ra lb« rp^utcr 
«hn^vci in FiK- ni. irii |dK<^ 3i^H «*Hli unifuiiuily uf Urlfa lulvm ^J Uh; 
fl*]il, it aU\ *T, AiiiH' Tjf i>M-n tlint five rli^rp» |n:]iml4 A pr i-^nt | tuiv» 
pftHvii t^lo O paint o| Ihc rernkrj fuTt>UTiUfin>. «b rtiliiiUoBkl iMrival 
(vqiULl tci 0,fi pci 4v(tL> lmi> |lll>*■^t Ihn [lüiiit t( Itiv ivitiüüi wliii^Ji 
nftw iT»t" li*twi#T^ tliif vlrvvnth »nd iwvllth intpiv»!. 'fiio O pnint ha« 
BOt ^lit« >t*e^ed tliG loiter; 111« dd^imal pcrwiitAj^ I» rai4 hj oWnin^ 
vbldk Vb« of Uj« r«mi>T (tu lKp rljfliE cf th« O puliill /otfaa n mntitimmt 
Unt ttith a f^n« on liw fntrr. ]» aut «umplp, lli« third tino of Il>t/ 
vtinW ia coatJnuous wiih on« lint ol Uw 4i'*J«; foi^*c<|U(ntl7. O^d pit 
«oat. mint be «ddixt io tlic 3,A |jrr c^nt^ Blnaiy obtAltitiJ, (iTln^ % tauI 
«f SJ p«r wnt. of ühui> bugiir, TbU muit hu« ivforvn» to tba vmitToj' 
mmi uf «n otiHT^ilJun t-u^>tr -Ort milüinrtrE» In |ri;);lli^ H « I0l>-njillj< 
mrt^r tti*v t* tivfl, ihr rp^lt auivt b? multiplied by tf. and. wi(h uv el 
a BinaJI tub« of AO raUlimtUn. by I. 

U tbv tiriijo (itRCunK altniinm (vrhldi roUU* to (h« left), a »ri»iad 
pAlitmaiiitii iriint tw rnidv a/ler eliiitinHlinn of t^U Ni]l>tt«ih-« hy boiltng 
and titration cf tbe vriuc. Tic riitlfrcnw bHitccn thp fine and »roonJ 
pvlaficatlon ifivr* tUu pcTi'vutiit£i: uf ■Tbuiuliii while Ibi* wcuud pi>1iiiixa- 
tii>n ffiv^ ihf niiTH-t |H'rrvntAj;c nf urine ■iiKDr ooEit^^nrd In th« fluid. 
If, lor uazupl«. tJie flr^l p('lHtiuli<>n ^av« 3-7 prr »nl. And tho woond 
3.n, Ibi' Urial tivtult iiould be S^V per cent, tti uitne »ugnr and 0^ prr oi?nt. 
of alhriTitiiL 

10. FchUn^t lUthod fur llic: quantitatire ««Urnitioin of 
Bil^r 1» UairPi\ iipriti Iht' fiurt tlmt («Kiully ^ inillij^rninA of g|iicn«o 
rMliicc! on« ruhJe ccntLiuefer of Pchling'« HoliitioD, 

Tfah »oluUoii Is beat prcBcnM by kcrpiihf boib nimpon«?ul* atpi« 
rataly and miiia^ IbMn frvtb vbtB taquind for ui#. For pivptraLloa <^ 
^4f«|li(in J,di"«oInS4439 p-atmi^f DODClHortcred crplnUvl fntrt<vpiipr 
«diphaliv vnivlinl brtvmi flttn-fiaprr, iu fruiri SOft to 3W> cubic crfiti- 
luc4«^ of VAtvr by ikl of ftvntl* heat, and Hlfulc Ihe «oluTjon at ordinary 
l«ni[»^fatut« to fiUD luLfo nDtlniel«T>. Tlv tvatcl «liould be carefully 
tloHinl wlili a iErt^ii'f~ir1>^"' Ktiipiwr. 

a^utiom 1/ ocinUiti« K3 ffiam« of rry»tallir^ R«?hello Mit», hi 310 
fill^c <TniEiUFl«ra of pure »>iiaai liydtale,— 4f>*clAc rratiiy. IJ4 lot 00 
ftana ed miule uida t /—ddulH t» ■ EoTal volume of MO i^itMr ^vntl. 
neifln. Tlrt tmbbI ahonld ba doa*d vith *topp«r oaaUd witb paraSa. 



After a sample of Fehling's Bolution haa been tested by boil- 
ing, to BDe that no precipitate occurs^ wliile such at once occurs on 
addition of sugar urine, the test can best be employed as fol- 
lows : — 

The Bampla of uHne to he oramined is diluted with from 4 to 10 
volumea of wnt«r, a^cordinf^ ae the specillc gravity ia 1,032 or over, and 
plotted la a burette. Five cubic ccntiinotera of SolutionH I and IT aro 
heated to boiliug in a porcelain diah and urine added, '/u cubic centimeter 
at a tiT^iOp under constant stirring. The titration ie continued ai long aa 
the fainteat blue colorntion can be noted in the dish. 

If we asBurae that 15 cubic centimete™ of a fourfold diluted urine 
were used, the estiniation ie at once very fiimple. We knov that 1 
cubic centimeter of Fchling^a solution ia reduced hy O.OOG of sugar. In 
our example 15 cubic centimetera of >irine have reduced 10 cubic centi- 
metera of Febling's solution- Accordingly:'— 

15,0: 0-05 = 100; x ot x = — = 0.33 


Since the urine waa diluted with four volumes of water, we obtain; 
4 X 0.33 i= 1.32 per cent, of augar- 


Ubjne Required to Decolob Exaitfly One Cubic Centihiteb 
ov Feblino's Solution. (After Woumley-) 

UKPii.CTn> Ueikk 


CL C- UrinB. 


C C Urin*^ 































1.4 1 3.5 



















Th« XKc^tfAry iMlniwu of tlie uriti^ i-iiii usually be diHiT* 
EEÜnod by Uie six^ifxf graYily^ wontT Uie eugac lijüWi is gcQ- 
crultv tho ^eat«r Üi« <]«jifler tbe urme. In a ^tMiile gravity of 
I.DdU it 18 Advisable to dilute fi^'ctiimtf.uiiil in f^Toatcr deoaity t^ci 
tiru««. In order to socruru tlL<r ^mlMt powibld accuracy, U U 
rtvinrtiii^tiLVd to ri^fxait tlie tilritinn once «r twipiv Tin» iesl 
gnisi di^iiJcilly more apmra\ti r^^ultv llinn tlie iiirtbud of tletvr- 
minutioii with ßinhorn'j) frrrocntation tube», b<7cau«c tbc icillif 
ciK* of üiu CiO present in iwrmnl (c^pwiaily coticvnt rated) 
uHnr« U Ttry much fvdPcM by dilution of tlie tirmti. 

If the djflbctic urine contAtna uiore Ibaii Old p«T mill« of 
albomin, it is neceuary ti> remove this before eetiraaÜng tbe 
sugAT, ftince, tbe more Üie albumin c^onlent approocliee the abo^'<: 
pcrceulaj^tf, the more »lovly the oxydut id predpilnted fri>m tbo 

II. J. SchtttE'i ArftcO'iftccharDmetcf i« 3 method iluflcrving 
of com mm dilti on in g^^noral fmctirv. The method » boapd u|)OU 
tlie foci thnt n xrnn^j fllnl with <iijdK'tic uHiirr Am! iimnrnnfl in 
vAtcr, Boat« at di^cTcnt l^rcl« ^^^ure And j/ffr f«rmcntatioii of 
titc lU^ar. An aracoiiictcroid vc^fcl with a Ion; dccJe can be 
ompirirAlly gTaduat«d, by means of whioh a quite acciirat« eeti- 
niAtion of the percentage of %vg&r in diabetes cbh be made. 

To prrfdini the tfftt Gil tlio rr*H'l «Ith urifn* to tlip full idaiIc ftnii 
add 1 gn&ni of ooipprfiind yviBt and »nnu^fh «hot to nu«r tbv Bplnctl« 
l9 itok In Ulo water to Um 0-|«rctiit. lugmr moTk [■«» Slem'« «pp^' 
ratuH^ iL in miiii>1v miiil vvr> t-vnvvJtteritl. Tbco by uiifcfid KkAMEi;{ 
Ihormigtilf miv *ho rm«t with ih^ iirin« and nH iM tittw ««nfiuninjr 
tlio njixtnre itii<Jo to ferment for froni tvcnlj four to tMrty iin houn al 
t\j^in l<rtB(ii;(ftlU(T. Al thü ru4 of ih'im Huk rriuiiiivi*« ilir »i^jinJl« lu 
vkUv And mad ulT Uia ip^clflc gntflj and tli* parconUf* of «Ugar, 

Many control tatc have connnccd the author ttmt thi« 
mothod pofliOMCS miuy advant^gc«« although, oa t^'^iirda accuracy, 
h« hu not found it as froe of objection as ScbutE »tales. UoV' 
ever, tbli method i» orrUinly p refniafale to Eiuhorn'i tnuthcd of 

[Lohnitein biu rtceatiy dcvifi«d a fermentatioa Mcehmrom- 
eter* uliich mdicului directly the aooount of su^ar in the urioe 
f ri)m to 10 per ornt. tpith^ui dÜ^it^f^ of tlie fqMcimen. AcoonI* 

IIPMSMW »JMnlaiav WiiliM^iliK im. lA» IL} 


MinttflropT AX n cnnc^fTsnnr, 

iug to the üu(lior, it work» monr iiiiick1> ihun any ollwr icr- 
meaUti^n inntuinK^tit, anO in actumcy it oi^iinl» cren Ihe mort 
expCAAivo |>üIuri;uttion npporatus. llr. A, Spacthc, of Berlin, 
wording in Si'nutor's ]>oIrc)itiic, hu oorapaivd llio rwult« »btnin^ 
wiLli Uli* iTv^triimriil wilh lhoiü> wnirod with Einhom'*, Fii'^big's, 
nm) thn 4>li1i'r l»bitr-b.'Ln jijipurntu^. Ae uoutn>l a|ijjr]rkliu» ho 
ompioircd tlic Imlf-frhiJow pulaniulion üitftruaicnt uf tlie ft^ljr- 
rlinic. Hi? coQclufl?« that tliv Loliri7tli>iii iudtriunont unqu<4* 
ticoiAUl}' L^c^^rv^tho prcfürLiK'ciin'ltitjLti-M: *' Willi thisupimmtui» 
we obTsin moHt Bflti«fadory niul priK'ticjl r»tul1it iu crwry iior- 
ikrular, urn] rtt- i'hji wtirmlj n"c*HTi"ii'ml il bt Ihi* ji met ilioiur 
piirlicukrJj iiLvaujuj «f lU ttrtiptlcitji nml pmrti'-nhUibj.^ J, 
McyüFf P. Meiflfii^r, C. S. Kngol» 0- JiOüvinn>nj F- (.JoHinjttin, Dr. 
U'eiij iLud 1'. StiMinmiuin ii]>;r) ipenlc bijchly of it> — Btioi^Kh.) 

Blood T«Ma. 

The hh'vd nf «IihIxIUx givi'h tw^j rt^av til »lift wIjtuIi iiuij b<? 
briefly iii(-DUun«?d here bffCftute tliey way occa*ionally be of diag- 
nostic hi;riiiHt!itioe. 

1. Brsm«T*i Tut.--Dried preparatioDs of dmbotic blood 
fixed at ISO" C. are stained mueh üiore tnleiisely nftor three 
mitnifi*' I'linlmi with l-pi'L-iTiiL »olulion nf jin'l!iylT-m? hlin* llm:i 
Muod prrpflrntit>n!i tibtoiiW fioni boaltliv indiridLinU. Normn] 
blood, alfo, mny manihnt tlic ryaction if treated with diabetic 
urinon Tli*> rmi-Hon iif rml u'holly fn^i nf fthjwtion, bcc«u*o it 
roay not flppnir in muny puju'* of dinbr^** or prun^niniH-d gl^- 
roftiiria, Bri^mi-r hitnwlf itntml tf«f nbwiur of thr n-jirtinn in a 
puLit'Ut who fXL'cHfJ mint.' ciJrtainiiig fi'/, per ifiil. of »ut'ar. 
On the oibtT lifliid (ftjiJ ihc name is tnjc of tVic follriwing 
tesl^)^ it may bo of vnliio iu manr caeoE of enioj; in wbioh an 
oxaminniion of fbo urine is ini|>oflsible. An oxpliination of ibis 
phi-nnrnonou is ^ti^ lacking. It I» very pmbublt- iIlaI tlio 
rpftptiim i* i-oniifrlM wilh IJie ebuormal acid pioperly of tlie 
urine (SrlinriiJrr). 

3, Willi DjnEcn'e Te(t— Twenty cubio millinietem of froatily 
dravn blood nm tnktii in a vm ulendfr leht-tiit*o and "ll} cutic 
milHmetoTv nf G-pri'-cint aiiistie potjinb iintl I I'l-utinict^r of 
wnltTV Bululioii of iiip|liyli-nr lilan (1 tn flOOO) iiddtnl. A conlrol 
tube cantaiiLiDg normal IjIwkI is truati-d in the triune niaiuirr. 



If the tnbo nr^ iiovr hi^Tiilt^rl in a wAtcr*bo1h, Ibc diabetic blood 
ftolutiOD wiil bvcomc decolored [cojorlc« or pule tidlow), oflwi 
iritliin froia one fn tvo min^itn^T f^t t^io latpft «ft^^r ti'ro minate«, 
wliili? a similAr d*'<vitfiTfltii>D in Ihe comrol luW ocntr» only «ftor 
oiutiiiijoiu lii?-JiliR£ for from f^n to Ivonty mtnutes. 

Finally, iu the cxnimoatioD o( dialfllc unW ihvr^ aro Iwo 
more ifrip^rlaut nuctbiia wliieb eboulJ ulwuy- Ut t^iiJuckd, 
boeaUBo Ihpy «re f\t valuable pro-^no^tie i&L;:ro''icnncc. 'I^h^y ire 
O^rhardt'« iron cblorld r^acifon niiJ lli^ ftoetone tnt. The for- 
mer 1^ iif jittjiLtrLiriiv in tnwu\ twixUi iufi-ttiouit itiM*iui«j lut urll 
an iti Mivert: foniui of OinWttaL 

I. Ihe Iron ChJoriJ Rtftclton i>f (jcrhjirJi. 

Preset d a Tf.— Iron rfiloH«! If mcIiUhI la ffrab urinv. 1 or S drop* ■! 
A linte, antlf ■ Uordtiftuir«! coW iippvon. wliiob I« <fuO ta tli« prttMiM 
ol onto ««"Ik l^bfcllcj ortrf. Al fir»! a chocokU rolorri prfcipjtute 
of En>fi |t]ii^>|i}iiiL4i i« foiiiiHtl. On uiliHiiim of »<ijEii1iurk at'iil Iltr intlcir Al 

4ibcctk A4id r*n be r^mrtc^ ^riUi tthrr. und thi* t*ft«4i lor tht tn>o 

The eigniflcancc of Qcrhardf« tot dcpon^le upon Ibo fact 
tbfll ita intene^ r«pODec in a n^num maji onjint-», whidi not iafre- 
i^aoully points to lm{>i?pd]ng diAhpUc poma, Aoconimf« to tiie 
T<*w»irt-fi<.-> tif Kiili.'] niJiiin And Minkow>ikt, there ^-jiii tx' no <h)ub1 
tlinl Lhü i» produced by on aeJd iotoiicatinn villi oxybulyric 
Jicii). If the iroü dilorid n^ctioa b »trongly nrnrk^^l, it may 
Mfdy be «jvuinul tUat ^(»\y butyric acid ijt prL^^cnt. 

3. Lesart Acf lone Tc«!. 

A frw dri>pt «1 frnli •■>lijijnr <jf •i>liiiiii riitropniMiaU «ro addvd 
to On »rlD* »bd utuinlFd lodmm hydratv unt^ * dl*Un<?( dkAlInc re 
MiOa U |iiit>ilLi«4. Aflt^ lh(> parpip n>lnr ptnduiMHl hy 1M> pdilltLon bM 
bMl wiOliffilril bj* • p4k yellow, forefully «dj m fvv 4h>p> «r ««tuiaUd 
ft4wtlo uH. If ■ Ifritjlfet pnrple or raivkin «lor *ppr«r«. Ibr pit^rvct ul 
«fvlotta U |irov«(1. 

tf iL ui abiuwUoüy prc^üt. tbt; urliiv not iufnf^itt^iUy hw n 
dnmg odor of «ppic». Amde from diobetca mdtitiu, it ocrurt in 
Ugh ir\^ft piäitie and intntinal coneert Acuto infectinUB difl- 
MWi, njul fHjrik- jpulric dbturbonf«« uf chitdrvn. 



The iKaxHrtaclion and Biinciindy Rca<(it>n. 

For 1h» Hukc <if »i(n|i]i<U-iiRM, irr mux ttgnlti briefly tnrnlinn 
Üie diatOTcactiau (Ehrlich«) am] the Bnr^ndy reaction <IEa* 

arid. DOO; Aiid ilUtltln] ^4hUr. ICKXk.O. 2, S<jaiiiin itiLmlr. O.A in i]lhU]l"d 
^'Bltr, ZOU-Q. In ]Hfrlormiii|t tlt» ImI i^ti} tm\Ät ctrnUmvt^f ol •oluüoit 
|Co> 1 ftro inlxfU vriLh ct^Mi: c^vliuirtcr* of «oJuüoa No- •> One pail of 
Uli« jiiUvil HMijfi^uL li yiiuied tii«Utt lule wiLh 1 part nf udnr nml about 
cn4-*tghtb tbi> volutu» at ckmnioulii a4dvfl- Uu thjtkmiE \hv< mixtLirvtlwn» 
pvflure in oiauj fi:bjjle dfrcunvn a ifJ t^olomLlun of T^iinblc intcivütj' 
This TGftf<tJcin I« ohtmixl ««ffH'rliijry in typhoid fcTor. vrt'rc pulinonur/ 
tubaroulotLi. and pDouDioDU^, Dliüppuranco uf ihr reaL^titjrt i» 'uiJ t^ 
bfi indicatiTv tif a latciraLlR prir|;nih>j»- {KlirluihS diiuu'i<?:i^ÜaD vn&bl«ii 
IIA tn fnfrli-ll n^rUin ntmplir^tiiin»- II im HEHnprimn Tnitnil^^nt ■> cH'lj 
Ufl the lliii^I fT fuurth day. Lut ktn apptarano« may be dda^'cd iiuUJ iho 
it-iiiiuiiu^f ift Lbc Uiiid «eck. If it u-ovrii iHudi1r-ii]> lu l;^|>liujil uuaI* 
liiTtdnil by ci»rM>i)iintanl jinii'linnilinii. Hnm^ iiri<ion4.]Hr^' inf^ritnn ar rfndl 
U^on mtut le dUitpwkd, On the mthor hitnJ, an incrca« In InUiiAitj 
iujjc&li« an «KMiQvnLliin uf lliv UlHa»t, lU ri:At'|K<jiri:LiJuf duriiig con' 
v;iT>4iiriiiitt> in tiiLlu^nlivv i'f 4 tclapun. Tlii^ diui^u-rt-nri^uTi ik aIho (>hu>rvod 
tn tjpbiiB f«vtri acu(<> luWioih^ii, pjvmi*, stptuvnüa, HarUliiiAB 
TncainEcj», n-lvt npriulDnally In pii^üinucilii^ Fn lliürt? dUpjum, vu>cpt 
tubvrciulotUt it dui>» not >ciom 1o be «jf anj ovih^claI (>ro^tiit&e aEffnlfl- 
CfliTCD. Ip .t COT nf flmrlutin* r*-Tiit|y liltnrr^vil hy ihv wnicr ihi» rüc- 
1l<>ii WD» vujy iLi:irkc^d diirii^;^ a nnnitwr of doyt. The rftu «Ubipiiu«LÜy 
TtiLidii a ifood rr ('OVBFVy— BreooK*. I 

KoBcnbAohn Ilciiolion h mikiiifvhU'd hy Ui» ■ppr^thuci? uf & iJeqi 
liiirgiimlv vM pi'D<liii^cd in lUf ii-iiiully pmlixit^ly ntrlrlUli urlni>». on roTi' 
1iniir4 l-oili"i: ai.ü nüdlUcn ol uitriL' avid drop by drop. Tl»c r»«1ian 
kri UALiiLlly iJiiuiJJr>«tt<d iji hcvi'iu iitltvLliml dUlurtniiuci n^iijclaU'd wlLU 


MioroBcopic oxaminntion of Ihe urine U OirecI^J olii^lly 
to tho fiodimcntj vUieb ie designated ae &r^j7T7reii or unorgünüed 
nroorilin^;^ nn if in c<nnp<»3P*l nf t<.'lb or IliHr di-nvaUvi» or of 

The acdirncTjt of Ihrt nrim^ (b iibtnim'ii tillicr rpüntnneoualy 
by allowing it to eUnd in u rp>iii(? gk&4 or it it protipitAtiv) 
quickly by thf» cpntnfii^\ Tlip tir^t mi*th*id is Ibo luunl fmn find 
tufHiCee for gpnrml pmdirp. In iinlrr In *«?urr thr wdimt^t n» 

Micitoscoric kx,\mjnatiün of the urjke. 


mpid))/ as poMJtiliv it ia advlaabk 1o iKt^4Ut Uio top of tiie urine 
oolkctcd in a htga uriae ^kae mi*i to poor oiaty the fon-«r por- 
tion» vhicli on standing Id ndicr tu form^ elem^ul^. into n 
confc g]n£8 ftfior lU* urine has been »hakeu tind altox^ the »(?Ji- 
ineot to settle, Ttu* m?iUmpnl will foriTi *|uidd7 ot iJowly and 
be ^tXive or netiuloun \u chatat-Avr jK-ri^rdiiig bp Üir nmoiint of *\x^ 
paidcd rlcmenlj prr»nt. If tlir tinnc i« ^cry clou<1v and rich 
tD fofmtwi clcincnU, it will be easy in <f\'cry tn^t^iniw to *ocure 
with ci ptptitt? £iil^d<>iit Mi!imt>nt for i>:iaTninfltinn ; if only a 
i^ligUt flcpiKJt I» pn**i»ni, mnfh care U DWi^wary. Un^er srcli 
circLiiriätanc», fA« pip&tie, held between ih9 thtjrrth and midtiU 
finijcr and ctt^tetl ifijhily al ihr upj^rr Bnit with Hit tip nf iht 
iiiätJ^ finger, thoutd Ic pa^ni to th^ Mi<im of Iht coriic ffla^S, 
tar^ Icing iaktn to afi?i4 any düipfrmQn of the «oiimffril. I'li« 
t!p of th*i iaikx 1:iip>r :« then rfiiMXl «lighUy, m tlint n litt!« of 
Ihr Kr^rliinruL ii; JtmrkiTl up into Üir pipll**, Anil Ht nntv rrjihircd ; 
Urn pipette [f< careful); witlidrawn am) wipE-il olT — fir^iV« ift/f 
dftssd ttsiih the fingtr'tip — mlh a dvtk (o rejiiave alt adherinff 
fiaid. Thi£ ia nocf^aaiy in order to Avoid «iilLitiou of tbe sodi- 
nuDt. A amall drop is now ollowixl to run trom the pipette 
upon a glaaa elide and t^ovored with a eover-glfi«et. The latter 
phould tint ftiml iipiiii till? AliIi], U^tiUH< thif inrrr<i9iiv|)i(; Jinld 
IK tlii^rr^by dinturlR^il nml mid«nxl inJintiaqt bjr the coitnUnt 
tremWing movt-mmtji,^ 

[Jtetter reaultc will be obtained by the following method: 
Ai'corvlifi;; to the dt^neitr of the todimrnt,* by mftaoa of a gently 
lupt-nnjC pifMttc iranxfer 5 or 10 drop« to a large dtxan «iLde 
ntid )ipr('n(l it out iiilu a niiti, unifcirm layi-r for i*vatm nation. 
Now plarc* the ulidc njjou thr fAit^r. of tljp irimwi>ipr — which 
iihoiild, of cxru»c, bo perfectly lc^-d— and <;xaniinc the a«diin«At 
t"iikGtti a co\er-ff1aM, 

nmH. Two ar H iKfa aS Uic ■rdlmcfil m* bUa4 U 1 »Ue cuLlivUn uf Ukt>ialaU«B. 
ia«f oft« or i**' iIbtx vlkni Ut MikUiKBt ttam «oiiiMiilr *itllttl» lb* Hid t* 4n«r üT 
■na tivlvml b? fwtn (fiiTrlL Uria« ir^BflDl impuvd lu tfiM utiantr Lnvi l^ir * \iMit 
Uivt BBtHafriL Tbi luoripliftWtlD (I<vkUil< «Avr rcuand vf Um «taitB kl4 wil wJilnr. 

• .in* nf »4* «tnj^f fr«» tk* W4i<«t «f Ik* «AHl wnlaUHg M vlU A»9 Iba f* Mw 



In fl e^^nrch fur cc*t* tho in<'thi:td of ixuniiiiii^;; Ihi> tiHno 
tirtiimnit i]ni3i*r a rovcr-glA^s ftnd *t]th hi^h-pow**r 1i*tik ofivii 
^ivi« iic^JUiiff rfMiiU f-ven trhon qiui^ « TiiimlHir of rnnU um 
prc»iit in Um spiTL-mien uiiii(?r eiaiuiuntioiL Comwiucntly, 
urinr aliment »houU ah-<iyi ho cxamitied fini vWt iütü'power ktiS 
[\\) and hi^h «vo[üeL>ü (1 inch)» Ihc eub^tußc lowcivd, or— in 
ihe abüonoe of thU ttlUuhmoiit — Ihe mirror liltixl no lu lo 
tfij'£>üi füü britlumt iUtimiafilion. TTw» pljuw^ (ni>l f^oricavo !) 
titirXDr. If iWi^ prrniiiriiiiiH iiir mit i>1isnrvt<i1, Üu- ilc?liculr 
hjfllinf und finely jeroniilar casU and ai><callcd "c^-lill<1^wIli'' 
(whJch have Uic aanic »igiiificoccc afl casts), wilj ufteo bc oTcr- 
Joakixl, and tho jnicroäco|)ic oAümin&tiort in thU reapect pro- 
iKiuncpd negativ«. 

rpüaH>. n mmk'nily amount of \ttfs,H\^ will etmWft on* 
to ^trlirriiütiu tltr dinrtu-Htfr of Ihif niHts wiÜi lli« V» ubit^t'livf 
üfid l-inüh eyf^j'u^rc. Should thcrrp W ftii.v (3otibt. litnvcrcr, £4 
tu üic cxiu't nntiiro of tho coat» e^on, iv-hr-tiicr Jiyolino, ftran- 
lüar, blooilj puft, «pitholiatcd» qiitlu.-Iia}, fntty, ole.»— plfltx* Ujö 
C'Hfit* pn^Hfi^ly in Ihft rrnipr of th«i fiwld of tht> low-pnwvr l^n*, 
rrtiwe the Milifita^i» U* tlie lost»! of Uli* umlfrftiirfrn^ uf llif bliile, 
clian^ju to tlw hiijii-power 0/, or VJ lena aad Wftcape mlnur 
and pMiUy lowtr the U^tia, Iw meuim of tlie coarao aiiju^tinent, 
until LUc übjtct üomoB uito vk^w, if thi- k*naet* are well ttn 
torvd, thiit c^un cuuLJly bc done. An «Oün lu thu ßhadott' af M# 
Hf>/fr? cfim'.'Ä iiilo ^'Ji'w, c*]miij(i> Ui thi? fini- ndjititinrnt. Hy 
^'riilli' iijox^iiipnt of Ihr (im; Jii1ju:(hiirnt (Ii'ImHa rnn niivi' W 
fttudicti. With n litllr carc Ihi« can bc ilcrn« without irnmora- 
in^' the Una in the flwid, provided Irneca not higher tbnn Vi 
are u^d. 

T\xQ «lal fefactor}' examtDatioD of ronal oIoiikdU, bli^od. and 
piii't'<irpiiscl*'s, j.'lr., ivlieii preftL^nt in «mall DLkrii1x<r. rtrniiri'* t!i(* 
liij:h- power (y, iir '/<} bran, coiinivt mirror, and fu!! itlumina' 
tion. lien?, nhft, covc'r->ibiwi i,i not ncccasiirv, though ificrc i* 
no objection to it^i nno if the «ctJimoiit 10 übundunt or ha« bi^coi 
ooneoatrated by appr^ipriatH!« in('thi>Jii of cr-iUfnoulsilioTi (otmtrt- 
fug*>). If Ifnees higher than '/^ inrli nn^ iiscib n Inrgr eovnr* 
^IdUM will avi.tkl umi-h einl>nrrflwnn"iit iinmi'ri^jnii of tho 
Irrnu In the lluiih Wboü prcBcntiü large amount pu« and Mood 
can icadily be made oat with low ('/■) power. Kxamination for 


nfDiil demente »hould Alwby* be «onJuoted vltk hi^ powcre — 
lit Ico^t Vi~i^^'i cbjcdivc. 

?;hoii!il th*' oryanUml cli>mernU of l!io urino *e<llEni^nt bo 
ob*c«rci] \iy tliP i^rptfurn of pTionjihrili«* c.r nlk»lim' urati% a 
few i]roj)e of acid viU clear them itwny; it «morptioti» uratn 
are the dbturbiog demeat* g^'clly hi.'fttinjr the clirji* of »mm^ 
Cfvcr ft BoD^cn i>r aloobol flamo will ilir^^ipat« thoTii. If thit 
vritc <oolä iTii4 A pfücipil4»to of th« umorphoiM uratoa nvforni* 
nil ih<> »liilv k>rjr<> ihv i-X4TiMQnlW*n of this particular pore inn of 
ihr itiHÜirnTtit Ik <'»iup]et4il, nrjN.'Hl tin.* )u<ü(iiig bnil njiiliuui- tliif 
«■xnmiiuLtion. A !cw flmpe g1 tnitiktic alkali »^jluttoii vill &Im> 
dear lip tho urfltf». — Unooits.] 

ItFriaar^ MdiACbla crmlmniri^ or^atiiiwil rrtjinwnl* majr pnnYvn- 
|rrjll> liF prifB«nrtä h^ uairiuMy liiTatiliti^r Llie uriu* ftuin Ihr Bi^lnient 
■nil flUUj^ th« i^H^I »illi K witcr; vottitidn of Dctlato 0] |iotn*b h*vLfij{ 
A Hlirdlir i^iiviLy nf frvni Ll}£0 to \SiGO. laitdc bj vJdiTtji »<vUt« >t 
potBiih in (llMl]lr<d uttff iJitlll Ihp «[M<Hllc j^jtvky rmmi-il Ih rt^rln^il. 
To thli !■ QiiiinI [)'} [icr wnt^ of d«h<]UcTKiW Itjy hf<ntt j^rtilaU of ««r- 
Ldlii; ju<iil. AftiT Ihp »nliioeht bftii i^titin ■uWUW to lUf bi<It<riii, ikeant 
■ npponrl iltnr iin'l tilil fffth wtHti^cirliolu' >i}luiii]n, IF rfcriMar}'. 
thli may I« ilonc a tbird time. By IbU method ttii> ihmIiiiiphI cap b# 
|]rv««r¥*d fairlj «all fur uiuoUi».— UnooK«.] 


BfCbiv ductsitfittg this Ktihj<¥7t in dt'üiil it flppi-sr« to ba 
düJfBbte bmlly to f^kf^-tcli tb{> 1ifjitolnj;;ic Hnlionji nf Ihi.- Kidntys 
&üd urinary Lraef» bccniiM a condnMua aa to Ütc participAtion of 
tlie variou« porUon» of th« unnArr Apparatus can be Jruwii from 
Ulo inorpholoffio ckmentA pri-^L-iit iu tbo aruw only vlit-ii ih« 
]iittolo);ie »tructun* is coiwtjmüy horoe io mind. 

Thr kjilni>y itr* liibnlnr ([IflhctK ^^nipAVil of iiinumgruM» dtifll< -th> 
"rafll caiialkuli/' Tbt kidnry U diridcd 1ti(<i n cortJc »nd » Btfdtiflv^ 
ihtt1i«tAni'r< by th« tdTtuoui coiirvp of thr pniphrnl HOd the ilnlght 
(«iLtw i>r IliB »ntrul lubull- Kji'^Ii tubiir* l«ftn« At tlta bmlbua glomir- 
uliHi f.Cv, Ui« t^Kvbr liift tuTrouiiikd bj BuinaAii'B c«|ibuIc, Aftsr 
A >llffh(. rvtiallirtlmt Ihf* turtunilti [mi-rstlnl iimiiiiial rvornliitpd piif 
lid a - IfnunK^J ttkbuld btgiTLfe, irilU th«? w«E1f n| vbirAi Ihf «tlrm^L Uyi>r 
of tluttiiLbiiV «Ap'tilr i> cuuUiiutfui- Tbc e?oiiv<j]u|ci| tubulr ih'ii ptun«« 
on lo form Ihf dcfltvnilinff midi »f I1ra1i:'i loap, vEildi in turn |>hH4<« »11 
U^ farm i\if nn^wttnx arni. vliKti ia iiiii1<v| mith tliu mJJwf^Hif l«A«fir by 
Uufi iaUiiuUfj lu-oftllcd dUt^ DonVfJat«4] poiUao. 

UlCROeCaPV AND (*HKUl!mtr. 

lluHiig Ihijt L<oiir» of Ihc urtDmy lilbul* lu fpiTUrlijI lining nndl 
fotfb nidpy Ehanj^Mk In iho o^nvolitlrü [>ortü>na thn tpHhi^lu 4rv itm 
Utv, tItU-k. Huil I'ufiii; i>1ia|>vi1» s^il,1l K'^m^'i^t pr>rli.i|i]H*iii * h) lliv ili»<viiiil' 
ing Eirn of lli-nlo'« livip, rWr onH HaUi^h»]: In Ihc v«rpnil;ji^ irni. 1ik« 
ihoAj üi tht caQvoluud portion, tut uuially not » high; tn the inter 
t^Ur/ portion 4iiJ Lhn cullvi'ljny tubule, iii>i;iill/ cjrlimlrjo. Thif iiuclni» 
nf 111» r«U in ^hUufiiy nvul und htifiw« t. hiipUuluL TA« äpitkrlln af thr 
tuhuIrA <in' itiiiili*iffui^hi\l frtjrii |1ip tntpti^/tpiid rjtitArtia tjf tkt! frvf viianry 
pUHiau^'K liUJXiLt caliocA, pL-hla, wad iitrttr*} ifv JArtr rjurc j/o/j/AnJi^ 
/orm dnd frrfjr'rr «irr, Tbe opkhvllum of the iviinl «lUo«. Uk« llml «f^ 
the bTn^ldrr, («»nna a Inycr comiiUucJ itt IliblUni^d r^Hndrin »IN. Mauj^' 
tmrLAillonal fomie udvue, ho*rvi.'r, U tnunl In- T^iivt-mlr/ riripluirfiud tbkt 
f nr /•pidirlia itj thr f<iniUieiinff urinarv pttJm^v*' 'f'i "! 'V btadder preavat 
VMnttu tiatilar appctjuiUKS. SIih« fpillwlio fiom ttc urethra ant] rntpn^ 
ana aIho iniu'il vltlj lUc Qrlnt, it iniut lurthcr b« inrntJuned Uiot tha 


El|t- US-^KpillwlJum from tbf Uriimry Tmot {Oblkinf^l b^ 

a, DciiA] pdrlflh ^. V rater- t. bluildiT, ij lCii:irt<'fy iii^ct of |in4t4iA 

«filhi?fiuni iti tho mole urcthru in tho pure pri»talinL I» lib« Ih^t «f tht 

bladder TuTllicr on, buwevirr. iL it dinliattly cyljnJrk, and ualy »ftcr 
Ibff foMiA naviriilftrln K mik^^bAil iUk'H It b^minf ilMdAlly llatt/iOBil 
(vrjiiiinioirHj, The fmutlo urvthrB ida)' ranlEtin HtjuiimouB et ujliadrio 

J'hft gLnndiilnr Colin af the protliite an of a Ic^w c^lkoflrii? tj^i 
wliilfl llin Fierotory dtn-t« or Ihfi proBt&l« »rv pro^tdcd with tnuuiUonal 
vpllhL'llii, llip epilbi'liA vt ili« rJAOulAtotj' dua aiiJ Lhxi of tUv tubul«! 

Tba vo^Euk is oowrcd vriÜi lamoUatod ti^mnioutt bpUlj«11um. 

Of tiTij'iniiv'} rondliutnU, tht folhmntf occar: — 
]. Bed Blcod-corpQ»ol«s.— TliOdU appear in tbe urine uflcr 
OTory hoinorrhiige ocuurriug upOD the tnuooufi mombraju of'tU^ 
urinftrr appnmtu^. In iKe\\ ncid rriuo thfy preserve thmr nor- 


mal risOi fom, and color. Voriaus nltorntion^ vhich an duo 
partly to imbibition, parti; to Blirinkage and ox^niction of thd 
hemoglobin, Hf^gin only aflf*r «orno time, ns tho remit of th(i 
jirlum of uririjiry tnMa auri water. The relia lint» oftt-ii Appear 
etilnrjc^^t] or »jukll And crciiattslr or, funftlly» ua dcUcatc» udAtly over* 
l<iokcd, pale Tias^ (fJiadowv [or f^bosta]), RoulcaitM formation 
i» nfi-pr c>&f0rirci. Not infre<iiic!Kit1)', hovover, tbcy sdhcro t» 
urinary caftU, or they form eaat« without domonfilntblo c^moDt 
sub«tanra tx'lwtvn tin* drnu^ly rtiJiRCi'd t*p\ht (era Pig. 113, hi). 

ÜMID [kntufBil In <mt tbim]^ Hen tad Uian «n Uuvd^vrF^v^v ilbci 
(-•hvlmrt" t|b«H^ 

Thu micro9copie drifictitm of rtd blood'Corpn^df^ dtHäett 
iht ofUn 0pf!n question ithcthsr a kematurU or k^^moytobitmria 
4itisi$* If UDftltcrod red blood -corpuscles arc fotind in tho vomo- 
tiiiK4 polo rc^j aoiaotimce dark- redd j&h<browD urincp then bcma- 
tnria exista; if auch are absent from a urine in vhi«h blood- 
coloriDg matter haa unfjuatLionülily h*vn determiiud by other 
method», tlun heonogloblnuna is pitftciit. 

Aa to tho hfiiiicn of Vi4 httnorrka^t laide from important 
dinicfl] aymptoma, other morpboJogic olcmcnU mnat dccidc- 
Th« coincident proaeoco of casta and roiud opitbfllia ap^aka in 



favor of renal hemorrhage. In vesical hemorrhage the above- 
mentioned elements are not found, but numerous squamous 
epithelia arö present. Numerous fragmented red blood-corpus- 
cleSj which, perhaps, are deserving of diagnostic attention, are 
occaßionally observed in renal hemorrhage. In addition, the 
above-named macroecopic difforeneca are to be considered. 




Hiffehk^tiaj, Poin-n. 

lliT Occua m; 



Cloto QHnaHy absent. Asso- 

Aoate and cbronio ae- 


ciated wilti blood-oneta, 

phritia. Malignant 


epiiheliat and hyaline 

growths. Renal 


casffl, renal epithelium. 

oalculus, taberoulo- 

Intimately mixed with 

ds, embolism^ ab- 

arinc. Many HwoLleo 

aoeea, aoate febrile 

(loea of hemoglobin) 

prooeflsea, h e m o " 

ph an torn oorpuaclefl- 

philLa, and in dlad- 

S«diment sligfat [ or 

nsis [malaria] and 
diatomiflflis [?J. Fre- 


quently In poisoa- 

in^;: from tarpeatine, 

carbolic aoid, etc. 

Pelvis of 


Absence of casta of any 

Disease of pelvis, cal- 


kind or renal epithelium. 

culus, elo. 

and ore- 

Fibrinoas molds of iir& 


teTB may be present. 
FoB-oella ia calcalns. 



Btood-cellii well preserved 

Stone» cystitis» tu- 

ly large. 

— nnless arins is am- 

moTH» varicose veins 

moniacal. Ctots fr«- 

of vesical neck [dis- 

qnent- Heav sediment 
[often ocanty . Pua in 

toTotim ha:mato- 

binm], etc. 

cystitis. In papilloma 

And maligoatlt growths 

may be shreds of sacli 

liiiSQe. II from neok of 

bladder, appe.iTB at end 

of mictaritioQ. 



May be ex^kreawd. First 

Uretbritis, traumat 

part of miobnritioa. 



2, LcacocyteH. — These are found normaHy in small numbers 
iE almoat every urine. Their frequent occurrence is pathologic, 
but they are often observefl in the most varied disturbances. In 
addition to many pathologic conditions of the esteraal and 




LnU>ru:it ;^*mtai( nncf in nU cAtonhM »Utt« of {ho llnddcr >i]d 
uri>t<>r«. Ilicy urv luunllj pn^nnt aliic> in gctiujno rcmnl iIUoim». 
TliR nHIt» und iiHi-Iri pri*rnt l!i4* ofiliTmrv *t7j' mid ftifTn, nitcl 
Li!fiially fliow in drj i*iv|MiiiÄli<jü& UL-utrojfliilic jjraDulattrftL Vrry 
Trf^^ucntly they arc ficcu adhering to ntdaI ca^te. In jiut Ib^vc 
inetiLni^«« lltov uia> rcadilv be luiblal^im for cpithdia of the rctiAl 
tiibtilce. In addition 10 the niarka of dietiDcUoii imm^dtatcly 
to b« ]peDt(oD«d. U should be ootod Npoelally that tlio loucocyti?« 
arv nmiiil ami iinimllv rharMrl^ud hy a ^ml^ftntirphinut riiideuB, 
ätmiÜDg i>f ÜK' lin»cüc>'lt» with i^hdich':» ^1aininj£ solutioiw Hiowa 
no uiiifcnnit}' in iht chomctcr of the cvlU. Somi^timci« itiim<!r- 
cue etiinll mcinonticTc!fLr c«]Ir aro nxii, which, pt-rhapit, apiicnr 
with the Irniph [ K inphfii-ytrti] nr^ hiivw ontcn^d ilio urinwy 
tiihul^ Hü n rnsnll nf inUting cpithrlirtl <Vf*<^i;, 

3. Epithclia. — iK^ldti'-ii ifiwimmtn riilihtlin are uot infrc- 
ilLicnUy fouini in nuniial uriin:, csptcinlly in wjin*^«, Nuruf^rou» 
cpUholia of lliia typo alvaya indicate eonio patbo[c>;ric prooe». 
Tboy aru fouud in all acuta and olironJc cBt^rhot rtuto« of the 
urpthfci ami hUiider. TIk»/ are large, ofltii |tfih^'i>iial or muudftd 
at tlw twnmr». iicuitlly flnlluii-d, mviiAiufinllj winu'what »hWi^I*-^ 
c«Jlä vJtL a large and gcQerally »harply defined, faintly gran- 
ular nuckua (Figie. 113, lU, and tl6). 

Chib-*ihjipcd cirmocoudato or potjcnin3ato iiLiclcatod «pilhelift 
wore ffiniv7riy ofl*?n very wrongly interpret«! a» cbaracto-istic 
rtnal pelvic epit^iolia. Kiactly the «ame caudjite formt may 
TOua* fnjir; tliQ ureleia aa well aa from tht bUildtr iL^lf. Swollen 
cyltndnc epithelial oelU with one or tv<; prolou^iitioii» may at» 
bo deriTcd from tbo excretory iluel« cf tbo protftotd, and art? not 
rarely found la tho mucoiu »hredi «0 fnsjucntly dUchAr^ct! fn>ni 
tlim Inciility. 

The dfsl^nninalioii of epithnliA from th^f rewjf tnhtiltt bt 
much more Cfri^in, The inexperienced olwenrr froquenily eon- 
fuf«e tLcni with oloHcf« blodii-corptiKlcfi [linicoevto, pu.^-eells 
— Bbooks], from vhjch xhisy 9(m*iini€a ennnot to lü^tin- 
jruitihed. \a a rule, however, they ar« ao dUtlucUy eliarac- 
teriÄvl bv lijeir ji'ityj'jncl form and Singh lafge. runiid «r soim^* 
vhnt oval ouclnui that thcry cäq be ^iagnoc^ticAled with eertuinty. 
Tbctr oceuTTtnce i» of crcat aeoMiolic Aifiiiificmice. for aocordiig 
to tbo qtumtity of ihe excrd<d eltraenta they alway« certainly 


indicsto ft more ct lou iat^ee opitholinJ di^iquatnutirtn. Finally» 
tlio renal ^it1i£)ia occur ^JDgly or in tmnll and lar^ groups lUi 
Ecvcro (e«pi^-Lb]Iy Acutv) m^plirltü ill tLe form of '^pitbdiall 
tute»/* Thuae are cylindric fonnationfl composed of dcnecl/ 
patkotl epilh**lia Biipotiiiiposptl lilic sliin^-li?« or arranged jji moaaja 
fonu williout datinot <^mcnt fiubatanoo (Fig. 113, *, and Fiß, 

Tha t:\)iüit-lia Arc often intact, but thcy nra not infrfV|ii(iiU/ 
"Albumin c]i>udcd," or Inuipformcd into the genuine, more or Inw 
large fftt^ffranub cell« n*ft;mb]ing Ihc e^lo«truin-corpiiBcJoe of 

n^. Hi.— Scvrrc Acut« fftt flrnt decidedly h^morrliiipc) N^phriijii 
wbkh Ktiikil FtitmUy in Four WecKb, X aao, 

A, UfAllae QOtL i^t GFAniilu oat v, W»xj ««L ^ 1^1Üi«UaJ 
OHt ip, Vn* rauiJ bpLUuitLjh. Xi^ two fluul/ s'>''<*'^i. unlfonul; Ukj 

milk. Thceo often pro^ont, Ln addition to numerous mmutc ftkt- 
globiiW, a quite difitinot nucleus; not infrequtml!)-, Iiovrcvcr, tliä 
cell ii io densely filled with «m&ll and large f&Udroplet« thnt tlin 
nucleus is vholly obRcurtr). Snuli a rell not rnirly ck]>tiiiiu n 
peculiar dork appearance ae & rcsvdt of ibc uiany intenbd^ re- 
fractiv« fat-glL>liulca hcapud npon «ach other (Fig. 110, it). 

The däiidlnua ia dcai^aUd &k ft1luininr>iii whc4i the IndlvMu&l 
^rKDulc*^ »li i}ii}y aHa,hl\y i^ttactivv acid ar^lulile In dlliHo rjoliuiMtini 
hydnU* »nd ftoatie add And in90tuJ>le in «thor. On Ihr otliar huid, thü 



graqulations oi the graDule celU, which arc produced by genuine fatt/ 
degeneratian of the protcid HUbataDcea, Are characterised by their iusol- 
ubilitj in potaaaium hydrate and acetic a^id and their aolubilitj in ether 
and alcohol, liluckcning in OBniic acid and briMiant-red coloration by 
äudan TU. 

The granule cells arc found particularly numerous, both free 
and adhering to castSi in the large white kidney. They arc less 
often observed in other forms of nephritis, and then usually in 
severe acute inflammation. In this instance their abundant 
presence is of decidedly unfavorable prognostic significance. 

Fig. 115.— "Large White Kidney." X 350. 

A, lr]riMpe oaiV ff. SplnJ cut. v» Wn^j ««(. /. Kti-granule rut 
Willi; 1, fit n«^t«. SUI] flnernceitlHnrUiU t^rpeupOD (he noL^htxtrLng 
fftl-RrnDiilgBiiberul«. jk^ FU-gruiule c«U. J,Leucocjl& f^ Vaginal ^iJlhs- 
Hum. < FBt-dnplBta, 

4. Benal Casts. — By these are understood delicate, cylin- 
dric formations of variable length, thickness, and external 
appearances. They were found firvt by Henle (1844) in the 
urine and in the kidney and described aa important accompani- 
m'^nls of n'njd affections. In addition to the epithelia of the 
kidney tuhuli's they occupy a prominent position among the 
organized seiliuients in the diagnosis of renal affections. 

Three vnrieü-'s are usually di^tinj:iiished: hyaline, graniüar, 
ani1 waxy eaati« 



Tlie liyftlijie caaU acut In vi?ry i-nri)i!>lc brij^lt (np ü> fioin 
I t> 2 milliiitcki^) mil] bivfulUi (froTri 10 to bO >i). Thf^ £re 
cl(Jicttit% trJinpluocail or trin^pntrat, glnwy» jifTfwtlj homoge- 
aeoun fcrmnti'>iut, and unmlly tinre a ptrri^fit or occationitlly a 
■lighth' tortuouK eontoiir, vitli punillrl outlin«f. They are CM^iIy 
f>vcrlo(>kKl, bill may bo rpndnird dUtinct by TfirlouB Btaiain;; 
giibBtjui<x«> »iiirh M jniliti, L'nrmifi, picric ncM, %Df] bn^tte juitliri 
djefl added to tb« ecdiincnt in diUite wlutions (aw PigE^ 1 13, 114, 
n&, and lis). 

IJlg. Iia- Narrow iljüllne Ciuts. 

Aller Pciffir.)! 

/fi tcitffT4j Ihpy present & ydlowieh-sTMn oolor> U&&y kinda 
of morpliolopc ^loiriMil*, in jidditioTi to iirute* (oxpeeially urate 
of srtda) and niiinito nlbiimii)mtn ^aniilos, nre fn"|m*iitly foun<l 
iifTburijig to tliom, whir'h, nwing io tht*ir bi^jli w^mrioUc voluc, 
Hore justly designated by Ficridw as "brmM» of the proceww 
iu tbe kidnoyB." Soirjctini^^s only iMalcd rrlla ar^ found ruih^^r- 
ing to Ihofc cueta, uud not infroqueoHy the laitt^r are ci<Mui^ly 
atudd«d wirb tbom. Siioh torias cotifititnU tranfiilioiifi b) gnm- 
tdir fflsb^ HjnHriH i'Hi*tB nn? easier to rt^rvifljniye by arTbrreiice of 
roll», jind n^so in comtctinrm'p of tbr t-\iiWü** of fatty diang« 
wbich are not infrequently to be noted in tlicm. 


:amination of tii« vnixK, 


Gmiitilmr ctiti nko occur in vi-ry vnrinblo <um*. TItdr »ur- 
fsce ii ftomctimcv lincJ}' gnmulflr^ «ftpf^oklly whcti tlioy trt cOfiw 
|Kurrf nf r^rnwiTy iirrnngi-d fioiünin iitjitp nr flue nlhimiinniis grnn* 
uLc«; »oMctimc» coarsely graQulai, wLf^a Üicy ixm^itl of rcd nit«! 
cobrlcw blcmd-oclli ot epithdift from the rrnal tubnlcf- Tfnikr 
tlic Utkr circunuta&ctt it la Qsuftl to dcsij^nat^ tlicni as rvd A^o^mT- 
t-ßfftttfit and cpithttial tmU (^piihfXial tvbvt} (iioc yig. 113, 
R *; Fig, 114, ff. A, «; Fig. 115, /; Fig, 117, ft, •)- 

In iDftnj <««r« • «]r*r ricir of tlw formation of luch C4itii na be 
obliüncd, Sal lnfrvquiully u «nmltrr cr UtKrv ponJon U compowd of 

l|f. IIT^— C&ronk Brifht'» Ditnu« (Clifosac PHnnct^finfttOlM 

and fbtcretitUI Nrpbriti"). X 3M. 

J^fi^h H^ Mj^fri^ yttJ3«hirj «^ihAllBl, «n.1 v«i^ «*aj. .^ ■* b«l Br^LMlnn. 

ii(DiK*t7 ftnttii0ed blood «orpuKka or «pJUicIlK, while Ih« nniuulD|: ^f 
Upu «pp««ra [nif»ly liyjillna. At ttthtr timn no tn» o! a ccmmt feDb- 
«t«im cftn 1m madv cui m tht caxl«, WlilU in tita fvnuor intt^niM on« 
li cnnntiMinr^ ta ^«tuiiii; thnt tlm in^lrix v( th« (B«U conai*!» of hyallnn 
mitrrial wbIeK M anlj In fArt ilfnHly iliidil^ vilh «Hl^ In tbo Utter 
inaUnn oo* » l«in|>lrd l4> ?'>ntla4e thftt Ibc vbolo ni«i4 of lb« «iM 
ecmaUU of ofIIb vilhoul nn/ «vmrnt ■MWam'n Ou« vÜI nnt fo »tiny, 
boir«T«r, If b* MvniB«« llint n otmMil »nhtUnr« u«i«lly nitta. 

A« tJi6 epithtlia not infK>qncf\tly undergo ft rnHftODorphodM 
mtr> f^DitlorrlU. <>r>o or mor# eiquini« fat-^rantilo o^lle Art 
occwioiially «opn jcUnrring to tli« cuti- In raf« IflAtonc«« «na 


th^ wliolo mrfaoe of a vast ie comj>OFi«d of i]pnai.»Iv arranged 
granule-celb, or by their coal^cenec and fiirlli«r tikity tfan&for* 
uifttion tlte cMt it ileuHtJj coverttl »lÜi SJuall and largo £at- 
globul«, the 'levylopnifiit 'yf which from individual falty 
inoTphoaoil opjUK^iu ia roinltTe<i protrnMo or wrUun, Now <in4' 
th<ui more or low lon^ fül-ervilül nt^udE« uppoor in »neb fflU 
grnnnl« jtpb'Ti'* nii(\ nnsta (Pig- ll-V f, n). 

Wftzy cBfttt nrL' mach rurL^r, uiiij iinr ufiiinlly fibwrvod only in 
chronic form» of nfrpliritis. They a\ro occvii, hiwCTcr, ia screrc 

[Tig. lia-Epithdliil C^Uh X »oU. (After r*v*r.)] 

nn(l usimlij futu! AcnUuepHrllip ["nli«o uftnr pmbngctl etlier atie»* 
thi^ifi, TitcplLrojicjtir»,, ür mjLiiipi'hitir:!!! oX Uic kidney in c4ß(^ä in 
wliich iipjmicully nüld renül aJToctions pic-cXTsterl — TIhOOKs]» 
Tlicv ar<* oftftn very lüngautl usually much lnir-ad*>r than the liret- 
mcniionod fornix. Thoy oru lii^Lin^in^ficd from byaline caeU l>y 
their eitremdy sliutp, intcnei?ly ri?frBo1ive contour end trrtri»- 
liicpni (^harndoT-. .4s ji niJe, thry nra vfrij re^i»ttmt to ttcidtt^ 
ii'hile the ht^alint m^tA ilU'ipprar on (heir cmpUft/inertt. Xjit^ptV» 
Bolutii^n fttain» Uiem eomctimcs tcdilish brown, and fuhs^tjuerU 
Addition of e\i]phnnc add a dirty violet (FJ^. IH nnd 115, w). 



lliH fftct IliHt, with fvw «^ii\<ptii>i]]i, ihi-y alu-ayx jmitit In thu* t^-xbt- 
cnce of inflamiiuitor^ prooeMcs in the kiilno>- ^^ «xccpfi'cn« 
Arc 1o be notcfj tbc almost coD»i[iDt occurrcDCC of d^licAtc hynliuc 
cylinder« in catarrhal icterus, in vhich thov Aro slightlj bile- 
etaiiiGd, as well ofi in many forau cf nlbuminiiTia. For «xampLis 
Id addition to (li.'Hoate hjalinu, usually also n few fnipJ^i grannlnr 
urate iriuil« are iiit-L vrltb in the urine üf fever hUil [^a^ivu vovy 
patioQ, tn tiercrc Aneniin, Icuke^iin, diobctc», etc, 

/n Mtf mojorify 6/ cöacj fAry (jre an ifvd%o:itir>n of g^uin6 
arphritii, tho cx&ct oalurc of vhich in rvvcak'ü by the ncccm- 
pnnying c^lhilnr «ilem^nU- The nvimhrr of cnxU h tuiwlly in 
proportian to thp iTt'^riN^ of nllinmiiiiiriA, and thit hfvrrity of \]\a 
alTet'liuu, HuuevLT, iiLfuierouii eAL-eptlooa oeour line. Not 
)[ifre(|u<?titly the caatd appear at tbc bri/inniny of the n<phntk 
bcfttre oUttiminario U {Umitft$trabte : and in hoaht»^ of tJx acute 
moritu Hrightii they V4r^ c&mmanlif jit?rfiijit uftcr the &lbtimlD 
eitn»tion htut ci'juuhI. Sfiortiv bi*fc>w ileulh imiiuTfjiw verv Üüek 
«nd lotij^ nutU nfli^n nf)[mir. Th» tiumhf-t of taaU in iiot infK- 
qomfly incrvfiW a]*o during; a uremic nltjirL 

A ccrUiD dio^oet^c ijikTC«t is ntlndicd to the at/ts occur- 
ring in dinMic coma, Thoy not infrei]uciitly appftav cv<« $hcrtJy 
bffort the attack, and conat^intly end ofti*ii id larg« niitnberv 
driririg the eoma In the fi>rm of short itumps of hyaline and 
dul],glisU?tiiDg grAiiuUr f'lrmo. KiUz finit doicrxbed Ihoir ofcur- 
renoe. like hin, the author never iniftM«! tlie^e chanctf^rifllic 
cart» in coma. If ttie attack cubEitflui (wh]<*h, lu is kumvo, otx^ura 
in rm'/ fov infltiiuoM)^ tho Gextj may ni|>i<lh ami completely 
duAppeor, It is worthy of mention that ei^^ri whi^n large nuni* 
here of cast* occtjr the nlhuinin ti^tfi nuiy tho« only n slight 
douiJing of the urine. [ A similar occurmio) t» f rt^tiently &Mcd 
nfl4^ prolonged other an*:«thc»ia.J 

Arndt' fn>ii] the very thick casta oocnrring In a»» of wmIc- 
D(x» of tht" fr>rcc of the heart and «eanty urino, tli« Mat of for- 
mation of whirh mar lie jii-iuiTied a« (>robuh1e in Ih« cDllL<i?iiug 
tuliiih«. it i» not pcrinUx\l/te to form further ciiK^lu?iioti» m hi 
thc'ir loc^l orij^in from Üic form of the coata. Kvm t^uito thick 
tuiB may. a« a reault of their eJaalicity, become miflicäcntij pla^ 
tio to paaa narrower tuhul««, Abo the occuioiully peculiar 



kriuons or CMoprmed, aocopdioalLke fomie muet in no to^Unco 
bu l<Kikril iijir'n s£ <I(>nTed from tl»0 convoluted tubulv^ Tbwu 
forni!^ »ro, pprhaps, pzx]düo«d bjr ihö cast meeting with «omo 
oUtiuctiou uiid beiug hjuHiniriouilj Hulijeclftl lo almag |ic«B»urp 
from Wiind (Fj;-. llö» j). 

A» to Ui^ ohEin of outi, clinical nod patholof^co-anatooiic, 
u v^Uui cj]>orinieijla1, rcwaivhc« hnvc thufi farolEonsd no geocr- 
altjr JidequAto cocorptiriu. Tho nrwt pmbablct AKumptkin iv tluii 
Uiey in; aUurrrtfio»« rfcnrafif« nnd wmwiim« fomnl wi a rimiU 
of Iran^formatioD And caalc^cence of itna] tubular cpithclia, 
BOn>ctimc« by tltc#« and tbc IcucocyUe to^iicr, or, ßnAÜy, t^t 
lliey orj^^iiatu b^ & coagulation of the prolcid bodioa id tbc roofll 
tubulea similar to coagulation of «he btood-coloriü^f matter. That 
til« ttiiupl? pri.rM.-n4*v of u]l>uiiiia doi« fi«f aufGi^ fur Hiv fomalloD 
of cvwU b tilitmn hy Ihi- fnrt IhüL fur «»xniiipli», iti rk^turut (visIb 
lurrcT occiir« U iX tbcrcforc» probable tbat, m oddition to albu- 
min, a f^itticlpaUon of the tpithtlia U c««(aitU] (Senator), 

Orllndtold« — \Mii1c tnie iirinitry Pftftts are orlf owMVonalljr Litur> 

Ulfd or tiraiirlktd, rniLlli-il itlicl (ll>MlIl1r<] ü\ Ihr iMlil«, ailil ft-Vt'ilVH 

ffaUnifilt rU'h'inlit'f (kjciuHliuii« ^liicU. Vcim«' irf a Cf^rlain aiaiilArity 
to ca6t>i, BFD diMpntnfT *>' mention T}ii'«r, hIao. nmj Tm Mudttrd With 
many furmt of finely firnimtiir «krriCtiU. Thi-y fctf mo*t lra>|UODllj ob- 
#*ivi'd L[j Hi-ili'm, w'urlaLiim. roi'uni'Ul fover. mid ji^'Hilis, Tli»l lliPy 
vripnito in ihv kjjiivy «fipk^jin la b* «iiiv-iiiHy iTn|Tnihib1«. 

S. Tm, — Fi]f~coTpu»clm arc ctiarncbi'nsed by tbcir ^anolar 
and often ftttty-dcgcaicrotal protop|j4irm aud iho prc««noa of 

4fv<tfal (from two to five) pohjmyirpho^is «uWri, Tlieir oconr- 
n.'n<*fl in lariat nuni&tfrf (micT^ftrnpir) indirnlm n jinibalib' iiiLip- 
pnmlioii, Ibi* oiiaU-'Jit* of which can u^imlly bff *uhjifdcd by tti« 
iTracrnoctipic ii|jprrininL'« of tlie nriiic. ITic wat i>f the Slip- 
püTütioQ niu^t bf drtorinttiüd by a aludy «f the other formod 
cicirient«. The *bapc of tUe pue'i^>rpu«?lffl Ja of no eepccial sig- 
nificance. MflTLT ->bu('rv!*r* »lute lliat Ihi» pti9-<H?Ili ofton show 
nuineroiui prc^tlongiilifliia [jitni^biiid tli^liirlioji] in rhnmi«^ |>>^ 
litia (?) tr^K*- ^^''V Aoconlin^ to von IXtkl, the urine of 
<-ysli(ift briiiTii™ Tieatral or alkaline in a few hour«, while in 
affeciiun* iff tlto rti^al f «JEÜ and kidmy 1\xq a^id reaction poi^ij^ta 
f^ days. 




In cmmonia<Al fcitHcniiUi&n a peculiar mudioifinous liqn6^ 
faction cf iha pu» tnl<» ^lact (fcc No< 6), in whicli, at nwftt, 
«nly n f^'vr niirli^i cfla be floam on mtcriM^r.pic «xamin.itmn in 
tdiJitJDii \q coTtoiD crjfttaUJIia elements Vkbu-h will be »pokcn af 

6. KucQA. — In ÜM* doud {**uebectiln'') to he «en vvca iii 
noi^in^l urme mitJimj; ib found cxcvpt a few «quiunoiu cpitliclia 
and l>aetenii, Tlic cuuiic* dctncnU occ-ur in a Iraitfpart-'nt, fuinÜy 
fit>nlltttcd miitrbt in miM ventral irritAtion. On nddition of 
dilutiT nn<Uc «i-id ■'lig^it, Imt diKtinrt, clmkHtti^ njiptinrK. 

Tlie foriQRtioEL of diiku« in chronic c^^ttis (aud id tlie rnrc 
jiLitrid form) is of mach iiiorc JmporUncD, In thU c(n%diti4tn a 
rapid di^inUgr-atii/R <ff the pus-CorpiOfUa ßvtn in the hla4der 
^ccane under ihi infi!ienc4- of ammonium tortonate and a gvfamj/ 
«r kr>ne^iii-tt mwy>uA fvrteiation &in bo ohtirrritd. Aci<<tnling to 
tbr iuvisti^|uhoii!« iif A. KiHurl^ Ihi« U rnuu'i} hy fi^dliiig nnil 
»oUitinii of tili* pnf&-t<rll nndni iimlrr ihv action of the sodiiun 
diEurid ond Ammonium c^rbooole pnemt in the urine (nuci€in* 

äoe alto ifonorrh«^! «Jtrcdn and tipurmat^jrrhca (pa|^ 3?1}. 

7, Fibrin Is mhlilj n-cuiitiitrd by tbe dinilix't dWin nvLwink »bii-h 
hAA «Irwtdy nip««1«lly ivt^w ipnkk>n of In oonnivOori xviTTj ullirr <-niiJi- 
lloa*. Tke fibiiA ALirillm «re moil bcAkiUfullj »Jimwu In the tifrliLUAUly 
ran croopuun coajcitla whldj jit« vniJml nfi^f ibu um tA imj »tmnji 

t. Fat acrnrt pArtlj indowd In p-aauUF «ltd, parilf In«» and i» 
Mtfttlj irü^ofniml by iu «»Il'kniknx opUe and chrtmlf |ipi7u1Ur1t1ci^ Home- 
Iuum it i* obtCTwd in thv form ol innanitmbl* minuta (flobittva. taniB- 
üuc* Id tafge Jrop». r*pcd&l]y In tke Uted what« ki-lntj-. L&nta DUmbm 
of fliuftLl and l»r^ f«tHJrop|*u uv jtlmnL cDnauntly («tind In rhyloiu 

i. famladJ oonatltDeati nsv ob^rnnl p«iin-u|]y in m^mmu urine 
ithon illtcbarH« »f »nn^n ha« omiiTPd ■« ■ ir^iitt nf tpAnUn^nu^ rrriin- 
Mon or of onwüvoi or ruitiik Tbe »prriiialAM« ofUn otTnir I« the form 
od A quit« dcnae uMte vluud flvct^ Hitb nurnU, iHt^l'-iiifiif irtinHii, «ml 
B«ii«By »bov fWTtAin VAhAtmn* in ibiip« In mirtmilifin «fvrinAlflrrhn, 
tb« «prniiAloua. «»unliiitf t« FUrbtin^r, ^bov po< ulUr " ni/H«¥ MfArvifi^ 
10 rJkv Arnrf.* Tiliii'li nuy bo lookfJ upon a* lutnibnoouA renmoDtn Indi- 
tnWVi^ UfviDi-ltl* d4vv4opm««t ttf tb* aptrniatajtoc- In tliA «uibar*! 
cAjivmnR. llili pbriLoiuFDon u mj ruv. 

10, PlgiB«aL— (ii/ Dtfhitd from bt^9d-c**Ufimf natttr. It 
omm »«all; nmorpbous or « tne and co«!» gnAulcg, froa or 


inclosed in cells. It ia much lees often observed in the form of 
iiematoldin crjetals and needles. (The latter have been observetl 
by the autlior in only a few instances, viz.: after severe acute 
hemorrhagic nephritis and in amyloid kidney.) It occurs 
abundantly in small and large clumps^ or in slender and thick 
cylinders, in hemoglobinuria (see page 303). 

This pigment is distinguished from bilirubinj which is mucli 
rarer, by iU insolubility in potassium hydrate. 

Blood-corpuscle detritus in the form of droplets, clods, and 
pigment casts occurs in hemoglobinuria (see page 304). 

(b) Melanin (tpp^ars la brown or deep black, Anally granular pig- 
ment, fre« and inclosed in leucocytea. 

(cj IndiffO ('^ urine-blue" } aometimea forms delicate, light- and dark- 
blue needles, which are iiBuall; arranged in stellate form (see page 306)- 

11. TisBTie-shreds in Tubcrcnloaia. — In the purulent or 
bloody-purulent sediment (of add urine) in urogenital tubercu- 
losis there are not infrequently seen with the naked eye rounded 
or sbredlike, somewhat ragged, floccuh, about tlie ei/^e of the 
head of a pin, which on nueroaeopic esamiuation sliow, in addi- 
tion to pus-cells, chäcfty fatty detritus. After specific staining 
with Koch's stain tliese can be recognized as dense collections 
of tubercle bacilli. 

12. Tisane and Neoplasm Elements. — In acute septic cystitis 
small and large shreds of mucous membrane are now and then 
voided witli the urine. More frequently, however, the necrotic 
tissue undergoes rapid disintegration. 

As a rule, portions of neoplasms are but seldom voided. 
They are most frequently observed in cases of villous tumors of 
the bladder after a catheter has been moved about several times 
in the bladder. Under these circumstances not only multilamel- 
lated e]>ithe]ia in large amount can be found, but also distinct 
villi coverwl by thick layers of epitlielia. In several instance:^ 
the autlior was able to obtain in this manner fresh fragments of 
villous tissue which established a diagnosis. 

Spontnnoously exfoliated fragments of tumor are not infre- 
quently voided with tlie urine alter tliey hove become more or 
less incrusted. Under such circumstances tlicir cliaraclerietie 
features are obscured. 



W« cAnnct too omphaticaUj vam flg^iiifit a itiftgnoffia hnsj^ 
xipt^n indhiduftl faii^r-cWff. AU ciperkuced oWirers vho arv 
ai.\-LiHU)meil lo ouulrul tlinr i^miciT i]iu}jiLfiaiet hy i^f-rrii[>«ii« ugi^ee 
lUat Üid diu^oftie of cacier can ne\«r be bused upon Ui« appear- 
auoe of eo-caUed potymorphous i^piikelial cdK Of ^eci vahie. 
hoiefv^, M *Ae numflrflu» prr*i>nrü ff tpithiüat tiwicnts in con' 
lu-ctittn with ofUr^prcUd ItfmorrhAgst^n the iib*«Mii^ of »rioiift 
*i^iia tit ifvitili« ([iu!i, vU'.,). T\ie uiuat;riauä (x^c-urtrnce of fat* 

fronnir tphtfut4s mnj abo occnuoDAltx be of diaf^iiüatic Talav, 
provid«! ncphritiit doe« itot cxul 

Th**u1hfir ob>m«d Iwn sncTk r«*f«4- tn niio whirli Kit« ■ <mn'!iinmii 

lirrtf«, «TilHi ilhwlnl «itcaUim lo rrnal bciuanliiLCv. A* nLimtious f«t- 
priniil* fOTf>u*-Wi vrvt« alio prvvnt azii! aIL lAgni of i>f<tPhElÜit ft|j*#Dl, 
hc HO («figVT doutlird 111« i|iJi^»u>U «f furointiD», wltifh w«4 «onArmciJ 
bL ortfroiMT' Xn lum^r tonU tv pii]|'ikUiI. 

19. r«ra«tut.— ^«J rrpr(uEiIf-'ln addition U niim*rüii< «oecl BBd 
bftrillii nliich UV |>aftl-ul«ilf Kuneroiu In uninoiüac«! urin« uid «n 


uimopoorr an'd niEMTwnY, 

jtorcfOfT. Icifjothrie. nin\ v^a4l fvlU, lUd loiter t-^itt!tini\y in xltiibctk iirii 

(]n^lly «ro fmini th« tbr^Ll» tad »jtoTM »I $^**r {tkmsh fvf^iuj, urMalk 
uiH^ bcT wAikcd iLway by tti« uHofr from thcdr nn locAtlon \it Ibc Tk^iui 

or paihoj^cTiu: b^tenA.thc etaphjlococcua (iu rvutü uWtw), 
t1i<7 MTX'[>t<H!r»L^eLi$ und f^ococ^us, Ibt; ttiberok and typhoid bacilli, 
rocurrvni» R|>ii'illi (GtÜber), anJ a^iinomj^ott aro obfcrvod la 
the uriu- 

r»g. ISK— E*urdy'i Moeiric Uvninfiigo. tOuo-Iourth Afftua! Hit*.) 

Biagnofctio intL^rüsl U Uiuä far confinod i>r4]>edaLI)' to OiB 
dclrc'tion iif gonococQlr tubercle bBcilli, ufid actiitomyCH «It*- 
monta» [The t>plit>icl, proluun, jind cnlou Ijacilluti 'iiiii tijr utrr-'p- 
tocöccu» are also fr«jiicntlj fouinl in »iippurnlivc condUioas of 
thu unuury imi-t. Incicod, ttio coJoii bjiL!illue in by twaay coU' 
sidt'ivcj llic jMiJut froijuDnt flxcitcr of cysUtis, pyolitiA^ anil pyclo- 
HfrpliriUK (in fiUxiI two-Ünnlii tt! the ciises), and it has r'-p^atMly 
bi?pn foiuid in purulf-nt noplintis, pro>iiili1ia, pannojdirlli^ and 
allied eJfocdoDiL, Tbc urine of uncMiipltcatcd colicyatitii Jü 
tlmoet invüHühly ncid. Ammoniacal cyatitia b due to miit4 



infection or lo tlifi rcktivelj^ mre t-XL<lLii^Lve |irtT4fnce of ol]iQr 

coccun. It Ü inipi>rtnnt to r^m^mbcr that Ihc colon bocUlufi U 
not iufrcqncatJy found iipnti the prcputiiiTn or TuJTft, lUid tbiAt 
calliotrrixntion may tmiiLifion it to Ui« liinddcir; uid, further- 
jnorr', that in Xht^ iDcontinc:tit!ü fff Mrnticn tlic- iirin« may bocomd 
iDfccti?i] fram Üio mvLlim- — Bi£WJKft,j 


\¥\g. ISi/^-Uriii« Cylindtr for 

i S(tiiuitfiiC-l 

JL< rrgttnb tha goiwovosiu w« hav» «Iranily «Iftl^d In pari tho ehivf 
icallirr*. 4»J vill iriT« Ul»« »upiriauBiituy rnntrkt i« cunnvcti^n «1th 
Ur* owmiilvnLion r>f /i>Liiiri1ir«, B|f the demonatimlion ol |]|]ii*ri'Li' li&ritli 
111* tdvlMwa of iiro^nitMl tubtrrblHij J« e4i4Mi»h#d, Attvnticn UioitM 
1m dlnc1«d eafiMbUbr to ■mftll, cniinblU« iJnaUiurt« b Cite purulent 
•Mllm*»t oi UiP faTobdy nr iMinirmi urina }fa« juul Lhfii fimoMMri uid 
tttb««l« bMÜfli AT« lobnd ftuoctntcd. tn luok mm« li« goionb«ftl IbI««- 


tion appears to have furnished a favorable soil for the tuberculous 

process (Stiozin^). 

/n the diagntals of tubercJe bacilli In the urine the ffreateai core 
should be oh«enxd^ Th« raietaklDg of $meffma iHicilli for tub«rclc bacilli 
has, irx thü respect, repeatedly led to error and Herioun coneequences 
(extirpation of hoaltbj kidneysl)- 

Whenever it in poaaible, the urine should tie secured, especially io 
women, with a sterile catheter after thorough cleansing of the urethral 
opening. If thia is not practicable, careful decoloration [of the prepara-- 

(¥1g. 123.— Micrococcus Ure«. X BOO. (After von Jak*ch.) ] 

tion] for at least one hour in alDOhol is neeesaarj. Under certain circum- 
stances animal experiments are required io decide the diagnodia. 

Actinoniycoiic rosettes are usually of much rarer occurrence in the 
urine than in t}ic aputum and stools. Here, also» they appear in the 
form of small, jcllow, aandlike granules. 

For the dcinonst ration of bacteria in the urine centrtfuga- 
tion of perfectly fresh urine is of the greatest value, Gärtner^a 
spinning centrifuge, made by Hugershoff, of Leipzig, appears 
to the author to be both practical and cheap- It is also adapted 

• o 

[Fig. I24-— Yi'ast Fungus, {After Harlet/.]] 

for tlie volumetric estimation and counting of the red blood- 
corpuscles. The author has used it for years in innumerable 
examinations with entire sfltisfactiom Krefting's centrifuge, 
made by Gallas, of Christiana, is less expensive, and can be 
reooinniendcd for physicians* use. This apparatus also is in dailv 
use by the author, [The Bausch & Ix)mb Optical Company 
make a reliable and most serviceable hand centrifuge (Fig. 119) 
which meets perfectly all requirements. The water-motor cen- 
trifuge (Fig, 120) is uaed to a very large e^ttent. It runs very 



smoothly and rapidly enough for all practical purposes and can 
be connected with any faucet. The best centrifugal apparatus 
is the electric (Pig. 131). With such an instniment almost any 
desired speed can be obtained. — Bhooks.] If for any reason 
centrifugatioQ cannot be done, sedimentation in a conic glass 
IB necessary. [The accompanying illustration (Fig. 123) shows 
the form of urine glass, made by Whitnil, Tatum & Co., now in 
use in the Post-graduate Laboratory to the exclusion of all others. 
These cylinders are made of very thick glass, measure nine inches 
in height and two inches in width, and weigh one and one-fourth 

Fig. 124— Urftt« of Soda and CryatalB ol Uric Acid (hj, 
Oxalat« of Lime (o), Lod CysUD (C). X 350. 

pounds. The great weight and broad base prevent tilting. They 
have given perfect satisfaction. — Bqooks-] If no granula are 
fotmd in the sediment, it is advisable to filter the concentrated 
sediment, carefully scrape off the residue with a spatula, and 
then gently triturate it with a glass rod (if neccpsary, a few 
drops of physiologic salt solution may be nddcd) in a watch- 
glass [or any appropriate dish], and make a dry preparation from 
the mixture. 

{b) Animal, — Echinotwrtu occun but mrely in the coum« of th« 
urianry apparatus- The diaguoai» can be made pnlj bj the microaeopio 
domnnittTaiion of hookleta or Iragmcnta of cybt membraae (page 390 
nn.l n-s. 141 anil 142). 


Tlw ova «f ^Mamam hirniut-tttiHUi. a wimn <icciirring lo the tvIiih 
<ti til« bl«4dnr and »ttum (Mp^iJidy in K|[Tpt}, afVn «ntv itul am 
pMAccI in clouilv und UtJOdj tiriUL\ Hurir nrr (IiA(Jtii:nJMla»I hj vh^ir 

nrtiir mnht numcrnintlj' in the Unnd-i^nngiiU Ipagr iSri und Fi^ W). 

KuTtJicroiort, tbc cml^ryo* üI /llaHtf «ai»^tf'rrb irc aUo frequfnlly 
ofjKTTtvHl tn Uii> I'lijrluuA urlnti voUnI b^ tJilLtlilbifilH ul LTii> in)|iU<>, H^r«, 
«Tbo» Ttw niEiii^wr nf nnhrjft« i« Vbv jfrvut«r ihtr ninr* rii^hly l>Jaodj the 
mine (on pfi^ 1U}. 

f>j-t/rjr<^ iijviEfcnfaF'fff may nocufcnally be fountl In the nrlni' r\1 
liitlo gitrli, into vtftilch th« tiiraidllk« onganUm «clDr« Irciin Um» vulva. 


irig, I^(L— Sodium UmlflOj-Uilt». X 350. lAltcr Ptr^cr.)! 

rrlc^ftWTHdiiiM »nri rm-fwrnnnrtJi forma are met with novr and thou in 
Ih« nrino nitliDUt any ttgniAcam^w 


Bluur A flAii;'p üi*üi]i-IurEi ln-lvhren llie t^ryalatlinc Ot amorrliiiu^ vie- 
invnta ftmiTTlnn in n<>\i\ or nlkallTi* m'inii U Impnaslhl*, Ihe (llfTcront do- 
pi>pila will bf* CDH'idtrrH v-lflimit reft.'iTiice tn thv nuidtjun of thci urin» 
and Ihc fiLtlcr ciily ooen^iLOJiany be uienLroiied. Tüd AUiurpKoiia uhI 
flPjitiilUnp jtSffirtfuiK hnvo afrrmly »wpn diwiiBsM i^nj^t 345). 

Add lodlDin UTato (Hff. )2G) forma tbo brick rvd ««diment (co4- 



lAltw Payer) J 


orvd by uracrjthriR) conaUntJy foiiml ui hifE^ilj <vnctiilrftUd urine. 
\Ur-ruftr'(f|iii-4iny it I* ctini\tif*i\ nf il^nkrl/ mmTi|E<>cl flnr |[tiii]dW wtilrh 
iiulivitlujilly du nol ajipcmr to bw <vUMd. It *ft«D i« frofly dvpn*- 
ittd upon aucb niorE-liu(oj£'C tiuuwnl» — v^^t». etc— ^l» «my be pfCMJit 
In tliA t]r1n#- It ftbAppoAiv at one» [in )i<»»Un2 or «MlHon af dihili* 
pAldtHium hj'dnlr, vhil« HCl nitirt il Unii> l&Dm tfn to iimilj minute^) 
foima vJth thvm {:rj^t4al> of iirio add. 

^rlo iOld [Ki(r. 175) h. «Pit Fi|E. 1V7, e-A) owun In mliiUlB Ia pln- 
hrad iiU«4l, L>rl^lil nd grVDUlc« vhloh ar« «omntlni« found in d»r urine, 
but nKrrv I'rqurblly in ujUtv ecml^iniiui Irfick iluhl i|(^>rj4it. Tbey «n 
troinpnwd of dt'niii'ly Arrongrd, piW' nr iiflrk iffllmd-cnlorfifJ rryjila/«, whleb 
o««uv in tho form «I vhoUtoo«, |il«1«i !]arroT-»hBpi>iJ) dumbbrrlf, and 
roMUo fciiua. Tlio; occur iuo»t iTrqucatlj lo Üw uric «eld dlathnia 

ng. m^UkppMt^a Add fd^(*A Bodiuni L'rat« /tfj, »QJ Uric A^id 
in mitUloQ«, Dumb brll, «tid llod Korm fcAj. X ZW. 

(«•pfefally d/lrr «n alUck of ifout). ic p«miciau« anrmit mnd Ivuk^inicL. 
«ftl in eoa^miratdl fcbrilo urift«, «c**jdve meat dlcl, ttc. hi prr- 
fecFllj nonnal urlnv ufk- >Hd !■ «^ouiblntd y/Uh baiir« aud bttd In RoEuUon 
u Bitulrü «odluni urtt*. 

AdddUon of todittm hydrnto dindW r« Ihr crynlAla ftt on«. Futtbcr 
addition of a frw drop« of liyiirmhlori« »eld FAt»H thr^ ta re«pftt»r In 
prnl«* md «hf>ittrirc form». 

OKAlto »Id itid;. 1*5, r>, irM Fi^'. I3«|, whUdi ■> dtwulrod in n'^minl 
iirino hj lu'id BUTliuiD pbii^iilihli-. (m^ii« in innnj iliv4*ni, and <jrnuffra- 
0/lf. 0f»>, «f^flnvT ffH(r ifrmrjfufmAM dMf«rbrmiic r'p]kyti<i|[>^« oiahitU}. 
II apiABn In th« xtjj vbaractf^fCÄi- form af cAlfium <iii«lnto crjiUln. 
J%fiy prrvnt the wllknnvn mTelopo aha)«. aomelimH mnr« In lb« 


lacsoecopy ako cubmmtbt. 

Jbm of points«! nrl«hwlT&, and Mmctime« ix cubia form. Th« «ni« 
cr^AUU arg tli« mnet r^fnioon f«ms |dumb-bcll, ofoid. «vd hri»eiMi 

ourrvnoft ia lifttwl«» m«Uitu«, vaUrrhal jauTidio«! ftud ■ iiuiii1««r «f oU>«\ 
di««»«, Uicy Dot infrrqnpQtlr ap|Hai m a£0i>T>ctniBt4>tTlini nod 
rlijlDUs mini- 1u flUHniA«. AlkUiidunt Ingnilön of fcodi o'^niAliiln 
osah« Bd'J f^pPt. ap;*Tpi. otaiii;» [rhubarb], cto.) inA^ In<TfBw Iho 
aiiiount af «si&lle «ad In Ihn urk«^ 

but rotint locüo jwid' Thfir oocvrT«m b of n» «fp^ial ftl«HgO(HlIo nlg- 

TFii;, I2S,— CitlciLiiii HkaIaTu CrjiluU in Urin«. 

nlf^»EiMi, [CofiitQUt 6V»i>a of OKilnte of Hin& In tlir llHiip U inrliraUvo 
of tlio ao cnlkd litliic add diatljLvU: f.ff,, M iMboxidatioD. In rrrrtJ, 
it bJgiiiJl» rNO:nH Etf mir aHiL Iil tlm wotdn of Dr^ IImIiaiu. wU-^-h wo 
unrvHtPcdly imtfirtu*, tliin ph^nfinirtmiii 'Mwlnr^gi lo ii Hu» td tl1»nrifiJni 
dmrpctcr^L^d by mal utirnil« lion» tito «vidpnvv of tvliicb im ilinivtL. not 
ini\y früiu IIld dUlUrbnncu in tlio ncrvoua, circrnUtf^r^, nn'l clij:«*tivo 
or^nn*. Init iTnin Üir |irripnfi.> Sn UiB urEne of nn dipt« of one of tin) 
iMonb IntportAht f^xcrrnicintitiouH uiotL^r« of Um uriuc— uHa «etd. Hid 
cKiJMiH tit tbc 4t[>(t,urbflni:a art vnmii«« Tbf-.v jimy I4 Irair««! cliti^Jljr to 
OTBrti^riHitm of tTif itiimiiqI fni^tiUh«. ti> tim an^jt^tie« of tiTtAlm-ft-i or ot 
profnfiornl life, couplod. pcrbapit vrlth «m>n of di«t »ad ncgfciFt la 

ri-A'iii m. 



inaoy minor m*ltort of ih* pfsnonü health." TiidUno U vnj comTnotily 

Hlppurlc m«ld (Vi^ \£7. a-vi lairl; «Ktim in ountml uihu*. iL Jn 

it U bIh ucn in dinbelM mdliliu and Diuiy hcpMk «iiitnrbADOC«- Ic 
apiviiT» In tht form of omkIIiüi «ltd tliuiiiblr prisiiu. uhU-h In tiriLtrbtl tci 
IriplB pliAiphAt* aryhlal» iwitibling l|]i>»i, nrn iiini/f/?j:f in oarifa ariä. 

Cyttld (Hjt ISS, rj U ow?Ai*iooftUi- olwninl in pi^notlio cyrtiburid 
of oÜierwUv hcatthy Autji-cta. ■ml atso Ln irtlaulii ilicuniatiiin- U 
ofwnr* Sn tb« (orm cf palo. ilinded prttcc, wlilth ninj- bo raUta-kdn !<-r 
im< ftcid' Hif-y ara dittint^Ubikblc ftcru Um UtUr by th« CmC Ihtt Üiry 
MTB di«n>^tetl {Jtf adiiiliim of ■> /«w drofj* 0/ omniorrfa. 

tPifT, 120.— FntTifry Or^Ul- of Tiiflu l*bu«pbftl*. X ^flO, 
(Afiar ftfjiaii,)] 

Lends «nd tyroaU iFi^- 9^. ire pnj^-c 21S1 «m uauaIIt b« drtmon- 
MtbM in OiH miliinriit only ifTi^r }^idii«] «vap^tmtian ar nporlutLon 
ot a Htnall amount tifofi a sÜdr, The Iftf^n *pAn-«f« may nomtqon^lly 
bff viiflairm ^itr fiavin«ii<uin vra^. Ftnm Lho bttvr, h^wcimr, cftu b« vb- 
l4inM by uilditLon tl UCI Uw» ftbov«-dverib*il cv^U«!« of frn ufk fl^^ld. 

T«*ui^ib nnd tyratin bnve mon fmiunrtlf bna foun<t in a^uI« irWIvir 
Rtrspbj of the llvrr, md lc>>fl riviuviiüy in pho«fi1ioni?i poLBanitix and n 
l«ir OOUl« kikf4<cflouB nrd Hiri^nlc hiovl dkvüu«- 

Cholesterlm (>V- Dl) otf&iloTiatly jif>p«*r« In Üic iirin« Tin flUrlA 
tAn^untn, f< )jin'>oi>-FQ*. Hcj. 

T&t-B««dlM ftnd iitiiLlJ fAt-^ryrtal rotHI«« %n «««««»nAily oburrcd 
in ÜL« mlue in "Urifv wMU klflaey." Tliey »d bv posJÜvcly HfuUDt^ 
bj- Ih» tr»<ttck|ti «Irr-adf T*lprred ic fpage £0>|, 



CrjitlAli vl triple phoapluta (Fly. 130. 1)*-^^. ftiuinouii' iiiae'i<'-^1'"^ 
(vlioptphatp — arr niott fnK|iii*nt]f met ;vitb In fainliv ofid trnrl ulk^litc 
urinal. Thpy appear c[ikÖj' Sti t*i< form «^1 llinw , f*»uf , or •!<- ftidfd 
prmiD» Willi 'tljlLpj* irnilii, mnd arv lli<'u (IvJicLiiiti^d ■* "ruirin-ti«!" crjtitalis 
[rwmhUn^ rh^ Wd at n (J(>nimfi nilTlii — HhookiJ. In ftililltion tn IliU fnrm 
thftTcM dfVfllopod "■iciiffp" ifitm i-i^uiu« often obHrvvit, Tboy or« diMin- 
gul»hcd From lltu vryiLulK of mnlu muI Uippurk; *dd by i.linir irmly »olu- 
hidty iTi iir*iie iu>id- In *THnif>"iflrtI frrmAftUlian iobniriic r-yniiti^j lh<y 
■ro BPVCT ImikinUi A^-nfinfr*! wilh ihun uro mtl IliQ 3TÜ0V or brwmi^li 
«pbinvin of lunaioaJusi a;AU fFii:, K'W, <M. Tlir» Brc utu^ljr roM^vtM 
fn mull group!, ard ana not mft^ucnily pTi>v)d«l vUh numiirüita »pictila, 
aIiicH jEivtr tlism Ibc oppenninpe of ft (*<*rn a^plt. Thrjirp ili*linjriii-tieil 

FJa. 130.— CrjulaU ol Tt^Ip PhonphÄtc f rj and Ammoniuni 
Ufiil* faJ. X 3G0. 

fymn Iciitin by Thrir rpHCtSim vitJi byilTtiMliU^TliT apI^Il na alrrody ■^lati'El, 
iinrf Mifir <o!i]lhiii1y in potastiiim liydtiEv. 

Onlcium oarbonatc (I'V- '31. n) oinirn in «rimtlrLr, but murA 
amallrr, iiiihat-a thuii (Lniiuotiiuui unite, BaiuclioH^i Utcy Wo In pAlm 
in bluQUlt or dumb-foil tom. Homtllmts in group» cl four, iln, ur incuvn 
On uiJditioD of lijclrorblorio aoid fnt>id eoluLiou of t^<^ orjetal« occuri 
with nctlvfl Uhoratiou of CO» 

U oouun ill an aniorpbotu fom, vHth, aa w«|| a« wUbuut, th« 
orjHtnlfl, and 1» tvnaii iu fjiEittly fttld, aJkAlme, anil ankoioniBrii] utltw. 

Calcium sulpbale (Klg, 131, h) »ciui» iu Lho fumi of Tonv. fn^orlawi 
ijofidi« or rod«, whith ara iiiftüLublti in acüU aad animoma. It ii aoldom 


Ilr^lTnuiii inij IlUiiuimi-) 1 



Kntral oftloluB photphate (Fig. 131, c) ia fmiad Bonietimefl in 
fKintlf ftdd» som«Umeft in diatinctly alkaline, urine It occurs in the 
form of pointed wedge-flhKped priHms, which appear ainglj^ or arrangi'd 
in roBettea. Thej disappear on addition of acetic acid. 

Xaffnetlnm phoiphate (Fig, 131. d) forms quite targe rhambic 
platea, which are readilv aoiuhle in acetic acid. It la found in |>art in Lhe 
white or whitieh-yeltow scdinivnt which not inFriyiiicntly forma abun- 
dantly in the urine of neuroathenica. It Cfin be obtained in i-cr// larffc 
thin plates from tftc surface of manif urities ictiirh present a deHcatc, 
fflUteninff iridescent surftuM {F^g. 133)- Theae plates ma^ be secured 
for exaujination by holding a eovcr-glasa in a pair of forceps in such 

f ^Ä (/ 



Fig. 131, (After ron JflAA<-Ä.) 

a manner that the whole surface of the glaaB conies in coniact with 
tho urine surface, and then placing on n gliisa slide. Tho ihm plates. 
with their man; sharp angles, rer^cniblc fr^grneuta r>f bnikon windiw- 

The phosphatn occur more frnjiient^y in anior^hou^ th;in iit crystal- 
line form. They appear as anmll. eolnrlpi^a grnniih>a whit-li arc itolulJo 
in acctie u-id. The ainiilar urate nediitient which may he iin<-tAken fi>T 
phOBphatca forma uric arid cry^Uls on additinn nf scrtic acid. 

The morphouH and crystalline pho*<phalrs oflpn oin-iir titgelher in 
faintly acid or alkaline iirin^; on tho other hum], the cr^-lallirin fnnu« 
are Jirrcr observed in auuiioniaoal fermentntion. 




With tlw "pocket •pedroflcope " (Fig. «Ü) Iho following 
fttihptnncfls ^-iir iiPiifllly rendily W disHngiiihlw^d (cbn^y uriiw» 
miBt be iIIIuUhI witli wa(er) : — 

1. Oxyhemoglobin, ciiarEtLtcnxcd b/ the weli-kno*n boiul» 
(piLj^c 13i>), i(* ff>tind in frfthly rfltrfW, blfwdy Hrinc containing 
w^U-prMorvocJ (honuiluriü) or no ro^i bloüd-corpuicl« (hoiuio^ 

[Fts. 132.— L^k-iuiii ThuvphjiL« Ci7>tftb. X 330. {Atiei i^rj/fr.^l 

8. KelIiemoglobin> chumcterizod ^[jot-ially hy the banda in 
red: — 

('aj In old, long-»tBinling urine in binnriUm. 

(h) III freshly voided urine in mothcnioglobinuria afkr 
pojHüuiug wilh clilomto ealU, fLnilin bodice, etc. 

3p Urobilin ia reoognwod by a band lyioj^ bclwocn grvon ami 

4, HeroatoporpliyrliiT almost enL-lu^iwly affcr pnUoDiiig 
rtidi suJpJffiniil nnd trional; recently, howuvcr, aImj nb*er7ed by 
FtönkeL and SobcmhciiL io <l typhus patient at the aciuc of the 



fever and during convalescence. 

normal urine, — Brooks.] 

[It may rarely be present in 

The urine » dark bluisb red, almoHt opaque, but grmdually clears 
up. No abnormal elements are found mimtcopicaUy. If the urine is 
heated, no distinct change occun» and Juat &fl tittle on addition of HCl. 
A jeJlow eoJor is produced by Uie additian of ammonia. On boiling with 
nitric acid it become« pale (bleached). 

Bpectrotmpicalll/ thero are found two absorption bands in yellov 
and light green and darkening of the whole right portion of the apcctrumt 
beginning with green-blue. Liquor ammonia aulphuraU produces no 

Fig. l33.^Mftgneaift Phosphate from a Frenh Peliide upon 
the Surface of Urine. 

alteration. On the other hand, addition of HCl causes the appvaraoce 
of tU'O bands, of wiiich the Arst is amaller and leSH distinct and lies at 
the junction of orange and yellow, and the second in yellow and 
green. Addition of ammonia causes the flnt-named two bandfl to 


It mny further be remarked tlmt, after siitphotml poisoning, 
A genuine (toxic) nephritis without hematoporphyrin may aUo 
occur« as has been observed by Stem and the author. 

The demon^trution of hematoporphyrin, afrrrous hemaiin 
( Hoppe- Sevier, Ni-noki, and others), iu the f^^nii of crystallized 
con lb i nations is pos^^ible (Fränkel). 



1, Acute Nephritis.' 

It is nioiit coDvcnieDt to dktinguiüh an acvfe hemorrhagic 
anü a nonhnmorrhagic form according to the bloody or non- 
blüoily character of tlie urine. 

In both conditions the quantity of urine voided is more or 
less connidcrably dimiDisbed, — to from 500 to 1Ü00 cubic centi- 
ineterä in twenty-four boors, — or there is transitory anuria, 
Soraetinics the oliguria persists only for a short time; not infre- 
<|uently, however, for weeks. With subsidonee of the inflamma- 
tory proccsa, increase in the quantity of urine gradually or rapidly 
begins; the latter is the case particularly in absorption of the 
not rarely intense hydropsic accumulations. In mild casea the 
diminution of the urine is slight. 

The specific gravity is very variable. In the hemorrhagic 
form it iö usually between 1. 010 and 1.015, but sometimes much 
higher; in the nonhemorrhagic form it ie usually raised to 1.025 
or 1-030. In both varieties the urine is strongly clouded by 
ftdmixture of morphologic clenients. 

The color of the bloody urine is light flesh-water to dark 
beer-brown, according to the amount of blood and the concentra- 
tion. In not too dark urine distinct dichroism is observed. 
In patients confined to bed the night urine is always less bloody 
than the day urine. In the second form the urine ia light or 
dark yellow in color Both varieties show a more or [e^ abundant 
sediment, which in the first form is dark brownish red, in the 
second pale yellow. 

The albumin content is usually more abundant in the non- 
hemorrhagic than in tlie hemorrhagic form; the latter not 
infrequently gives only a slight precipitate. The total loss of 
albumin in twenty-four hours averages from 5 to 8 grams, but 
may reach 20 grams or more. Urea, uric acid, and chlorids are 
usually diminished. 

MicruscopicifUy there are found in the hemorrhagic form 
numerous red blood -corpuscles, partly isolated, partly in clumps 

See FIe^ 114 knil HIL 


jii-ruiiittAr«i> CAV^rAL«. x «Ml. «Afln IV^vf.>) 

cf AdIieriDg to ca«U, Theee S4>metiiutft> nliow 00 «Jteratioti, cither 
in fonn or ^m: more fr«*ju*iilly. however, they uppear emollcr 
than norrijfll, W^r^' ufleu, ivpvi^^iUly wbvn tho itiM-OdC butt uxistod 
for a ikiinitH-'r ot ilaj» or ww-k*, IIkttv ure *oi>ii in mlditlou to mial* 
L*ra) red I'tlU fltrlicnlr', Iramtjinn-nt dvH^ with «hnrjs rirvuljir ««t» 
line; time nrc^ tlif ''lr«i-hcd" n^ b1ooiI-4-rl]^ or *' lilooJ^ringG." 
Alrnoat iDtiLnnbl> there arc alao obscrrcd "rc<i bJooti-c^rpudcle 
casta,'' coiripc^d of ticcflcly coUoctcd crythnwytcs or blood-Pingi; 
linally» Ir^ncocytm, usually in nirid^rate numbers. Uoi^ or lf>M 
iiiiEnrrniit byalia« and granulär ca^ls nn? s^n whose granulaiiom 
nro e(»m]Kih«<l parlially of albuniin gramiK*« or IcuLXtcvlw» par- 
tially of qatbclm frum Llio ruuül tuliuli:«. Th« hitter Jtlso occur 
free or in groupe^ in ;;rL'ater or leA« nunibcnt, and niter Uic di^ 
Cdoe )iu^ IhvIih! for «toioe tiitio arc in a i^tat^; of parliallj fatty 

In tbr K'lltrnrMt of llie nonhifmarrhjigic farm iRoUtej ird 
lilcKxI-mrptLKclcv oTOtir, if ill all, whiJc the letiwcjl« are alvay» 
very nuiuoron«^ Epithclia arc not infrequently found in large 
nunibcr«, and oJfio £» '*e[>i1heUnl tcbnlar forinntione," though Iom 
often tiuw ID Uic abov^meutioned variety. They are frequently 
in a itutö of adrAncpd fatty defeneration, however, even after 
tlw i]i»<nHn Imn Irtfllwl fur 11 ftw daj-a. 

'Hic (ii\i--iiou of morlufl Bnghlii into tvo ^ubTn^4^1il« a» here 
^vcn u jujtiüetj, £ii»L of ail, by Üie anatomic picture 

In I))« Snt r«im ibtf Udufryi iLn ft!«'Ay« cntnr^^t cfUn to 4 «cn«ld- 
nabl« <I#iiii<i^, and ikuinvroui hauorrbajce» m« i^rewul apuii tUi: uütcr 
■ml cut mirtanA. Th» ln1lHTr>in«türy pfaflnamiBUi tnvnlr« tho f1oin»iil1 
*d wdl PIB lie ivpaI litltili. la th« HC4nd fonD Xht UiAntyt »r* uauülly 
tinly modpinlvly enliirj^d «dJ Jtn? frvm bi.'[itorrhHKviii Tbv dlttmban« 
BffHiU pfiifiTly Ihn rpinl lnhutr^. Atipmla of thr vtj^n nml a[butiiinou4 
rtndling *i'l futtf incUfDar^hfiiU of ih» nnal tpULolla tU4»e(«ls« thi« 

aiutomk^llyi art not bi£rti|ura(ty ob«*TVHf. 

In trnkrT Iv Jvtrnninc vlk«1b« oa aouI« ocf-biilU ot vi intvrcurrntl 
flltgrmlton <>f » pn^i^Un^ chrontr nffrpMiii k« [iiptmi, ihi* Mlwr Hln^ 
It*} AnAiag^t •« vtJl ^ th9 i^namfiHl« »UtcincBt«, uiu^t Hrwl b« Mn 
■Idcnd. TUi; IaIUt t'ouilillo» rtiu«i W U^ovtfbt of ««|i«c;iiUj vfacn, in 
«pif« of ib# «ppmrrnt frrfttmmi of tli» A^wfion. thp ndiomit of urtca b 
i|llit* Bli^ndaDt or crcn IncFT«««d, Uio «peeiAe irmvlty low, uid ml blOi»d 
OoryuAclH and eaMi itiv tuiitHl m Ibt «oauly «tdtniriiL 



Etialogtc ililTi-rL'uuT-n fur both of Ui«Ae larina of aculo' 
GH^iI'a Jibirafle «BouM diao be oonaiJered. 

Jk* n kaovriit thf äiwmK« vvrj mMohi occtint primkril^- It apprAra 
fn^n]i»ntly a« s ifpordtary nfftrtion, «wpc'^mTfy umW th* 1nrt"H*nr» »f 
inl«rli«u< bbd louc jigonlt. KxpcrK^n» hki thowii Ihctt tn f*jr' ««ri«« 
L-hlcilj ftcutc leirtün h»Kir, In «nMlicr prUidptllj öoubcniorrhfl^, nc 
(ilii'itin citTiiix. Alt u rt>rihi>«^ui>ni-4L of fjphoUl ttsVff, crijiipnu« pnviiinuuiA» 
MTH« ''«oMfe,** In tPp4U anil aiti^ inunction« vtitli yir'lroli'urn, nnplitol, 
pU'., lliP flulhor alinoflt f^onslontly üt^wnrtl llif ftcuW befnonLcicIc form, 
whSI* In [lip^ltb*'Jln and pn^gnnncy nonhcmnrrhflgic ncpLrliiJ" uccirrml. 
Tliiv funn uf Df-pbritiH ia ilIho <if cunatülil ot'iiil"cn<v in ('bf^Ibrii, in wluvli 
uuiui.'Ti>tiB fnlty cpElhtliiL nni dlBtin^t Ut-j^riLiiult cclU «iipuAr ic ihv 
tihDfl with mrjirtfting raj^^JHy. 

Jn »rnrlhliiiA the iLiJthvr mw ohivflj tho Riycoiid fomi, AUIioiis(h 
uHno ivlth i]Hd«lLy blooily ch&m:ttr wtis not, r^rrly vbflvm<i]; tlw 
''(W«<u* fptd/rini<V'^' BpppinMl to p^ay an impnrtiint rOle in fhii r#*pM!tv 
AniittmiifAllyr thr HcurUllnal kidntj nlmoHt alv&y* pn«cnU the appear- 
AUCQ of Ihr* ''lar^ MliEtv VhJitry." 

"Bright'» dUtOM t>f jtrfffnartcif," to which yon }j*y6mi oipwially 
haji jii>ifi:iirJ u jinouildmit positjon, a]<u manifi^tl« fa the tT^at majority 
uf liiHlHni'tt* Ih*- TrHtuTivt of Qm \mW ffiUy kliliH'y. Tim uriiiw In »ciinLy. 
unulty highly albiiminaux, nnd oontninii niJinrruiin jfraniilaT nn^tB with 
fal^oplHa aud not rnrrly tfat-i^rniinlc »11s. Ccd blaod-rcbn and c\cii 
lieiniinMIn crystuU alto occur, alttjLiii^ tha laltflr ate very rarv. 

X Chrofik Nfphrltis- 

(a) Diffase Neplintia (Xai^e White Kidney'). — This form 

ofcurn lui nirety in prudtcs, sod ^üti iit«nlJj be tliftgOf^aticÄled 
with certainty: rar(?ful '■vaminalKm oi the wrine contribuJw 1j> 
tliia enil in a Ingli Oegrw, »nil eveii ii\onv ofttii smffitta for liie 
n^cögiiition of the tliseape. 

The vrine is pnlc yHltw, rlwoy« cloudy, »ind not infrtvjticntlj" 
sti0wa upon i1^ t!urfu<'C a &>inim-\\tit f>itLy >:Ioiv. Uiuiitly aq 
abundant sediment is precipitntnd. Tho quantity i% alvayit 
äiminUlf fid, ctt\\y t^Mn^m on riTUin dnyt «imnwhnl mnrp flbuii- 
Ojuit^ averagitL^ froitr 300 (o GOO cubic ei-ntlnieters auil to^vanl 
tlie end of life uaLiolly reducoü to from SOO to 100 cul)k cgdU* 

I'hc fpecipc tjrtivitij Ir fllmoat idway» in<?peiufi!. InverMly 
pro|>ortioiuite to the (quantity. Aa a ruk% it ü bvtw^tiU J.OSO 

!&»* Y\t IIIl 


X UOl 




nnd IMO, The filbmuin ci>ttient b a1tvaji'& very bigh; often 
more thou the half of llie volume of uriue examined coagulate« 
Ml heat inj:, 

Microsc&pieoUy there are cooatontly fotmd v*>ry nnmoron« 
tormod elunii^'uls. Tho*e üjv toiitposed of amut^röuA iGucocjt», 
n vi'i")' scRDly iiurnlH-'r of i*rylhr>cyt^^ und ii=iially eitn-mt'l^- 
nuriipr^njE aiais of vnrkjUA wiUtht^ nnd leitgtfis, fint iiiffi'tiucittlj 
prtficnting itotclic^ facet*, convoluiiooe, swelling*» etc. In mo*t 
of thorn ciu be aooo f nc or C4>aiv^ ^^rnnukr f^t Aud nuni^Toiin 
M-grBDiil« cell«. The latter ar« alw quit« often <ibi^r\4^ fn^o 
ID tti« flold of the mJcTOAoop^, and undoubtedty oorreäpond to 
fAtiy-degenerabtd renal e|)!tlke]ifi. 

If these iindings ore obtwrvei] almu^t unaltL^red at n iLumUur 
cf cjcamioatioua, tlie diatciioifiijt of Inr^ vhttc kidnry ccn hv: mad«; 
vith the >^nt«t prolmbihty, partipiUnrly if \hc FiÄn« of carduio 
hypertrophy orci iibM-nt and hydr4>pit (uniAlly quit« mnrkt'd) is 
prracDt. The CEhuTnoIcrr of tha tiring i« «»xplaini'd by tho intent* 
fntty dPgpnfrstiQTi of n-nn] epilhelia, the ani^mia, and the difiimu- 
tion in »ieot or complete atrophy of Uie majority or aü of the 
f^'lomerukr convolations, all of vhicb are con&lantJjr prevent ib 
tlua renal alTeetion- 

S^rerc colds, aypMli«, molaTin, eiCttrlatina, ote., nro «tiologio 

(l) Chronic Nephritis {with Caidiac Hypertrophy). 

L The Ordinary Chronic Briifht'* Disease/ — Thia subordor 
ia the variety jno*t frcijucniiy md Ntth in praciü^, and ctm W 
recognizi^d with quilo a d«grev of o.-rtaia^ by 1h< cliuract«r T>f the 

TW urine b generally eTotidy, }>ale yellmr, niid^ n» a ml^, 
dcjioftittf only a scanty, faint HHlirueut. It i» tiMiully toidod in 
üiryEcr qunnttty Ihfto in the Unt-t^wcribtid form, avrro^ng 
tHilvTiW^n ^^00 and 1 lüO eubio ccntinMitn«. Tli>^ i^iuiiititf Bcldom 
r^niaiitfi for any length of timo at 600 or hbUk, Tho epeciie 
grarily in vannblr, mint fm^iimtly iicmi^vbnl minted — 1.01? 
and 1.010. On tlir otlirr hand, Uio dbntntn content i» ahr«y« 

MicTMCifpiraiitf thero are u«ually fuund, in addUion to occa* 

>Nw n« la 


mcjioscovr akd cirEMismr, 

riotut red and «omcwbat more auinoroü« roTorlc«« bLood-oelU» 
quite a niimKr of more ov k-^ fatty hyaltno cast», to vrhtrh 
occofiiooially adhere ohaniot^ri^tie, moderately fatty T^nal «pi- 
Ihelia wliioh at« ofl^n tran*f<inneii inta fai-graiiüle cellfi Not 
iiifiviliii.-iitlj tlicvtf uiv iilw obiM-rvwl fn^L' in LtiL- iinD^> 

The diaraiHen» of Wit uriitr arc UilXy cxpUined by the 
anatomic Bniliit^'ri. wliich, in addilbn to atrophic foci of vaHoitt 
vxtunt, nrvcol in Uio nurmnl tix^dr rariHy inoiJorntuly iT(iUr^*d, 
otcniiionnlly «otm'^lint lEhruiikon kiiTnf>y>^. niimc-muG frffh p^rrn* 
£9iymäU'tiH and ^nUniitittl infinniniati'm. The qiiniiHIy of nrine 
IB more or lese dirnmi^ihf^il «tfurdiii^ lo Uie |nv(i"Jii(l*»rÄrrtv of llic 
paivnchjiiiatouä infliimmaticiEi. Oo tli« other hand^ it it 
iucTOoeed when tUcru te a niorkvd tendoTicy to traiuitiun into the 
controctiKl kidiioy. 

£vm iii^dor tlic^o eonUitiona, however, whicih hare led to Lhi^ 
drrrOopiiirrit. «f ttii* ffvititi'i« of Moondnry contntcted kidney, hiir 
amount of AlliiKiiin will fllw^ya inswrp ihc ȟa^iinwfc. In tipil<^ ftf 
the fact ttat tlic quantity of urine ia angmcnti^J to SOOO culjic 
ocntiniclira or tnori.\ I'liis, however, ie ouplniiiod by tho cor^atant 
participation of tlit^ par^acliyiiiatoufi inltaifjiiJAtory prooeaws, m 
l]]dicaü?d by the fat-^anulo cells, and tlio numw^us casta. If 
Hie /hniicnl i-l(>nii"«Ui »re i^iiUn-ly Tnikiiig for vrtxkt tit ii tiuii', Ihi* 
di«giii>sia of grniiinr cnntrnrtrd kidnry niay WTonÄ^y b«? made. 
The fact tliat thi^ upwific KTJivity, cvi?n ie npitc of the incrcgiMd 
«Linount «1 uritio, roachoe L0(2 to 1-Ö18 and tho allmmin nont>nt 
h uBUfllly high, generally protoi-l* n^iiirit thin ^rror, Fwrlhef- 
niow, oarefiil si?di mental inn or rprif rifngnlion uniially prrmitB the 
ifioj^uiliou tit rlLMiiH'l*.'n?^(k' fi>itii"'il r.'k'iiJi.[jTj-. 

fi. Chronic Htmorrhagic Ncphhtia (Wci^rl'» Bed or Mot- 
tled Eidaey).— In thi» renal affection, tekick in acute exactrba* 
tions rtvt irifrrqumthi ^wca rw*i io conftntinn Wfft acufc hem<ir- 
rhagic m'l'hntu, thr urJnfl grncrnliy |ii'i»"nU tho rhnrnclwr of 
thfi iirirr ob*i*rv<*d \x\ itmtrnrtiTil kifln^y. Ktir this n^nton, th^TO- 
forCp it retfuirea e&pccial mention, Fincc without J^monFtmbli; 
cauae it ehoMi« a diaiinclly bfoody chorndcr of varlaMc frtxjucncv 
iiiid inlt'iwity. — a feature which is ob^^orrfd in genniao contracted 
kiilnoy onhf in a very imall proportion of eas», 

Tim iiiirLe In ofti>n pale v-'llow, Hiid lK'po^ita only a wiinty^ 
piilr-yrllriw or reddinh H-diiiieut, ur tiply a witii-whiit mnrp dlft* 



Hoct *'nobccaU" in »hlch a tew mtldifti «0 l^IooO-coipiuclfe» 
Djorc Jrcqdtntl)' blood-mgs ("elmiiow»"), and a email liumber 
of ii^-aline coeU ot^tiupied by bloo(i-riii>,^ ort? aJwnyr: founiL I'be 
quAntlty fa norma) cr inorenBeJ — Ut from iiOO to 2U00 cubic cen* 
tlineten. Tbc Amount of nlbLuiiiit bt «li^hl. 

Anotbrr picture i:^ prt^^itt^ \>y IIlc- iirinr .it tfirr tniir of 
licmorrhofo, vhicti ^m^-tinK^s rm^ur* «iTilfrklj or ifl mürkcd by ii& 
iulcrral of many mnnthfi. The biOTrnUh-rwl or intniMly-dirty* 
bruwfi urin« ofi^m (Irpoiitn an abimilaiit t*?*liiiMit, Ite iippPT 
bi^wr i* Ihi'n from ligM t-i ilurk fiwli-wator <'ftIon4l, The ijua»- 
tiij iläc^iJua to 100(1 triihic L-entiin^ers or lew, Ihu Albiiiiiiu oon- 
tcnt i^mauiB modent^ and Die ^p«I£c ^ravit.v i» hIkiuI I.OIOl 
Od tbo other hond^ tbert are foand micmrcc^piciiiZy nitmcrous 
cotrb vhicb arc oft^n w thickly corcrod with rod blood-oorpuecio« 
and "blowl*ring>" that tltcy mxy jujatlj b« ^Migiutcd aa bTf>o<!- 
(nr|ixi»fl<- r»><U, Alvn, ns n tuTf^ piimfimnH renal ppTOiMU iirr 
lilifmni frt'c nn<l tijinn *'a*J», Fal-gramile o^lU nn- never wcti, 

3> Contr&cUd Eidnej [Chronic Intentitial Vephritii]. — 
The nrine in pnlc yHlow cr p;tk p^rccn nnd perfectly cli:ar- It 
d«p(i*iU only a T(?ry «canty Miluiicnt, «'hi<rh may, howcTor, be 
i-ntiri'ly nU^iit for wp«ka^ Tbo i^tiantity i« ii^tially incrra^W 
to from Ä frt 3 iit4»rs and mjiy riw to from n to ft lilprs in twf eily- 
f«>ur boirrfc. Tkte ^pK-lflc gravity seldom ■Itaiita 1.010. and 
UJiuBlly afcragt?» ].005> Aaidc from intercurr«nt dUtorb- 
anfri':^ — uremia, eta,— the ntbumin content i« alwayi very 
ulitrht, and may 6e> enfir^lp ab^nt for day« on4 ir/rir^. Tb^ 
ijp4H.'ili<- gnivily «rid the albutiün »ortFtion arc K^i^fi In ni^ht urifio 
tbiLO in dAT iirinp. 

Mirftaropir^lij/ nftr'n no forinix) i*Ifninit# ritvpt JKoleted 
lL*'Lii:oc)i€0 and oomaioojiI hyalin« out» arc found cTcn «ftir vetk* 
of exankination with iwMt catvful illumincition. If, bovover, the 
urine h ^xamin^ daring oooadionn] di^ttjrbunct« of gtocnü w«)l- 
bein^. ftp^ially dnrln^ nnd after a ürpmi« attack, eosti and par* 
tiniinr^y aliio epiOirlia will not rarely \w found. 

It aliould be e>]>eciaUy emplitiMxefl that in inliTmrrml 
feWil« dif«iu*»t aiic-h oa pneumonJA and the likr, contrary to 
vrliat i« ordinanly olu^rred, no ooneontntod 'afebrile urino" u 
ihp^n, biit tiFually a pde^yvltovr nrino with low specUle gravity 
(Traube^ Wagnrr). 


MimrarnpT axd nroirsrnT- 



The featuru» of itiv uritin nr«^ nstuAllj lo clmrnclcrivtic tlint, 
with tvinndcration of the flthcr clinico) phcaomcnn, lypcciolly 
thoM mnnifcstod b^ the heart, tljc dia^osifl cen be mod« with 
certniat}', Tnclvvd, cr>nfii<;ioc only with amybid kidiwy c&n 

Thfi larg» anrnTint of urin» voiiJ*() Sn ponlnrr*<t Itidnvj U fur- 
nlithni hy \ht nil]] prrsfrvrd lUid camptnitirdj «troa^ljr liypirrlrnpTtioJ 
imrla ot Hit kMiicy» ntcd^Uy thr vpllfu-lU ahiI gtouiiWL The ülC«r 
form Kid ^'gmnula" upoa lhi> r<iilular imrfiiou of tJiio kidiicj^^ Tl« 
AUfiken jiart' coriTiipi>niL t<j tlio aIk^jI^Ig |>utTru-)iyii»alAUA aroA^ Ui« 
fujii:liuü uf ^'likki liJt» brtii vnÜnly alH>|ibhed. If uuulc-pjub cttta An 
fountt in th« ui-inc. it tnny be nuumpd that a part of thv kidney U Again 

KM'.n?U>H iirim^ ImiI. uwinjf iv ihv niiirr rjT \n$ Ailvniicinl miiftL Atn}[jtij, 
ullciw« ulVnmin (r tntniiidi'- 

4- Amyloid Kidney U uut iufrH^utnUj^ miftaki?!: for t!Oo- 
trAchMi kidncj-, bociiufie a rery abundant, pal«, clear, und aligblly 
ulbuminou» urine may nlflo bo cccrctod in nmyloid dcgcuorutioo. 
Aside from tho f«.Rt tlist araylaid kidnoy ülmoet nlwAys d^volop« 

ir polmonary nti^ inti^jstinal tuhprpulosia^ chronir horn* and joint 
Buppurationfl, sjjihilis, bronchi>^^ta*iflj etc., tlie urJim usually pro^ 
tienl** ifOfeilivo jjointft of difference. 

In tljo ninjoriiy of cases the quantity of urlw^ \r liiminUh^i 
to from 1000 to ei»0 uubio eüntimet^^ra mid thi> ftpoclfit» ^-ravity 
nrurag» 1.015 to 1. 0^0, but often elUI higiior In addition, tbQ 
nlbumin c^ontiTt in nlnmdiint, nnd a mortt-d^ though Hc«ntj, 
teditLii'iji U pn^^fiit. 

ifii-ru&rtjfmnUy it i* usually chrtractcnzed by its oftco ricb 
content of long hyaline cflbts, which arc often two or throe tim« 
tu Jon;; u» tlii^ dianiotor of the field of the inioroBei:t[)e« a»d uäually 
«lendtT. in ttie ki^t days of life the uiimber of enistä U oft^n 
eoTJpidtfrnb!y itirmtspd, nnd iinLisanlly long nitiH vvty hittat] fdrnis 
apjjcnr, Itivl l^lood-nticpusflia um ^rhlotrt ül?wn'i?i], but tvili>rl(»i» 
corpuscles arc quite frc^jiient (ihr. üttihor scverüt t\ai(S ohserx^ed a 
fafi/fl numhcr of ihcm covf:rcd wiik li/ng, dtUcati hcrintio'i^irt 
nvcdle^). As a rule, ppithclia ar^i but m-ldom m^t with, Tlie 
author irns nev^ observed fut-grnniili? ^»11« (ftlth'nJgh ho has fo]* 
lowed moro than Uiirly t-a**.-» lo LeiTüpsy). 

Conlmr-Ud amyloid kidiiet/ »liouhJ be ftOapevt^d especially in 
fypbilitii: »ubjotU, 



CoBtuflioni or th« Kidney oflfji giva riaa to hamaturU loxt* 
log for dA/B or for from tliroo to four vroptE. Ocwionnlljr Uiif 
lifüiULlurin itiu> mt rHviir until on^ nr tux) flji^t iLft4*r tho injuf^', 
iinil mcur nt irr«^;r'iliir intorfal*'. 

Hydropjrr>ii«phri»li U not tnJnx|iirollf att«odp4 bj u ^i<M iDtcr- 
tiiilk^nLT in t\te jLntuuitL of urinr. t.intv DlraUuclion of t.lin iiiclci lOAj 
■jtiL»ri< ii[ ri'i^t (tf iho firw I'f Etrlirc, himI, nn lliL' »Ui"T IihuiI» Tm|ii'ikinir<>' 111? 
jr^tniL^ proilui'«* a ffr^Kt and mpiil tncrt^Hrtif' Haw^vpr» a 'liii|piifBi* «an 
nti*r be bint*! u|toH Hit ilu/MU-r of Use mibv sloue, 

Euptnre of Abicnin of the KliSoer Wil« in 1Iil< fljiptaniniw of 
Dißra f<r l««» ■«oiiMidiinihiD tkninijfiU M pun m Iho tirinn, 

Hali^Fuit HcoplsAms of the KJdnc; gi^« rise to Ai-inufrin^ 
iii BOiut'Ahiil iciort lUau liwlf of the. i-isi-s. rortioiiB of türimr arc 
found in the uriDL- ouly in ejitrcmely rtLre ictilanci:« (occ j'ngc 


Concretiont in the Fclvii of the Kidney not infn^LiiiTiüv 
im«lijw nn went»* irrilülirtn (with n>3ir), wluclt »»metiiiif** orciin 
iL'iihout, iOmctiniGS with, chan^ m the urine* The latter cbicfiy 
consist of hhodt/ admiitnroe. ii the nmount of Mood preecnt i« 
Isjgeg the quMtion can at one« bo J^'cii}(?d L_v tho unaided eys; it 
it othcnriso when the urine ia maerotcrk pic-ally unaltered and th« 
ühvfiiic twin for liWd give iif^^Nillve nt»u]üi. 

In all iLj((niici!9 m uhlch thtr djaguwiü of stüxal nolic durr to 
fdonc is cntcrtAined, careful micToncopJc examination of even 
apparently perfectly normal urino nhould alwayn he made. If 
r<xl blood-eorpuKlof, somi^timi« in »mAll groupt, sro found in tho 
sediment (unäer certain clrernnstanees after eentHfagatloo), 
Uiia may be of great vatue. In additiou to blood-erll^ variona 
«tystals arc frequently met irith : urate. ouUte, or pliwphftt« of 

A« B rahf pytUti» can be Oiaj^uoatiuutc^l with n coriain 
fl4^g^«« of pmbabiUtT frum the diutuctcr of tho urine only in tlie 
dirtinir form. 

Tlie urine ia tmially palu yellow and rtoudy, and depcsita it 
floe, floceulent, pitmlcnt tediment in vTiirh uiicrMcopicälly tiuiall 
plogs {"piw-casU") not infrt^Tinntly c«D bd found. These com*' 
from tiic papillur}- portion of tlio kidney. If nnnl imtation 
Coexbts, bjaline and granular casts axQ »eldona abiont. 


The quantity of urine is almost alwaya increased to from 
3 to 4 and more litere; ita specific gravity is reduced to from 
1.008 to 1.010. Albuminuria is not infrequent. Heraorrhagea 
and discharge of cylindric blood -coagu la, from 5 to 6 millime- 
ters thick and 8 to 13 centimeters long, often occur. 

lu th« flo-calted "oyitlc kldaey" the urine not infr^quenll; preoenU 
■ quite BimilaT character; it may, however^ resemble more doaely the 
urine of cootrBctcd kidney, owing to the faot that pua may be absent 
for a long time and that other morpholo^c elementa rarely occur. 

CystitiB. — In mild vesical irritation or mucous catarrh tlie 
urine is generally faintly acid, nonalbuminoua, and pale yellow 
in color. It deposits a scanty nebulous sediment which micro- 
Bcopically shows only a slightly increased number of bladder 
epithelia and leacocytes. In purulent catarrh, also, the findings 
are uaually similar. The sediment is finely flocculent in acid 
urine, and greenish and slimy in alkaline urine. The formed 
elements are usually altered^ and a slight albuminous eloudineea 
ie also observed. 

Ammoniacal urine presents a repulsive odor, a dirty-hrown- 
isb color^ and a thick, mucilaginous sediment, which i3 formed 
by decomposition of the puB-corpuecIes caused by the action of 
ammonium carbonate. It contains cbiefiy large numbers of 
bacteria and triple phosphate crystals. 

The deeompoaitioa of urea into ammonium carbonate oocun either 
in the bladder or shortly after voiding. H always takes place under the 
influence of certain microbes» among which, according to Schaitzlcr, the 
Proteus wJffaria Häuser is most frequently found. It can split up urfa 
and produce ammoniacal fermentation. It occurs in pure culture not 
only in the bladder, but also in the renal pelvis. The equally important 
badcrium coli la Icbb Infectioua (page 78). Veaieal catarrh [cystitisj 
19 caused either indirectly by the decomposed urine fRovaing) or 
directly by pyogenic bacteria — probably by both influences {SchnitElert. 

In tubcrculoaa cystitis the purulect urine has a distinctly acid 

[The Differential Diagnoais of Pyelitis and Cystitis.— C. 
Dosenfeld stales that in pyelitis the urine is almost always 
acid. Without incilidnal action he has never seen pyclilic 
urine otherwise than acid. It is important, however, to employ 
fresh urine for determining the reaction. An axiom, he says, 
which we can make use of in diagnosis is^ Nonacid urine does 


nol beloTiif h an urKompUciiUd pyeUli$. In tnmrTj form« of cratUb 
the urinc' ia usually ncld—e-g. m fonorrhcAt and ttiWrcolor 
cystitifi and in «jetirt« of urio acrid etonk»^^ — bid, *mcg uo Oo nol 
oonslder tho afid reaction in a positive »en^i?, thin h of no 
<t]^)Oc:ial HSffiiifii^Anoe, 

As to llii? flfrwns>emrnrf 0/ iA* ptv^cvrpuit^lts, they dt> ftot 
offrr tunny Viirialioni': they otc ritJicr siuglr, in ^hred», or ool- 
kctcd in »phcric maMC«, The «pbrric mosöes, which coa*iflt 
only <*i pTift-i^rpni^los, nro of no di^aTiofitio Bigoificüiii'i* ; ihoy 
ncrnnipATiy nny giippnralifin nt a carity rnntiprtril vrhh ihn 
uropnietic ayat^m. The ahred«. wbkrh, ah iiniv^rtally accrptoil, 
urigmntc tunii the urethra, indicate that Ihc Li>unc prut-esi 
U located i-ithcr in the urethra or a ci>nip]R4Lt4'd nith hucK 
Thi«, of coxirnc, point« rather to a cy»titi« tfiau t^ a pyotiltB. 
Tho fonn cf ih^ Umtca^teii in alutt of grv^t importniii^n: thj^y art 
HthfiT rmrnd, cronAlmJ. or r^ggptl, as though H^c^ <3unng inip- 
bnit3 movoni(<nt Tliwa ragged, non motile leucocyt«« are de- 
rived, according to Ro»eafeld. from the pelvi*. When thb 
pheoomenoD id ohocrvcd only id tMlot^d corpuhck» it m of littte 
imporlativo, but when lu uno <tu« th« vholc ftdd of the micro- 
aoopt* » üllrd with (juito round Uuoocytcjf, in nnolhi-r c*r^ full 
of amiOviid-diRtorlpd ]nurr>ry(nb, tho diETprt^ntinl din^tUKia Ift 
t[iipt>iifli^t Ilvnro KnApnfptd fiUte«: Amtiwd'disiorM Uueo- 
Ciftu «ptcie in favor of pi/tiiti^. The find ing of round forma only 
d^a not exclude pyelitis» but directe attention rather to the 
«ifltecco of cyMitia. 

Th« red hhad-e^ptiteUa uUo irumlfcat (Mrrtain foAlurt's of 
ttiiigiioüLic tnluiT: Wht-n IIlov uic ilrrivrd from tht» hlaHdc^r th«j 
arr m-II pn<*rrv<si (except («'«icnl tumtinn), nhilc- Ihnae from 
the renal pclvi« arc morphohigically altered and are partly or 
vholly deprived of their coloring matter. 

Ai re^arda tho #pJA«fto, only kucIi uaaMa n are ehaniy 
teriz^d by a bright nnc^ena, a rmmd^ form, and a i^ixe «ot moeb 
liirvr tluo a wbltdr btofid'eorpuHcle.^^iiudj perhnp«^ «Iso ttmo 
or two Atich epithelial cellH if they bti< imlirddf^d in a dump of 
leucocyte»,— <«Ti be reimrdi^ aa coming from tho renal p^tTi«, 
'llie frequently described imbricated ■rrangenent of the renal 
pelvic «pjthuli« ia Derer obsnrod in tbe urine, Tho atatementa 
in thia r«^rd and in r^fflrone« to the oocurr^nco of l^rg^ 



(filuAfnout epilbelta io cjttitU ar« of a LmJitiona] nuLure nnil 
inappHcfiUe in eitli«r iostauce. Lurgu vqiuuiuu« celU liave 
diafnoaiicultjr rothing io do wilh vcröcal caUrrh; lo tittk, 
indcod, ihat in the pr^Mwncc of lar^sc nuinhvn of them aivd a 
tuvf while c^rptjjAcic« ono cnn Mfuly di Aft» optica to loucorrh^^a 
luid uri'thrititt, but not rj»titU- 

TI1Ü mn»t imporlArt of all criteria is fkt rtUio of aOfUvtin 
eonteiü h Uit ^smuni of pi«. TbU mual Iju ik-lt-niniHHl tiiiaa- 
tiUlivclj. Id cvaticia, gv«ii in iiuuimtil mmmnU of ]i^a whrch 
mako a ^miont WT^ral ocEttim&t«» in hi^i^iit, tkcrc ia ncv^r 
an albumin coDtent of moro tton OJ to 0.15 por cent Tho cn^ 
It ijuHo üt)i<^rwiii<? with thv uriiic! of pjHitJi. Twri viih an 
amount of piJ« nuiTkiciit tn mnkr ■ lajror of bnt frnm 1 lo 2 
millinicter« hi^ at ihc bottom of the Tcstd, tbero will be found 
an anaount of albumin equaling tliat obdcrt^c^d in tnaMmnl dc- 
l^rcce of oydtitie, namol^ : O.L to 0.1b and moro. In very Ian:« 
antouiiU of pu£ tbo albumin content Ib not often above 0.3 por 
uoiU.; biti what ii oharBL-kTistic is Ibe high albamiu content 
in HQiall and niinuta quautitiuK of puj and nn ani<junt of allin- 
tnin always exceeding that present in tbe maximal degnMrn of 
cyetitia. The autbor oJTcre tbe following acbema of four do- 
gr«c« to oxprees this ratio: — 








MmimTim ilJ^r"! : 

NniiK^iiu ]iLtiM^i<ll> in Ub«T 





Modbnit« drgr» : 

r« — dltnant about } etfill- 



mtVir hiah. 



I'Dii'wdtmciil 1 to il mllli- 

JUBl ilmciTiTilf 


mctf^i« liiftli, 



Minimum «li^ji^rtw^ 

fi«ooi^itoMo Alnio»t only t^r 

Sfoi »l^iftDLUillll*^ 

Difi.«i«»tl^ rvh 



TUia table, it Ahoi;ld bo re uic Timbered, is only approximat«. 
Thütie nilf» are baaed upon practical oxpcrionce and hare b«rtt 
contrcllt-'d and x^nfiod h\ cliiiif^al and aoatoinio ob^erraliona. 


Itoficnfctd cites a caae of a man, 37 years of age, in whom 
puncture of a hydronephrotic aac at laparotomy offered an op- 
portunity to Btudy the urine derived from the kidney- The 
urine secreted was acid and deposited a sediraent of from 1 to 3 
millimeters in height- This sediment consisted almost wholly 
of ameboid-distorted leucocytes and a few decolored and micro- 
cytic disintegrated red hlood*celIs. In this urine there was 
0.175 per cent of albumin: i^., the urine showed ail of the 
characteristics of pyelitis as above described, namely: add 
reaction, ameboid -distorted leucocytes, disintegration of the 
erythrocytes, and — above alt — a relatively high albumin 

To aummarize: Alkaline reaction is not found in uncom- 
plicated pyelitis- The limit of albumin content, even in max- 
imal cystitis, is 0.1, at most 0.15 per cent. 

If nearly all pus-cells are ragged in contour, this phenome- 
non speaks in favor of pyelitis. 

If the red blood-corpuscles present are princijinlly chem- 
ically or morphologically di?* integrated, this, only in microscopie 
hemorrhage, and in the absence of a vesical tumor, speaks in 
favor of pyelitis. 

The characteristic symptom for diagnosis is the relation of 
albumin and pus according to the above scheme. — Brooks.] 

Urethritis. — Simple acute inflammations of the urethra 
occur almost exclusively after direct irritation, and quickly sub- 
side. The mucoid or purulent discharge mixes with the urine, 
and usually in the form of muco-purulent shreds, which are, as 
a rule, formed during the passage of the urine. Careful exam- 
ination of the pus, which in such cases must, if possible, be 
secured in the pure state by stripping pressure upon the urethra, 
should be directed toward detection of gonococci. Mucoid or 
slightly muco-pumlent shreds — which, for ctiologic reaponsi, are 
designated as ^* tripper- fäd&n" [or "gonorrheal shreds"] — are 
much oftener met with, especially in mon. 

CUp [Gonorrhea].— In the acute infii-tion the discharge, 
after it has been simple mucoid for alH>ut two or three day:*, 
becomes distinctly yellowish green, purulent, or dirty brownish 
red, when the inflammatory phenomena are yory vinlrnt and lead 
to admixture of blood with the secn-tion. On ct'iwation of the 




luSuuimatioA the dJtfcbArge egniti oicutncp n inoni mucoi<! dinric- 
icr Ki>r t^raminatton of the woMion h fr*tbk tfipr^wd divp 
of piifi ifi lirti nrlapW, tlioHgh iJap latW car cUn bp lAkoti from 
the uriufi with a pipiftt«^. lu wottiva, in aililitioa to Uie urelbra, 
tiie <cTvu Ü jkrinci pally alToctetS- 

iIi<ToecopioMittf there arv fomij in llio miueoid äccrotio». in 
Addition to l«iiodoytoi» ^iftvn'at tiurj« i>r t^piOiulium, mmotim« 
simple Bi|Uftiiif»u^>omi^timn nion^ polygnnjil nrc'vnl i-nrintii« utUi 
IniMiVii prctcuMM. FilHiriti^r «aw many ponjjfnr hyalin«» «pi- 
tlidia nLidi, bec^u«« of tWir terdeacy to lurL diAtinet browi^ 
nith iodin, lie d^^i^niakd as iodnpLilic. lu the etadjum bknaor- 
rboicuin pUB-corpuecloj almost (-xclugiTcly arc ms^t wiUi, noarly 
n}} of which arc polynudoar and un staining of ^ry proparationa 

Cf^ijf, Mueh 4:i arr i«i!ii tit tlitt hlociil in li-uktvuin, iUa griuiuhv cif 
which ilo not fil! the i-.ttU. arc nlmo#t tD^arinhly friund- At i^vty 
«to^o of viniloDni^ tKc rhnnict4:mtic diplococci ltci?nococci| con 
bo rfcmonslmlpd in the w>crction. They aro most niimcroite ia 
Ihf'crPiimlilc*' pn*. 

If all trace of dincEiArgti is absent, especially any atlmiiiture 
Hitli tlie iinjcijiii^ uiißt, and if the nioul tran^fLil twiibbing of Uie 
urethra no longer ehows a trarc of iH?rrcti'>n, then the di*wiKr 
mny be c^mÄidorctJ entirL-]y ciirciL l'ortüuatMy, thin occur» in 
the inajority of caeoe, am] ehontd bn especially omphaencd id 
vi^tr of iho widely <li*tribnted pr^siTnigm <if many phyAtcians 
whü ileiij that heallTig of a gr*n*>irli''a €'vi?r occur». 

It it true that in not n small numbf-r of ca^c« |:onori1it-<it 
becomes chronic, A cloudy *miicoi J dii^chargc pcr»i»ta vhicli 
boootnes purulont after overy ^ocng in Baccho aut Verterc, orwl 
which UEuaUy it distinctly pri?ecnt only as tho «o^eallod "tni^rniog 
drop." Tn wai^h patient«, who, vith tnattenlum to their erudi- 
tion, jnny no loogcr bi- coii»czout» of thur diM^lmrüi-, wc invariably 
obeene Ibt " irifps/'faderi,'' the important «i^iliea»c€ of which 
hoB bceu emphasised fupodally by Mirbrmp^r. 'J'hey arr Irfiiia- 
luct^ntj niHooid nr mora opnc^uo yellow, c^tjhcrent forrnatiMie of 
variable length {the author found ihcm tut long att «ii ouiti* 
mete»), ranging' tn t^i/c fmni ¥ery fine thrcAils to lite thieknan 
of a kuiltJug-ntedle, which usually appear at the begrfnnlitgp nior«; 
»cldom at the cod, of orination and can be iccogniied at once aa 



&hn?d^ hy elrong foi'c^ ^r llii« itrliiarv rttvuiu and ij;rGat ilj^turb- 
lUit* of Die duüi, lUHiij an." flMlnli-i^rutifl nml i|u«"kl)r rärluctMj in 
eb«; ütbcrs, again, rwist cviui tlic »troiLifivt flow of unnc. 

It i» iLclTi»«bIi; tu ui-curv tlicm an quickly ru pca^iblo from 
the Liriiw with d pi|K»1t« and «^ifltiiiitif witli<»tit A^iny. Micrctf<&p' 
iritUy Ihon* will thm bo foTind,ai'»*nr'liiig lo tli<* yrll^w tvilorÄt io», 
m^in^ f>r lev« iiuiiu-niiih ]iut<-Cfii|iuM-]f« (und ewiLLopliülc cr-l]j^) in 
odditioii io variouHl> äWped epiüi^lia from Uk urlnArj tract 
8onidimc« Üiorc will b« acfu ouly aolaUd «quamoiu cpiibHin; 
at otlior timce tlit-äo are mf>r<i iiuui(.'ri>us. Tbe author aivsjt 
obaerved numcroitf clitb*»haped und «ivkle-formcd epitbdia, noI 
mrply t^ollptted in iknw rli^mpit ninJ bmu^ willi dUlind^ nom» 
|mrii1ivdy »mall nurlt^L )n ntlditioD tlicrr uUo occur (lov and 
higb] cylindric and gobIct-ci-11« ; furthermore, noir and then 
epcrroatezoa and ij^oIßW blood-crlU, 

H is of the greatfmi irnporlam-^ fi/r the practitioner to exarn- 
■110 tft^e thretU for ^*}nococci, and very omcntiftl to niak« reppalH 
eiH>iiinaHon<< of a iiufuber of tbetn. Imifrd, tftey jt/rtiu/if A« 
4!zaptirieil v}i(k a cotiArü^ntiimimeMB ^qiiai t^ thct miini{cjti>'\i in 
examination of the ^patam for iubtrcte ha<iHi in doubtful onsets 
if repeated ciftTainAhnc« invariably itriTc nc^tivc resulU oa to Die 
^DOcoecujt, thfn tht timlfnat of tmnh shrtds w eirrtost cerUiniif 
to hs excluded, and, in a givtn cost, marriage ma^ be jiermitttd. 

Wc will Kere emisider a wr\€e of patliologic «latce oocuniitg 
partlj* in conjuaction with gouorrhea, the r«oognilion of whidi 
ttdociiWiy fnciliUtcii bj tliL- niicfOKo|R", 

Spermatorrhea.— Uu unuatiort ^nd duna^ [|eJoc?iilE(in (miis 
lurifion niid drfot'nliou tEpuruutorrbf^u) tliwo U di«clurgiH3 4 thitip 
ropj nuieu» wbit-H may be »ocmvi! tn n fr«^ *ta(e by tlm pntinnt 
UicrMcopic rAiuiit nation ühow» mitiibttnkjihlfr |inwrnrf of ^yvf- 
mofcocoii, which ^ticn monifnl perfwt rootrlity. Not rarely, 
hf^f^ver, Ihry *how flIi4:>;i,Hh movrmrat» in addition to eit^nial 
clianj^c«. Thcae eporinatoiioa (liko ilie noniml) lako up Üi« 
flfiilüi d^n vdL If atainlng U done vilb a dilute Kotution of 
mrM-fudii^in and aflerwan.) vilh »Tetbyli^ne Htip, i\ta tail :iih^ 
iLkiddlr- porlioQ ilain lirtjflit n^d, the brad blur, ami not tafrv- 
queatty with a pale-Hue cap <l*o«ncr), 

yioftn^i Hmtn-'Tvaeiion may alio he mcntionrd here: — 


A t!ii?p «f polftffilun Irl'iodld« «olntkn (iod^n, 1.6£i potAjunm 
itfd'id. ZM-. waUt, 3D) b ptarH b«r«tli ft L'vteri(l*«a with & diQ|i of 

DftHmM tfvyrfgJ«, the lonnAtion of «Mdi k Juc to • «ctAitt ■t«fi« *>' 
JimiulrfTAliou uf Ivdtliin, In Cicabl/ «J^cuIaUiJ mm-ii iLu ileminpiuitiiia 

In aftDMp«Tm«t«rthca bo tf<rmmlo«na mr^ fooai in tkc tkJA, 

FrottilorrliM -AfTrr h fr"<>'^^t^B Ihfra not bifr^quently rwmainjt 
ft cbtonk |iii>*l*fr<Tiljcik wlui:ti. iiviit iimr l<? Udh^ c*porUT|jr after fi^ 
quoit mitu*« may Ictfil Iv & tbin ur lliicW fluid, purvlcai diicbufe. 
t iui*r 4Uoh FirT<um>:iHnr#i» » rnnirrnirv 4f Ibi* ^onorrh«« vl^ rm/äWf 
b« jufluuicil. Tb? prsvllUoDcr max mon r««iJi1f b« IH to vuA a «on* 

Flff, IM^^-Sprniistorrljtii mad ProftAtorrlivn. X 330. 

duftiun itlii^n n diup of rfraniy »section cftn U« iticuln tu cxud« («t the 
invHiuhJ by Hlmnjr prt»iiiurB (with tb* AnpriJ fKpin lb* |M'r(ni*iim tnr- 
warö. At olher tim^i lh<r pftUcnt i>bt«rvDB thttt «iLch ■ itri^p apiiMtr« oit 
uvcrc »ti^intiig at itool or uiLnfttion- Tbl* iccidlUoii >L«t inficijucaUr 
fiwtUtM ;vhb tpnfmttftrrbfa, 

MicroMopic cxaminnfion is dccfcipo in pro«tntorrlica. Jd 
euch JrptAnfrii iinq^ic^tionrtblo (*ylindric cpilholin. nro »vd, an*l 
also coInrlriüL Mrxiil^vllt, fftt-(!roplctS fn^^H'>nf. Inmrllfltrd "amy- 
loid eleniente," aiid very numrroii* BültchRr crystal octnhedni^ 

ir^ the prostatic juice end gieü h ih^ ^iman Hi charuci^rüiic ^or. 


Here, also, a most careful aeareh for gonococci should be 
made. If they are absent in spite of the large numbers of pua- 
corpuBcles present in the secretion, then, according to the author^» 
firm conviction, supported by practice, tbe virulence of such a 
secretion can be eicluded. 

AsoÖapennia. — In order to determine the procreative power 
of a male it is necessary in doubtful cases to examine for the 
presence of spermatozoa in the semen ejaculated during coitus 
(received in a condom). If permanent azoospermia eiieta as a 
result of bilateral epididymitis, tbcn the secretion, which ü 

Fig. 135. — Henioglobtniiria. 

exacily like the normal semen in qaantily and odor, but often 
somewhat thinner and clearer, contains no sign of spermatozoa, 
but only a few round cells, epilhclia, and octahedral crystals. 

In oligoioöspermia the product contains a few spermatozoa, 
which show slu^^i^rlk movcznents. In a ca£e of this nature, 
although the patient has urinated freely before coitun» the author 
found in the condom contents, in addition to those feebly motile 
bodies and llottHier'ä crystals, a large number of pus-cells con- 
taining g<it\oan-i-i ! 

In every severe liemoglobinemia produced by tJio different 
causes already referred to (p&ge 134) there is an excretion of 


Jinf3lOfifX>7Y AXD ClltMlMTflY. 

bloa(!-corp»ftpb r»iiJu4? in the vritit, bucauM the uplw-n aiu! livi*r 

Tlic tfnri? j^ pale ivil to brownifb bUck, nsd nlwijs cledd- 
cdlf dimi&kbixl : sometimn 1o a few ctüitc centimeter» in tv^nty- 
four hoürü. It it otUm voUM only a drop At n tim;», und u^imllv 
lUpofiiti; A d(>nKj>, brown iiili-n?d or blackuh Bodiiii<<n( c*>niiKiti>il of 
HiKi ant] oonr^^ granule«. 

The fepit-iöt' t'raiity varli«. It b timiall/ low or Dori 
le«a «rflai mi^'d to LO^u. Tlit jilbumin cootccit it tiow and 
CDiofiidcrabk- ; uffunUy, hon^ver, only a brcm-nialired, floccul«ii1 
congutum of nlbiumii floaU upou Uio surfnw. The CJittot lutnro 
of th»> ntlnimiiif which^ jir^jrcling lo Harlr/n U not «^nuii- 
nlhuinin, ]uw cint litviJ HHrrmiitfvl- At aII r^riitü, aUiUEniD liiJ 
ocrnr in thfr urine in hemoglobin cm in u^Hhout hcmo^flobin 
(Ko^t). The »pcftrwcopc ehowa the band» diaracteri^lic of 
oxyiif^nio^l'jlin or mttboinogldbiu {pogt? ISO, Fi^- 70). 

Aticrvjtcopica}fy the complete (or ninioat lotol) e/^jtrnr« of 
rfd lhof!-t:crfuisi-tcs in v^\H.'n]n\\y ^rjrt}iy trt utlt'iitiou. In udc1i> 
tioii iti finf grmuilir, brnwalsh tjrinluji On- fii'M nf the- micr^ 
scope eliows :iHnif^>iifi smal] nnd lurj^f. pule or ydioHX-ili "drivp- 
Iclj"; flls/^ oonreccluinpe of ypihwirlitjrtiwti polor, nnd espocialtj/ 
in Süi'ürü rü*/'fl, more or kes lon^ ctflirnlrtc fonnalions of a aJiDllj 
iialnre. HematoVdin cr^^lala or pigDuiiiti.»d epithclU are Wfo!] 


9cmc^ half c^f the nifcä of ncoplaaiBs of lite kidaej 
TtPftHy all of ilioee of the bl^ddet nra aceutnpiinit'd by homoT' 
rhagps, Pi-fharge of ebarnclnristif" carcinoniji or «urcinna vk** 
mpiitfi seldom oceur*. In tu/nors of the kiiJ/t^j/ (^ylindrk, tarth' 
tL'itrmlik-n bUnul't^oaifuIa iirA irmtsiiifiuUf/ iliftcht\Ttjvd. Tb»e do 
nol rt'jn'i*T!nt teste of the meter*, but ait thua furimHl on tbcjr 
pnsftfl^ tbvüLTgh this lurrow tluct. Their Jarh color «peaka in 
ffiTOr nf thdr not toining from a vosieul liümorrhu^'O. Jn a v©ry 
charaotpmtio ewse of inuliirannt tumor of tt^L» kidnoyj cotifinnail 
hj npcropfi/t *hp niilhor «icw Tiiimcnnis ^iicli vonnlikr foT-miitinns 
ri'iiioved fn^m tlu' |iiilK-iit by ^I'sii'iil irrigaHoii. A* reKnMs Ihp 
eignificaiice of "cancor-celU" find W\t diagnoslic Tftlue of Iftt- 
^rftnulo cell«, t^c reader ie referred to rcniArlca proviou^y mode 
tpa^GB ^ 13, 315, and 3tiü}. 


The charapier of tbe urine voided hj aubjeota affected with 
^hmot^ocoua, diatomum, and fllaria, bh well aa with urogenital tubercu- 
IohIh, hae already been diseuaaed at length. 

Iß calculus formatioiiH in the renal pelvii hemorrhagee are 
more frequent than in neoplasms. The bleedings generally recur 
with colic. Catarrh of the renal pelvis UBually coesists. Tlie 
stones diecbargcd from that location attain the ^ize of a pea or 
bean and are often nodular. 

Tcucftl calculi composed of urates^ phosphates, and very 
rarely of cyatin, frequently give rise to hemorrhages and mild 
muco-purulent catarrh, especially after bodily exertion. Am- 
moniacal urine is observed only after catheterization or other 
[mechanical] procedures. 

Uric acid calculi are yellowish brown, smooth or slightly 
nodulated, and hard; oxalate calculi are much harder, mulberry- 
like, roughened, and usually dark in color. Phosphatic coucre- 
tioßs are soft, finely roughened, and clayey. The stones are 
often composed of several bodies, and aeourate chemic examina- 
tion alone reveals the character and proportion of the individual 
eartliy elements and organic matrix, which is always present, 
composing them (Ebstein). 



1. As is well known,afew dropaof a whitish or whitiah-yellow 
fluid can often by mild pressure be cxpre^ed from the mammEe 
of pregnant and puerperal women and those who have borne 
children. In addition to minute fat-dropiets this fluid is micro- 
scopieally characterized by the presence of fat-granule cells 
(folostruin-corpusclt's). Tbcse resemble in every way the cells 
formed in "white kidney" (Fig. 115), and sometimes contain 
small, Bometiinea large, fat-flroplels. They sometimes appear 
with nnd somelinios without a nucleus. 

2. The fully formed milk presents a very uniform, fine 
emulsion without cellular elements. 

3. In ni'*' J 'I lis Ml,'* of the mamnw a blofuly discharge (from 
the healthy nipple) has been observed in rare instances. 




[The following directions are given by Holt for the use of 
the apparatus shown iß Fig. 136 : — 

"The sample taken for examination should be from the 
middle of the nursing or when the breast has been about one- 
half emptied^ ae the ürst milk is always poorer and the last 
richer than the average. About half an ounce ia required. 

"The specific gravity should be taken at a temperature of 
from 65* to 72' P. By giving the stem of the lactometer a 
twirl as it is introduced, it readily settles to the proper level, 
which may otherwise be prevented by the adhesion of the milk 
to the glaeSj especially in a rich specimen. 

"The cylinder for cream test should be filled exactly to 
the top of the scale. After twenty-four hours the percentage 
of cream ia read oif, each degree in the scale being 1 per cent. 
A temperature ranging between 60" and 75° F. should be main- 

"NoU that the quantity of milk must be determined by 
otlier means; milk may be average in quality ajid very acanty. 

"Human Mile. 

ITT, 7*P K. 

C&iuH^ 14 BouBs 


Normal average. 




Healthy vftriationa 

1.033 toro2e 


Normal (rich milk) 

Healthy variations . 

1.032 to 1.033 

5 toe« 

Normal (fair milk) 

Dnheolthy variatioiiÄ 

Below 1,098 

High {ab. ]0< ] ^JlJ^mal or slightly below 

VariatioaH ^ . 

Belon ].02d 

Nor. (5toJ0^3'Low 


Below 1-028 

Low (bei. r>:i ) 

Very low{ffei7 poor milk) 

Variations .... 

Above 1.033 


Very high { vcjy rioh mil k ) 

Variations . - . , 

Above 1.033 



Above 1.033 


Normal (or nearly eo) 

"Milk presenting only moderate variations from the average — V-Q.» 
Biwcific grflvity, 1,038; cream, 4 per wut.i or epwifio gravity, 1.033; 
CTPam, 10 per cent. — can uaualty be modiriod by appropriate treatment. 
If, however, the npecilic gravity is from 1.018 to 1.024 and the cream only 
from 2 to 3 per oent., it is hopeleafi,"— Bbookä.] 


■ pncticaL rca^ns the ^AminAtion of cows* laiik with 
Ui0 IftetDdonfiuudtcr and LactoHopc is rfrcrixd to m UiU pUco. 
TtiO dend^ ii ikt4.'rmmod vith the former, tm^ wiili ther Utlcr 
tht' pLT^*nttu!i- of fdt is okUitiat^d. Both melltods of determinA- 
titm kIiouIiI uU'^jp be miiile iu i-uuJLiiii'tioa, 

1. Tlic dendtj of fOod (uoD.^kiniiu«d) milk abnuld b«, at 
iri* C, bcturrcit I.0S9 And 1.0;f3. 

The specific jj-ravitr ii dttfruuncd with the T»c4odtnetmeUr (of 
Qurvoino) by pUcInij t^'c ipbdlfl rattifuUj IdLo th« cvliiidti ci;rDtAiQiDi£ 

ttnä Ibc Icnipf-FitDr«, m »hown bj Ui« AiT»ni|ittnjiii|r IlitrninnivUrt &f* 
rairvtullf nconlhL With thi" »id of ft "carrtrtJan Uhlc" U* Actual 

%^*tith gTm*itf «n At on» tv Qblmin«<ü, If tucfe ft iftTil« U not it fi»nd> 
Iho «ftlcidfttbii miiflt be mnde l^ «iddinj; to tkA «p<*dAo Kntitj i* for 
«cb 1* C- ivhloh tlir milk Bhon ftboi« tbe noraml (10' C) tempcmtura' 
ftjid rln ivr#a. 

S. Tbc uaoQUt of ttX in good mftrkut milk should Kiot be ieH 
thfu: 3 pc*r cgdL 

Thv r»:Jnuition v^th Fcht's la^OMope i« based upon tlw 
i&pftAUrcmout of the dq,Tcc of opacity of the milk, ithkh b 
ciuieed l> Ihe M it co&t«ijM [Fi^ 137). 

Frowdftrc— iV'iib ihc t>ip«lt4 /i*J »uck up t^ft lljortii)«ti1jr tnbrd 
nUk to iJie «iftfk If Bad «^inptj tJui «vnlnttjt nf thr IuItp Inio thpc/hndtr 
^f?/, ftl ODM vuUftf tlM milk noDftintog In tlie phpttt« Into lb« ejlLod«r 
«Hb •anw «ftl«r^ Jkua »dd «at«-, «Ule conUftadj aluikinj^ until tb< 




bJack marks upoo tbe mitk-glaaB (A.) iaaicle the cjlioder are juat made 
Bufficientlj diatinct to be counUd. Tbe soale at the right at one« givea 
the pereeutage of fat in the milk. The Dumber» od the scale at the left 
^re the amount of water added in cubic ceatimeters. 

[It is occaBionally necefisary to examine cowa' milk for the 
presence of formalin, which lias been adt^ed as a preservative. 
To this end use may be made of Jotissen's reagent. This consists 
of an absolutely colorloss Bolution of 1 gram of phloroglucin in 

£^ v^ e 



Fig. 137. — Feaer'i Loctowopfl. 

1000 cubic centimeters of water and ordinary potash lye reduced 
to one-third strength. Place 25 cubic centimeters of the miUc 
in a test-tube and add 10 eubic centimeten of the phloroglucin 
solution. After shaking and adding from 5 to 10 cubic centi- 
meters of tbe jwtafih lye, ibe presence of formaldehyd is shown 
by a &ahnou-red color, which disappears in a few müiutes. 

The TolatnetTic Determination of Tme Casein and Other 
Proteids in Uilk by Senf^ei'i Method. — Twenty-five cubic centi^ 
meters of the milk are shaken with 1 cubic centimeter nf a 


nO-pcr-cciit. (»olutioD ol potaaaium oxalnt«, auJ (lifa tnaU^d 
^rith S^0 rubic ciMitimvt^n of a solution of 1-1.53 jjnuriti of mcr- 
ruHc clilcirid intd Itti t^nium of polAdiiiuni \odid in n liter, fol- 
]'3vr«d by 2 cubic cuntim4>t(^r£ at gitn^iul «I'vtic aoiil. After 
<3iliition to ii^(y cubic ct^ntinif^t^m tho Itfpnil i« filt4*r»<1» nnil lOCi 
cubic coHliriietfi* tniilnl witli 10 cuUic rrtilinn-ii i> i^f jiotrts- 
Aium cjanid AoiutioD, cijuivalcnt tn jS «her nitrate solution 
and 13 cubic coCLtimoter» of ammonium hydroiid, an4 litrat^rd 
with fl^ i^il^^r Tiittate Boluiion uatil a permaneEt turbjtijty up- 
pBinr*. Tlie «Jifftfrtfnce betw^een the number t>t oulio «wntioLvlvra 

Tig, 138. — ClivrianJt V;Ui, tmm > Fnvll AlK^rllvii 
{Ijdv M«<ni6fAti0D>. 

KitfA and 4!f give« a rain« i^omapObdinjir ^ith Lb« total amount 
of pmluiJiA ill ^mtntt pt^r lii4*rof milk. 

To obtain the prot^ida not prvi^ipitnlM} br toi^tfo acid, 50 
(Tubic orulimetert uf thu milk mn- ililul'-tt willi Mbnut I.HO ntblr 
ccDtimcter« of «ntpr, and after th« a^ldition of i}.$ enbic ccnU- 
muten of jcfnctiü acetic acül, macic tip ti) ?£0 riibi«: CfiotlmaUr» 
and fi]t<<r#<d, and tho protf^id« in I3<^ cubi« rrntiai«ti»re {=^2& 
cubdo c«ntim«ter« of milk) iMtrminod tu ibovo. Tlio dilbranoD 
Iwtwe^n the tvo iwailta givM« tlie anount of tnio coaoin in a 
Uta of IbL* milk. 



Antold and Uent»!'« Method for the Deletion of H^drogtn 
Pvroxid in Jfilk.^As hydrAg^ii poroild h fiomiftin^t» ii»c<l ot ft 
jfrrKi'fTiitivt' of milk, i1 may he nowewry to tp*l for il« jirrw^ua?. 
'J'hc following molhod» wlijoU Ih »uitalile for the detection «f 
tliia suLataiLtu in loiU raw «n«! heated milk, may be employed: 
Add to 10 cüLic cx-uliineten of the milk sample about 10 dTt>pi 
ci ft l-por-eont. aolutioa of vaDodic acid in diluto iulphurk add, 
A rL*J ctilonitioD i* jirodut^ed by the pn'*i>nt«» of O.OI prujw of 
hjclnj^^ii piTtuid in ](i(\ cii!>ic rnntimrl^ni nr milk, 'ilUiiii* 
Dcfd diMoLvcd in diltile iulphuric acid g'tjob a jflloir cotomiioe 
"^ih 0,01C ^nm of hydrogi^n peroxid. The milk ihould be 
l^tcd as iooQ as poääihk after it is recoivfid- 

Dettction of Tuberol« B&«mi in UiUL— To 50 cubic cenii* 
nit^tvnt of milk aJd 10 fulii? OL>iiljniLHt*r£ of cnrbolip ucid snd 
»hukrt vigtiniiFi<l> Uit frirtJi two lu fivu niiuutje«. 'Vlu'ii pour in 
A conic glow and let alßnd for twenty-four hoiira» or ccntnfu^ 
to obtoin acdimcnt. Make prrpafations from the flrdia^cbL &« 
directed in eputum oxaminationä, dry in the flame, vaah for a 
few minutes in. equal parts of akoho] aTid ctlier to removt^ fat, 
agaiD dry in Ibi* flame, and tituin Ly one of Ibe r]|l^lbodl» givi^n 


Tfl^lnal Saontioni,— In tlio pbykioluHic vo^iual »AcfcUon th«r« arv 
found jiilL7roBti;i[jlL'Ji]1y sguuriiuun epltliclia aud a vhtwiLIu Dumber of 
lflUi^i3i?yloK. Afl Iho roüUlt of Dunicraua injun?! Ihc fiiwiiargp tnoy bt- 

Jn vtioli CRH» the Bot^rction \*, iinrlcr o«rt»iii cirfnimttanoc«. to be 
«NAUjncd for gniiOFüPcl. Äi?türd&D)f to prr^vuiHn^ view« of KynCooloi^t«. 
hOTwvep. a iiH^THtlv*» ryhiilt I" tTiIi* nw^pirl U ijf n« <il|rnifi^'ft»ffl. W1ietli«r 
In tho Ah«ont>« of ^oiior«wi it U jiuUflnhlo almunt iut-irinbl/ to ntir 
ÜK iiiunifuM tlS^U^banoci (c^pccUlIj ca^CB of p;oiBlpnnj(] to uononhc* 

it mil Q ftiurtcj- fif tiitaM. 

Tlio fart dihtvii-iTiHt hy lV\dt^r\pUi—^thai iTt« HDc-ralioci nf tint^i^^ ^ 
sXteaif^ fl.iid thai of mnrrtrd ttoluch or^OAinnjiHr cKitrnct^riJ^ hy the 
pn-HUEiL^ of a fpi^-inl tinollliift oni in wid TPA'Ainti, bhilr ri>ccl mil an 
ulknliuv rf^at'LUm iin^ (t[i«i*r^*'d in tin- mn^orltii of nit^ womon in wh^TTi 
nlturn liana liavc lhi'iimtiI in tli«^ vii^inH — is wuiLliy iff itUciilirjri, iMitlliPi- 
mtiTO. tbo A?1d r^Ai-ilvn fi nnt i'iiii.4<^i] by l^f? bKrllll nUn''^ fat rvm ihip 
titf^Hh vjLglnP of tbo hpaltliy Tivwl>i>ni aIwdj« »nnirokU an add iTBctK>n. 



Tl>« origin and nttur« of tht ai^id iiftv« rot b*?D d*pi'liil At *ll «vnaU, 
Ui» MlJ eaolvat apptara to be of th« eihImI ojcnidotiio* ta Ih« ">«1f- 
pUfiAcDtlcin" <tf Mia iD^nn, ilm^r. tccordlnjr la the Invert l^tiobb of 
Htpgr, ltd vnlriuiL-« amJ ffiowlh of luoUrU in Uui vLglva U ftlwny« ilv- 
p«nd<rQt vpOD Xht drirrw of acidity. "Ltnc« numbrr* nf nt rt I'totiitvj und 
ttdtilijWntoi lTTlrnclutv<d fntn th« ««jfinA of dvwIhuk irirl» und adull 
ivoravn wvre ninr« or lit* rapidly tilM " 

Tbc whotlj IhMgtiiflcaDb irkfawirU IccmmoDu «od trichomuniu. 

Loal&l&,— Tho ftlnnmt par« blindj tor-Hiii ruhni, prcwnt during tfac 
f&r*t d»ja ftftti Ubor unu»Ux 4">ume a Af^h-iraicr ociluf ffofTiJir jrro^aj 
rin tb« fhird Ar fourth djij': ffom Ihtr ninth doj^ orwanl llicj ar* moro 
grajr or jvUow whiU (Uthki n'Acr;. 

rig. 1B8.~nf^^iiftl (VI)«, from a PrMb Abortion- X Isbnui) SSO. 

lb jwiiiJtioii to nunieruu* btooil cntjiunrlv« tbo mJciccKOpe rvrcftl« 
IB thn ftnt «qiuLmfiita «ptl^ioJift «nd not bnfr*f|iiiiotly r^mQUiti of dodiluA; 
Id iho lator irarbtioo aumoKni» pti»«orpuiidoa nn oWnroi vbioh «rv In 
Crrol iKift Uitjr -. iIh fat-opherDlM uid ocudonaltj rholnUrhl crjitah, 

AbottioQ H«n{>tTh^t,»A liecisfoEi ta if> vUe^ihi^ a bloo<]- 
eod^ilum tliachoT^iTii from (Lo tn^iDii FpOiiitAtkm»ly or hy arti- 
fldiil mtuui uintHiim mnnjiu nf tlio nvTim or nut — i f]iK«ti'>D of 
practical a» well n» forauLic imporljuicc— can be grv^tly TikHli' 
UM by the microscope. 

Jf in Bu^li A blooJ-coojculttiD ihe «ZiorJoiüc rilli il1ii*trAUxl in 
Pig. 13d ftn foan<lj in «bkh, ia tdditlou to ft «apdiUr; nHicvlumt 


laore or lees advanced fatty degeneration can^ not infrequently, 
be made oat^ this alone euflicee to asEure the diagnosie of hemor- 
rhage of pregnancy. 

Furthermore^ the detection of deeidital Cflh — which arc 
characterized hy their size; round, polygonal, or spindle-shaped 
contour; and usually very distinct nucleus and nucleolus (Fig. 
130)' — is of importance. The preparations can l)e easily madi? 
by teasing minute fragments. 



TuK microscopic examination of aepirafed fluids eupplc- 
mente to a marked degree the macroecopic findings. It often 
reveals certain clementB which not infrequently furnish the first 
evidence of the character of the essential lesion. Both of these 
methods of examination should, therefore, be conducted in con- 

The author very frequently practices exploratory puncture, 
and in innumerable instances he has been greatly aided in diag- 
nosis thereby. If the skin is always earefully cleansed with 
ether and a sterilized needle is employed, infection, which has 
brought this method of examination into discredit witb many 
physicians, need not be feared. It is true that, even at the 
present day, many unusual things may be esperienecd; asepsis 
is still defective in many respects! Especial precaution is neces- 
sary in punctures in the region of the kidney and in enlarge- 
ments of the liver. In spite of numerous exploratory punctures 
in these regions, the author has never experienced bad results. 
Nevertheless, three cases of fatal intraperitoneal hemorrhage are 
known to him which were caused by puncture of enlarged livers. 
In all three instances, however, severe infectious suppuration of 
the gall-bladder and bile-ducts, with intense icterus, were pres- 
ent. Apparently the coexistent blood niecomposition favored the 
unfortunate result 


Transudates originate without inflammatory processes. 
They are usually translucent, light yellow in color, with a slight- 
greenish tinge^ alkaline in reaction, and on standing deposit a 
floceulcnt eoagulum which is usually scanty. Their specific 
gravity at room temperature (not in fiuids at the temperature of 
the body) varies according to their origin. According to the 
careful rcHOarches of Roiiss (from the clinic at Tübingen) it is: — 

In hjdrothorax lower than .,..,.......,.. 1,015 

In afu'lfea lover than IJIIS 

In anasarca lowor than lOlO 

In hydrocephalua lower Uuui 1.0085 



In plcuritis it varies between 1.017 and 1.0^7^ and in peri- 
tonitis between 1,016 and 1.022. 

As the specific gravity of these fluids cliiefly depends upon 
their albumin content, the latter, according to Reuea, can be 
determined with tolerable certainty from the former. In the 
eerofibrinous exudates of the pleura the albumin content is almost 
never below 4.5 per cent. ; those of the peritoneum, 2 to 2.5 per 
cent. In traneudates of the pleura it is always below 2.5 per 
cent, and of the peritoneum between 1.5 and 3 per cent. 

Microscopically a few leucocytes^ usually in a state of fatty 
metaraorphoais, and occasional normal squamous epitheüa are 


Exudates originating as the result of inflammatory proccuea 
preeent many variations. According to their external appear- 
ance we distinguish serovs (serofibrinous), hemorrhagic, pura- 
lent, and ichorous esudates, and the mixed forms resulting from 
commingling of these chief constituents. 

The specific gravity of all of these is above 1,018, and the 
reaction is always alkaline. On standing they depoeit more or 
lesB fibrin, and above this a bloody, purulent, or ichorous sedi- 

In rare instances a progressive, dark-htue discoloration of a 
previously transparent yellow exudate is observed. In such cases 
the coloring matter is at first contained in the exudate aa a 
so-called leuco-prodiici and develops into the blue body only on 
oxidation (exposure to air). By reduction (addition of strong 
alkaline solution of grape-sugar) it can be rendered invisible and 
be made to reappear in the yellowish solution by addition of a 
few drops of pure hydrochloric acid and dilute solution of iron 
chlorid. Addition of fuming sulphuric acid causes Separation of 
deep-blue iadigo-sulphate. 

In melanotic carcinosis a cloudy, darJc'hrown fluid may be 
discharged in which a hlacliish sediment is deposited. 

Sometimes a peculiar glistening, iridescent pellicle is 
observed upon the surface of aspirated fluids obtained from old 
pleuritic exudates. This shimmer is due to the presence of 
Cholesterin (see page 210), 


Sctohb ExTidatcB.— The yellow, translucent fluids which ia 
slightly cloudy inunediately after evacuation, sooner or later 
throws down slightly flocculent or dense coagula, which not 
infrequently show a faint-roddish streak. 

Microscopically a dense fibrin reticulum is found in the 
flocculent coagnla; a few red blood-ceils, which are chiefly de- 
rived from the puncture itself, arc always observed, and likewise 
numerous multinucleated leucocytes with a greater or less amount 
of usually finely or coarsely granular protoplasm. Not infre- 
quently these cells are considerably enlarged, and are then 
scarcely distinguishable from pleura endothelia- 

H«morrhagic ExudAt«^. — Sero-flbrinous exudate is colored 
dark or Hgbt red by the rich admixture of blood. Microscop- 
ically, the same elements observed in the former variety are 
found in it, but, of course, the red blood-cells are present in 
much larger number, Tbc latter are, for the most part, well 
preserved, though in chronic exudates they are in part "l.eached," 
or decolored. 

As bloody exudates, aside from existing hemorrhAgic diath- 
esis and traumatism, most frequently occur in tuberculosis and 
neoplasms, their occurrence is of important diagnostic and prog- 
nostic value. Thorough microscopic examination of the sedi- 
ment must, therefore, never be neglected, because it often 
furnishes valuable infonuation for a positive diagnosis. 

Demonstration of tubercle haciili is rare, even after centrif- 
ugatiou of the aspirated fluid. 

In cases of carcinoma it is sometimea possible to find pecul- 
iar cell -format ions or even viJli. In a case under the author*fl 
observation, which has been published by Dr. Harries, the fluid 
was mixed with countless colloid masses. 

In previous chapters of this work the author has repeatedly 
warned against the diagnosis of '' cancer-eel b/' However, as 
we consider the frequent occurrence of massed groups of epithelial 
elements in vesical cancer as of diagnostic value, u-c must also, in 
the present instance, emphasize the importance of the ahundant 
appearance of large cells manifesting marked morphologic vana- 

In cnsi»s of neoplasms the cells may often attain extraordi* 
fwry size, even as larqe oi 1^0^, and (hey are usually character' 

wirnffitropT AXD nmirmiT, 

iw^ hy one or moro vacuole anO generally He \n gnnipA. Tb«; 
con(j&iii El «ingk larg« nudeua or. \em oftL'o, £«v<-ral nuclei, luid 
fllui«ft alvra/d «uittU ood krg« fAt-^roplcto, Ihc clone accufiiuU- 
tion of vrhich may nirc mn tA rnormoue '^fat-£raiiulc> corpu»- 
ül*t«" [Glnga'i coTpa«t!l<^i). Tho dügnoAtic vnliic of ihv^o oelU 
hs» Alrencly b^on fully r^feriril to on pagp«^ £43 nnri H4A Ami 
UlustTBtet] ii> FJg. 97. 

In A'lilitton io «lieh cell aggr^^lmnn 1U« oet^urrt-Tice of nu- 
lllöroua iartje free f<U-<irvphl$ nhould arouH! fu*j»kioii «f nei>- 
plunL ömnctimoe the fat-dropJcl« aro ga minute and Hut^jK-ndt^i 
In tho fluid in tufh lorpe niimTtcrE im to gitö (o Iho Uttor a rfy- 
fcwjr npfu-jirunre. If this is the cnso^ the milky Hiarui-trr ili»np- 
pT'iirh on mWitioii of stHliiiiii hj<lrntp ami i^^inklikg wilh etlwr. In 
othci ca^es, htjwovcr» the chvlons fluid is not Tendered dear hy 
tliiä pru^-t-tJurt', which U proof thai Ihe opdeaccnce ia not du« lo 
amuUified fat, but to tino albnmini>U8 grarula (Quineke), 

In % 0»« ßf fiMinomn uf th* Mrniii ni4»nihi*nM fl^»p^T*rt by thfl 
nutlior roci'tilly in tlnmLniriE, h? found »n i>«pri>tnil n^plmlifm of Xht 
]«ft pliriira Knd pfHtoDriil cutilim a pure cbjloii^t aiül in Ww rljjlit 
plpiirol pnvUy n vro-h^TnorrhHg^c, pKUiliitr. 'Ihv itorrrip»^ ^'v* no dX' 
pLanitrion nf thi* rlilTcrtiK«. Thi? «*vAp< of cbylp tva« fttoiird by CARinofcU 
of tlie lliurueii; duvl« 

Soniolimva tlie rich occurrmee of rifStU^fvrrned mimsf* of 
fine fai-nctdlts, 20 to 30 ^ in ebse. ib worthy of uttcnlion (mw 
Fiß, 41), TlieuutJicir found euch Jn larj^ numben in nn rxplor- 
utury puncture, whiuh ho made in a o«*« of «vconiUry p]<<uritif 
i^n£4>cutivD lo eardnum& of (he bronehi vhlch vm conBrn^M at 

Til primtxry ettdulkrUal carcinoma of ßir plaum (E, Wiig* 
net) the abundant occurrence of pol^morplioua ce!b und fat* 

granule «pherulM has also repoatorily boon ohperved. 

In ft <iftBn npUTif<il Uy A, FrAnlcfll, Iti ISOil, ftMinrution niton«) & 
durk-rcd, doudy Ifuid rt^HtnMin^ rcnr>u# blnod, mhich c^nraJned unoivir' 
oil*. Inrgf round or Piiiilultc pulj-njoiphtm*, piilyhrdmU ■qtmniou«» 
opilhtliuid »Jl* ir'l L<t>il> ^hnpcd and oDUilat« vnrktiUot In ikdililiou tn n 
Inrjte üUck'O» nrnl vininilr* [imny of Khvin «howr<l— Ity viiiut o| Ihrir 
rlrli oointfTir i>f r*l-ilroiil''t-"— h tWidi^il nmlWrrv iHl»H|ie <an|urfmiy fnl- 
^raniitc «phcruioi; ico ^■'ig VT). At nvoropvy (iLl wt^i^ki ftfEor b^HÜuiiinjf 
of the ftlTwiHonl FriUikrl found, nut iht Pirw-led plntml ivttiiiionin. but 
ttia ftbor*'i[wnliijiied »ir^ctlou, whitii, from thn vw^ flrrt, li aipi^mliy 


chtr&cterued by a pronouTiced tendency to diffuse exUnHioD by way of 
the lympb-cbanneU. AccordtDg to Neeleen, this peculiarity makca the 
aaautDptioD of an iafectioua inflammation more probable than of a 
tumor-farmation. The author himself, in a similar, but more chronic, 
caKt based a dia^osis especially upon the findings in the aspirated fluid. 
The ncHrropsy showed that the whole Left pleural cavity was occupied by 
an endothelial carcinoma. 

Villoiu fragment« or colloid maues and other oontsiitucßls of 
the neoplasm, however, render a diagnoais absolutely certain. In 
a case of peritoneal carcinoma obeened by the author, innumer' 
abU, soft, tJaslic, translucent^ colhid masse», ahouL tke diamiter 
of a lentil or a pea, were found in the hemorrhagic exudate 
removed with an ordinary Billroth trocar. At first these were 
thought to tie small echinococcic vesiclee, but microscopic exam- 
ination of fresh *' crush '^ preparations at once corrected the error. 
Tliey presented an exquisite alveolar structure [of colloid car- 
cinoma] - 

[A aimilar oaee was recently admitted to the New York 
Pofit-graduate Hospital, in the service of Prof. S. S. Burl> in 
which the pinkish fluid withdrawn hy cannula from the peri- 
toneal cavity showed numerous colloid masses. MicroBcopic 
examination of these masses showed the characteristic alveolar 
structure of colloid carcinoma and at once established the diag- 
nosis. The case subsequently came to necropsy, which revealed 
colloid cancer of the stomach and omentum, and confirmed the 
microscopic findings. A history of the case was published in 
the Zeitschrift für Pralrtische Äertle, 1 and 2, 1902.— Brookb.] 

On slaining with hematoxylin and eosia a reticulum, composed of 
connective-tinsue ttaada^ appeared surrounding irref^lar alveoli. Some 
of the alveoli were filled at the periphery with cylindrtc epithelial but 
the majority of them contained irregularly distributed» round, elongalcti, 
or branchinjr cellK. In the areas of advanced degeneration, which oc^ 
Gurred from the center toward the periphery [of the atveolu«], the eon- 
tents consisted of a granular» red» mucoid mass, which prcscnled dintinet 
Htriafions runninji parallel to the wall of the alveoli, with hciv and there 
nuclei or isolatH round or cylindric cells filled with finely grjinuiar pro- 
toplasm. The necropsy showed an unusually extensive colloiil curcinoKia 
of the omentum. 

According to the authors experience, csplorat<>ry puncture 
may be of decided value in firm tumora involTLOg, for example. 


the upper lobes of a lung, and reveal the above-mentioned ele- 

Choleiterin erystalB are occasionalTy met with in scro-bemor^ 
rhagic exudutea present in chronic pleuritis. Attention ie 
directed to them by a peculiar shimmer upon the eurface of the 
fluid. This appearance, however, is quite infrequent, for, among 
several hundred eiploratory punctures of the pleural cavity, the 
author met with it in only a few cases. The crystals are readily 
identified by their characteristic form of crystallization and their 
cheraic peculiarities. 

Hemoiiderin granules and clumps are quite frequent in 
chronic hemorrhagic exudates- 

Fnmlent exudates are more or less deep yellow in color and 
deposit a corresponding sediment of pus. They usually present 
no especial microscopic peculiarities. Esamination for bacteria 
is particularly important. For this reason, in addition to insppc- 
tion of the fresh pus, which usually shows fatty-degenerated 
pus-corpuscles, it is always advisable to Btain dry preparations. 
In tuberculous exudates (pneumopyothorax) tubercle badlli are 
very rarely found. [One case has recently come under our obser- 
vation in which considerable numbers of these bacilli were readily 
found in a pleura! exudate. — Brooks.] In other exudates, how- 
ever, staphylococci, streptococci, and Frankers pneumococci are 
found, the latter almost invariably in metapneuiuonic empyema. 
In B nonputrid pneumotlkoracic exudate Litten repeatedly found 
numerous cercomonas forms. Empyemas which are found free 
of micro-organi'ima are almost always titherculoits in character, 

[The effusion of primary tubercular pleurisy contains 
almost exclusively small lymphatics. In hydropneumothorax, 
cancerous or ulcerating lesions of the lungs, numeroua poly- 
nuclcars are found, while in mechanical pleurisy the endothe- 
lial cells of the pleura predominate (Hoger). In streptococcic 
pleuritis neutrophilic polynucloars arc almost exclusively prea- 
cnt. In pncumococcic pleuritis the majority of the cells arc 
polynuclcars and large mononuclears mixed with erythrocytes, 
and a few lymphocytes. — Brooks.] 

In every obscure case actinomyces should also be looked for 
and the purulent deposit very carefully scrutinized (upon a 
porcelain dish or glass plate) for the fungous granules, Theeo 



app«ar o« «uiiU, (tritty pfirticlot of chalkliko c^iigi«tcnc«, Thioh 
ciui ti£UflIly r^düy be oniebed b^ncftth a oover-glas» (Flg. 3!^}. 
In mlrliticin to thwp botli«^, düHnct fat-gTÄOuIe corpiiflclea are 
often i>Wr>'?i3- 

Putrid cxndfttet occur in the pleural as well ta iii the prri- 
tOUnJiaaTit}' AB ttic Keiilt of porforation of k&qjttcdou» foci, or 
%Oni'g|ltric or int^titLnl uice» and msopliwnUj aiid som^timM 
wUhöut difliinct cam^. The lupfmti'il fluid ofton emit« a etink- 
iii^ odor; Üit; (ir«et3ic« of i(u)|>hur<'ltil liyflrngrn Is reco^ixed by 
the durk dücobntioti of the cftUDnla. li & miuu» vauOuUt » 

Ft|r. ItO^'-J^iKJluiii Chluiid Crj»tAli FrwJucvd bj C^ii^fnl Eii}>uTmllL>n 

awt with OD upIratJon of an upptr interoostal spa» and a putrid 
exudate in a lower, sobphranjo abace« riiould be aoBpected. 

Jn audi iDKlAiiOi«. In Uia uitlior'a opinion, tli« prcisacc of th« 
lafllJJitf rvfl fomntNnii HhoiiM b« leak«d for mora otUa thnn hu b^nl^ 
fon bvcti the caslotn. Tbc «iJthor met * c&t« q( Urv* ^xu^aU (IooaM 
(n th* l^rft [ t ] plevnl Avitj^J bMcIi, In i Jditiun ta feir, ovnLAluftl chJeflj 
■bundAnl bilt-tlliavd tuid wLtb (notfcntcly twulnit odör Iteritriologio 
lüuUoD ihoiMd pure culture ol bat^fffui cofJ mmmvnti. 

Id perforation of a gaairic lUctr the aapiiotni fluid may 
contain $^Q$t aii<l «ifctna fan^, and the r«a<f»oii of the txtidaU 
ttiay be aWtf . 




Echinococcic cyst contents is perfectly clear and nonalbu- 
miBoiis. In addition to succinic acid it contains chiefly aodium 
chloride which, on slow evaporation of a drop of the fluid upon 
a glass slide, crystallizes in the forma shown in Fig. 134, The 
specific gravity varies between 1.008 and 1.013. 

Frequently no trace of morphologic elements is found on 
mioroicopio examination. Sometimes only a few hemosiderin 
granules or Cholesterin crystals and isolated fatty-degenerated 
cells are observed. Not infrequently, however, the scolioes, hook- 

Fig. 141. — RchinoooccLc llookieU, Obtaioed by AapiratEoix 
of ■ Cyst- X 3,W, 

lets, or membrane fragments offer absolute evidence (Fig. 141), 
The crystals shown in Fig. 140 can almost always be demon- 
strated. On a number of occasions, however, the author Kas 
obtained an opalescent and very cloudy fluid by aspiration. In 
these instances the cysts had remained unrecognized up to that 
time, and they certainly had not been punctured before. Micro- 
scopically there were found various bacteria, among them pyo- 
genic cocci; also invariabty Cholesterin crystals, hooklets, and 
shreds of membrane. There is no donbt that such formations 
as are shown in Fig- 143 can also occasionally be seen in the 


ftspirated fluid. The prcparntion from which the illustration 
waB t&ken vaa obtained from a superficial hepatic cyst, about 
the aize of the fiat, which was accideEtally discovered in a 
cadaver. Ten cubic centimeters of fluid vith the interesting 
contents wb£ obtained by aspiration. [Several years ago, in a 
case of echinococcic cyst of the liver involving the spinal canal 
and presenting Bymptoms of paralysis, I observed in the per- 
fectly clear fluid aspirated from the side of the spine a number 
of motile scolices like those shown in Fig. 142, The case oc- 
curred in the practice of Prof. Samuel Lloyd during his service 
in the surgical wards of the New York Fost-gradnate Hospital. 

Fig- 14S-— IBYom ta Bchinococcic Cyst- X 350. 

The eaae was subsequently reported by him in the American 
Medico-Surgical Bulhiin, December 5, 1896. By an oversight, 
credit for the discovery of these bodies was given to Dr. W, D. 
Bullardj then house surgeon, to whom they were demonstrated 
by me. — Brooks.] 

If the fluid is characterized by a large amount of Cholesterin, 
a decided shimmer, due to the agglomerated crystals, can be 
noted oven with the naked eye. 

Chemto Tcit. — Id addilion to trata for ■Ibumin, the drmoastrmtion 
ot mecinic acid is in «ome initanpc« desirable. Some of the fluid i» 

aridiilated with HCl, eva|>onited, and thea iihaken with ethtr. If nuccinio 
aoid iH pretent, tlie semifluid rryatHlline masa left after evaporation of th« 



•tbv BtTM fn v»t*irj »olulion ■ nttiy, srlHtiTKiuH procipiuit (lucc-inata 
of boa) «-ith iron vhlorid. 


Kpocjfic j^rnTity. It mn^ rnrtg^ f rom L00& to 1,0A0, but generally 
lim bctww'n 1,020 ini3 1.0S4, i\s s rn^*, it ü strongly albu- 
ntitioa« aud ridi In rnetalbufinn, vfhich b not prei-ipithl^il by 
cithci flcttic acid, nitric acid, or boiliug- Ou additiuLi uf alcv- 
li->L, however, the mcUlbuiuin is p^«^cIpitflted in a äucculeot aUte. 
in whioh respiwt it differ» dooidoiily frum raufin. In pcrfonauij! 
thfi tost i?iii aßfumin tnwtt ftrnt h^ rfmaved (soo " IJnn«''}, 

Tlwt cyst t'OHtf-nU, which is osunllj' yellow in color, mny 
ocnLsionally pmspnt n dark-rtiil ar choiyihtU^ hue. 

Ited and colorlf^ss blond^cdb, adJ not iofrctjLiontly bbod» 
pi^cnt fta3 choJcatcric, quite often fftt^anulo cells, compound 
granular cclh [Qluge'i corpuaclee], und largo, T&auolated aoUa 
ara found on mioroacopic eiaminalion- 

The presence of cylindrlc epithelial, ciliated, and gobleU 
cqUs, bs well na citlkid concretions, la cmpKnsizi^ by ^iizozrro 
a» of considerabli- importaace. *'The latter nm from n ftw 
fk to onc-tcnth millimeter ii: ei^c, Lirogulorly form^, homogt- 
Docua, and p^U yallov in color^ arid ere dietingniah«d fiom lat 
aud oftlcarüOitB aiibfttancw by th^Ir paloTin»." 


Thfl author ha* obtainfld th^ conlpüta of acute unci «ubi 
bydroaephrotic cysts at Ipaat a dozen tiinea by oHptraüoQ 
thuB aet^iired imi>urUut mfoimaÜuu for dia^uostii- aud 
tic ptu'poeca. Cnlculi, aUmoMS, unkuf^u^n cauäee, and eapectallj' 
trauma hod produced Uic affi^tioua. The u&uuJly waUir^eart 
Icfts oit^n cloudy, reddiflh, or dirty-yellcw content« aro also di*- 
tin;;ui$hcd from ovarian cyetic ilnid by a low Bpncififl gravity, 
which ia conatantly bHnw 1.02ft (uKunäly bftwirn 1,010 and 
I.OIS). Furthennorej uiea and uric acid (see pa^e !^S3) and only 
alight amounts of albumin arc generally found, it »hould be 
remembered that the urinary couatituontd niny be abeoct in old 
cyaU, and that oliglit omounta of uric acid may be pKKSt fal 
ovarian cyata. 



The loLcroKopJc finding:« at«, aa a tulc> extremely meo^r. 
OiguUacd ekzncnt«, «nch m epithclm from the kidlid)^ 4mil 
urinary pnswigc*, ard but aeldom oWri'ed^ th«flo hftr* olrondy 
been fully i?*>fl<Til*ed- UeiioUy only red and coloHess hlinMl-rnlU 

III rmof ItfvufTj, aIho« «MpirBifon mny oeoaKlcjimlly *ld In iliagtKndL 
In > ca*^ of o-n «nvrmouM tumor of thr Ifft kEiln4>T, »Iiudqe aa lirgr a* A 
niac'd htad. upon Ihc aaturc of which mnnj di^voiliJi^ pr^rfnuJiinHL vpm- 
lon« lud liofii «iprpurj. tlm nuLhor oblKlucd by a.«plrut]on. In ftcldLtlon 
U f«<ttiljaT tumor-oalli, oh»r*clcr»*tie rcnol turfe^cifrlK , vhose oi?iUrrtn» 
left Abwlutcly CO doubt ms to Uio oriiriu i^f Hi« tumor. }:C:itir|iaUoD [«' 
vtajrd EUi Mionnous adpnoTn« of Tn«Uifiiiiiit lj|>K 


Exploratory upiration, vhich is UEnuUly net to be com* 
mended, somHimcs showe only n clear tnuroid or ^roua fluid. 
Id innnnimntory protc^^od ji more or lees Inr^c number of colon 
bacterifl are u^nally prrai^nl. In dironic biliary cr>ngipfition the 
UaciUi cAi\»c ^n iufMioiiB aiigiitclidliti^ &nd mny very probably 
«It« riee to «tonc-fürmatioQ by decompofition of tlie bile Hud 
-OE^Mutuni of prccipÄtat^B of bUinibüi-cuIciiuii aroiuid Uie luxuri- 
iiitlj developing maä&^ of bacilli» In «mpycma Ute pus orten 
bis an ofFensIve odor. 


Owing to iU d(a;,'uo*tic vnJne, tliip mi-tbod, first rncom- 
niendvd by Qulncti.'. la dtvorviog of cooiiiduration jt> thi« p]aee. 

Th* piiUvtit U pljiotd upon tit« Aid« with Lh« »pin« arvlitd wvll oDt- 
nard, A lli>r, hvllov »i.<<dle it iairotliUTtd bilo the Bpiu«l cnnjil al ■ point 
h*Tov Ibe npinouf prrrMn of Ihe imfiiiii sml tliiH litmhur itprirlirr. m- 
nr-tly la tb« mlddlo Jincn t^od lh* lliiid illaifni to «up« by liit*riift1 
.pnWHtVh If LI» iutviuaL pii^tftiirv t* hiartxtl (AUÜ to TUU inniliDa^tAri ul 
lÜliffp thfl fliii«! will Pi HiMi fliiu' tn Mr «rrliod «IriMiin. At nlhor ficiifa 
U will CHapc only in dr<j|i* «vi^n al Uip Ij#(rinnmg, At on» fitting ffoni 
£0 to 100 cubk ceitlitDrlm lahy ]ft «btAinvd, 

Aooordin^ to the author's cxpi:rimn\ buhi*} ujh>[i a ImDdred 
»pinal punctun«, tlic followini: fcnturr« Arc of importuice : — 

]. In Tnbercnlotii CerebroepinAl Hcniniptit. — Tb« fluid, 
vhkb, »jth TirinMi' oTc^pliona, is always abnndautly obUinc^d 



jtjiJur hijfh prf-^Auro, iie nnunlty vnlor-dciir, nitieh 1<>im fr^ncttly 
»omcwhnt ojmhT-^i-vtiL In it thoro oftfta iiL>parAti?K a dHicft1<r, 
£piilrrwi*ti1ikr riRrribraiifr itt vhir)] tlw tubi^rrln bgrilli htp mni^l 

ever, in only Laif of the caao^H The fluid almost alwaysccntaiafr a 
Urgo nnmbor of ieuctfcjftes. The specific gravity varies btitrffcn 
l-ffOS and LOU; thf prottid ccnttnt U »eldom found to bu \*¥^ 
tliati '^.'i (WT mille willi Eftbach'a, oBUall^^ 3 lo 3, but It may be 

S, la Acute K«ntuberculoiift FornLi of Menincitu. — fler«, 
alfto, cttpcfinlly in that form cnuaivi by W<ich4tlbaum's cocoiS, the 
fluid mny b*> ül«iir. Moro froqueijUy, howuvur, it is ftomcwhat 
opulefiot^ikt. 8oiiii'tim4'S it ie f^lightly or fv<m drniu?!/ puraL^nL 
The Inticr h much more ramnicin in tittvplococcic m^ingitig, 

T]ic »pccißc parity and alhiumiD content vai7 about ae iD 
tiie preco<]iii£ section, Ko. 1h 

Id aoQte pnmArj cerebroepiiial tacnin^tia there is found in 
th^ oKucl^^tt. m adi:3ition to tho amall dlplocoet^Lia infnteelZuLari#, 
which alBci *>{:fji*iüuully or^r-ura oulsitle the eells (see jia^ 43), 
iiwt*i fivijtieiitly Fraiiki?! s i]i|>loi:tK!ciiB. The ijuöjLion wTiliii 
coccus » to be consitlered oa tlic; true cauGc o( «piJomic cere* 
broapinoJ miüiiugttifi tci not yot settled. Mftiij obfcrvcr», nmoDg 
thorn the author, iitcUne to the opinion that Woich«(ftbaum'f 
coocua is the spoci^c etiologie factor. The author, how*Y?r, doM 
iiüt think an iLhM>1tLlf (]f^ii4ion in tbi« n?gjLrd is possible, becaufee 
in more tlian two dozeu east« of prtmarj uienin^itis he found 
Weicliaeibaum« coccus in only 60 per cent« and FrlnketV coccus 
(oicluHiTely) in aboiil Sv per cent. 

In Wetchaelbauni'i^ meringitiä the clmract^rietic bacteria 
(see pugi? 43) im* vi'ry rarttly Tui**t'd. In thft iitr*?ptot*ocde fonii 
rt long Ä<*rtri'.h for thir biietena i» uft4?a at fir*t DegatiTe, Thi* it 
apparently diir to the frtct that an iatt-'iiBL- inflnmnmtorj irrlta- 
tioD* funnifriiti^fl by ret^tvtion of lurge nunibere of K^ucocytc*. 
starts frrtin an (otitic or otlitr) ubscL-ss-foetJä, the gernm appear- 
ing only flft^-r tnu- njpturt* of iho abscosa hua occiirrvd. 

Only in (he ran»! inj«tnnrp* arc othtr bmtrna — t.g., typhoi«! 
Imcilli (the firet eaae of thia kind was reported by the author in 
1887. at th(? International Conjrr^M at berlio) — to be fooad 
oa aioiten of tbo meningltie. 


In clironio pachymeningitis the aspirated fluid is usually 
clouded by blood, 

3. In severe chloroiii accompanied by violent headache, the 
latter can, not infrequently, be entirely dissipated by lumbar 
puncture. In such instances the pressure wilt be found to be 
greatly augmented (300 to 450 millimeters) and the fluid 
increased to such a degree that from 20 to 30 and even 50 cubic 
centiraetere quickly escape. 

4. In apoplexy a rupture into tlie lateral yentrioles may be 
diagnosticated from the pure bloody character of the aspirated 
fluid ; while in severe injuries to the skull the absence of admix- 
ture of blood may, under certain circumstances, justify the diag- 
nosis of an extradural hemorrhage, 

5. In oerebTftl tumors the water-clear fluid ia rarely rich in 
leucocytes or albumin. It usually contains only traces of theee. 
The author^ however, has seen a few cases (confirmed at 
necropsy) with high albumin content. In ad^mün, small 
amounts of sugar are occasionally found. 




TQatfBDUr, ^luallrivul Of, tvl hr|l- 
flr<tAl lltni, V: drbviMC i]i>t<nra- 
lui. T, 
AFiTnflnn, rhmmjiMn, 1; *rih«n'^. i 

Atv'ow. «Tr«briL afdlun ■IMeuw Iq, 

BDUft>4*u, ■anrH<onpiii in. «t 
kldsfv, sMluu fttlii^^uik la. M; urine 

10, Uh. 
puLmoTiVT. ffaolHttfrlo In, fV^i hen- 

la. te 
rttnphftcyoEE«!, Mtt- 
lOtltflltr. UKlnoptlt Ifl cell» TD. M«. 

AbMTTiLlAn, Infivimal, ip<U Ibr. 7« 
AcanjB IblhiuluriiQi. HI 

in tAMtF\c j-aicr. ^3; bn4 po(u- 
iiuju ri'iTOijujiid imt for iluuu^rif 
Ed iirJo», sc 

Ae*1jv(Lfi La ufliie, tfec^r* Inl fvc, KT^ 

Ai-hArifin f-rfionlriml, 9t- 

Actiro4ilfit"ft. Wt 

AcM. k>«ur. ii ft mffDi. ]>: ijtBl Cor. 

bulrrit. tr>i fur, abJl 
r«rfH>Ll9» In vnu*, UM t ar, tIL 
brtt}. Id stf trie caBVcr> lA 
hlppiiftr. m uniM. V[, SA 

u K rvwnil. 13: utvi^iv pmihi- 

^«^lauLBlflE «citQD vf. 8U; «juall- 
ur(r* THta fnr, S«: qoantJurlTF 

iJiFllc. iFfli far. MOl tu 

fitDhr, in xirli>tf. V*! 
^lerli?, ju 4 nnjiruE, tn. 

«^1^d|||Itf. la hFiIiioc««:!« OiiLd. 110. 

■»Iftburi^. •■ D rt4«BDi. IS: v>*- 

lumifid III unbt. In. 
nrltf. In urLi*. SK. CI; «vllnaMnir 

*r. wt. 

Arl4 rvli* of fttmirri. i*i 

Aet* «oAium «™** iu urlao, Kft. 

Ai^ldHf. tuul, of c**tnQ Jiilc«. £». 

••liistilaB Af Ti^ 
Ael^ iMltr» fb MLrlv C4r<lft#«iJL 9U 
A«UaoDTWB » wn, O: la vltn, m 

la «piiliin. Vit. Bl' lb iiibp. tiA. 

Ml MklOla« nr. H 
AilHt0f MTLnamH «T lun^ Ii«! 
AftlkitiBviitt f^tm, Ji flfliv 1 
A«r*blt Mftarii« tl. 

AffeTrom hvraatin m uriA^ 1V7; 

klOldln lU BULILUUI, c^. 

Agar, rml'lflnf pro[jj-*rion ol. tt^ 

AJbtifnlu la urlno, ^3; tif«ls far. SD&. 
■tf^o Hold tr« for. 3«: Biti4rb'« 
fHt for, »I; c;citiUt'fl tM( ffir 
tM, llvltrr'a lul tor. W. uvU^ 
l>bavpbarl<^ «4ij(l («m tt,t_ tB7'. bl- 
iric Im for. KM. tM; plctlr 
■»4 i*ci fnr. S;«!; [NilAriuttiiti Iwf 
r«^. mi: p4[&«aivtti fdrrwirDbid 
tnx r<ir. tH. ^Uuluv tulCiDa 
i')riinBi«4<!i>ri0 DvH (Ml for, SB?. 
quutlUiUvv tHt tVT, Sn: H^lunt 
ctilnrKl hial for, M; Spi^vltr'« 
Icri fw. Wi; ÜCttC* tut M, a«, 
S^ui-bln«'t (fit for. vt. 

A1buninoni*Ii-r. IbibanUX ^^- 

AlbuiuiuufU. •.r-ii'.; X»l; m rincltla 
Ml; la 4ubffiMin*}]iii|a, n«; ji-rt^ 
«die, W: HnlHUDi, at. pbfiilD- 
loci«: W: mncMarr. AL 

XlWmoioop*, tffi.. 

Albumaif, lirncY-J«!]^^ Bp; Dot- 
«on^t E'Bt fi^r^ 7n. 

AltvbuL ■■ & rMcvdt. IC 

AU* in fthuiiim. ^^Zt i^r« »|ao -ßt« 
(crib.' I 

AlUsvaurr ■lv?aniri^ jis, 

AlktllBllT Df blNd. d'tpPTDlBMlM «f. 

AltipTonnrla ^tM- 

Alifvlur r]'liltrlLa En 'putuib, HH- 

AEiLtnnntn-iTinm'^liim fihHfiliiiU rtf«' 

fdJ« lA «|TUlaEn, ;iif; In iirli«, Bl 
Amo-bh coTl. 1U4. L^ivfi. In |i«««- *ii 
AtnphntvtilLie rcJI» in |*iit*tnt«. }T] 
AoiTlvId m4i]<». uriu« IB. atl; Uth, 

tiw« in, rt 
AftiAnibkc hmttfeia, Hi cuWrktM» Vt. 

AftckrhMlnxplBtld. bidod in, IIOl 1M. 

rvr«« tb. VH. 
Ailc>iTlCHtfimum itiin'1ir4]p, 11^; 4n<<- 

ni* rrDfn. iic^. IU, 
AnB^nlA. JUii^brJMir^^iTktiin la. Ilt>. ICA 

blovd Id, iC*: boIbn^Kiphfttui In 

12L. I«, VI-. Id tirphlllD, IBft. 
rwreloloun. blac4-nii4inip lii. IX 

bl*«d iriAtH Im. iBI. bvu^autvm 

rtwttc*« In, Iff: i<«nv« «f. IU 

4l«4Dmi cf, lfi?r »«Iria^bJltB m 

iiu; nur^tim« la, itt: bcnMiabiii 

1A. It«: roikiiMYbflia in, 1«, w 

iHabr'.HPUia Ui. W. 
HmntiArr. ii^hhI in, ifii: m fyvudo- 

lr«1i«ntK Ifti. 
IIEDPI* DVlBUrf. blood 1T1. 114; h«B»' 

■l«bla li, li4: »«10« iTftVltr «| 

blov4 ll IM 

ABMUt*«lA. M«U lb urin« «Ffitr. UL 




AnaiuiiuiiMr*. r*cM ui. jJo, 
ADLlia-vMrr^CvniUB-'riDlft «oIoisob, H- 

111 ui Lui-, M» 
Animal', iran>fpr*ii« af 41plith«Tl« 

^(ILli tt>, n, 
%iiinrm> ivrLiiuH in bloody ]jr7: iporo- 

fomultfli] la, £t. In ■putufv. LIS: 

UsIdIdh of, QT 
AntJfivnn Vn qriav, laul ror. AtO. 
Adu«, «Mi um ^hi)DUi* In. to 
Aphtaja, »; »«dairx :«■ Tuncim 01, 

lA. 10. 
Ap«ohnB)Jitle aM»tl*p*. ?^ 

Aliu|>tt>7, iljljtaf k4uli«lli>o Id. 3». 
ApjuirKiiEB liivlmtniiEi A fur frMViu- 

paini cf bLotiJ, ilfi, cOüdrfiiliiSt J, 

ni^rnuArT. I 
Anv-urtidiiB, tru'-uL'T-ruiii* Le, m. 
Arit?o-Hi'i'1i4ifvEi'it'Tr, S^LlUh 33^ 
Arp^* nrnni'ii, 9t\ 
AruuM'i BLfDUf iL^rOtHF. 21- 
Arimifh^ A ir]^:iiri<i Hrmn. lu, 
AHfirltlt, fivE]OH:oi<:iiA la, II. 
Anür[i»pr>r'H, IT 

ArEjnciH) littii. Mtm or, Iei luUToh'orr. 

Aur-jinii liirnhrlrflL^H. M,V t»i t**!*« J7D; 
lb »Pmli, I», 

'^•iBrr' ^hnier«, cAninA biciMii" in. w 

A«pi>rcLriui fualutiu. ftj in doroi* 
lH\m. », In E«lKllle. t», ]n ts^U' 
rum, Uin 

AipL»[JuEi ItulJ, m, choliwtFrlu 1E1, 
t^l- trnw *^tt\t] pAiLJil, u:i; In 
cblOTQai*. 3SA^ In rchlnocfli^fliv njrti 
nuK. ISO: In hrdroi^npürofli», ^i: 
In bydnftpt of rtH-Maddar, UU; (a 
■uiiiluKlllflh ^Mi '■■ vnrilfeLL if*L^. 
BIT: In r^nnl tnmm^ MWl in Mi- 
bivrc^ulbr fnciitKClti>. !Dt: mkroion: 
IMJI Inirar'^lhilirm in ,1X1: ri-PHl 
lulte-TMiüi m» ^J, aariLHiiia la, liSv» 
ur>'u Lu. itH. r^'»!! (ii- ^V1» 

jl4iriina, ^□■^k]>1■1t* ci^liB in ipuTun r>r 

[fi3. brtrEK-hloI, nqiliirphlllB Lli, liilfi, 

Iiiii>ili1iiin. Hiiuinin in. UH: iLtniuni 
Id. SSJ, 
Atroribi- EutrLc ft^KOCa of frv« HCl 

Aii1i>[-tHvi.', tS. 

Aii1r»LTi<^i^iikrliHi In tirnln ■alHim. UTr 
AluUnprl'inilfiiFrhrA, «HtjEboiil* l4. 371, 
A|DO»i>rrinla, «lltCTJOPli of, m 

fi«cuii, toFoiM of, IT, kfi oral «kvnr. 

?<T, , baih^v^nlo, tT: " flpnr« ■**!>- 
UIuLpIp ' IH- 
njtoilloh nDibroi. Mi. Sir». 33?; Iti ipu' 
um, lit. 
bnbflmi! nlhcne. *T. 

C9. lu fcLV-p STuata. lumiull, »» 
frkll mmmunl«, lU, '1; In f-)rii|iMdp RtH: 

In viudBEc«, iM. 
«HDHift, ID Jhflatir rhfilMa, At 
dlpblberLjPH TI: Lu ipqliiv, 3it. 
OtHUCarlie. 8D. 
TVÄnki-Tp fpiTfl»iinfnn>. 40. 
rrWLanJirz'a L>E»i<uiuoala. SO, tt 

Shndonit CO, 1c Apulufn, SIK. 
BucnUp 1«: Id iputum. UI. 

llADtirui, Ki»f<b^< tiibtrrl*. C (Vr* 
"TtllÄrvic U»x:lHll»."J 

Konb-WvAki t. n. 

pnlaTL*. In urlb*'. IM, ^fiC 
^•TtiplifdiiiltlTirrU, ■!, In tputUQ], m. 

iw»4iii^-nutiii-c-\p In »putiim. %j, BS. 

»Uet, in f><»fB. ?n 

•niiftfuk. 111 «putun, U^ SK- 

iTiliriyirluitIk In mid*!'«, UK; tn 
f#*.o», ST1. m: [|E milit. IV; in 
pputuiD. IT, zzi, 3M. JVi; tn urin«. 

lyphoJd, m blHHl. «<: In r*t«L 131. 
rt; ID urln*. H*. 
nai<|'fi«, nil iridic, 19. luMrubLc. 1>, 
t^; hinlncr FiT II: ftroviiiin miiVV' 
n«fil iir. Dt(: clikullkttlnn oT. to, 
t^aiatiin of. lO. fAirr^fllMH i^id* 
ntns of. S3; rmuvatlan «I» Uh 
dllTvrvullAl tUiulriit uT, M; *»Un- 
iBAdoii tvi, n- rt'uluiiv«. U; in 
tf^r*. ailp JTl: nntDD. IT; loroW 
nt. II; «anortl cODiilflmUon nr it; 
«vrblniiUQA af, li- ontiu'a neiLucJ 
of vWiilac- tf. ntntXat-Araii duI- 
lUH cf, A: la urlno. ^lA; LbAu 
»DO* of tciEiiiTnlitr« uo. ifr ld«j- 
ulUlAn nf, :ai, 11 ml^^roA^Aple vi- 
wblnaOon of. ;?: nwtllL» gnt. IT. 
nhiiam«. 18; 04Kr*ii vipplt to. IN; 
parAiiiEir, It; patbDMl«^ S«, W: 
Iflxvtvni luriuutiur bj. It: vU» 
PLtlELirn nf, Tt: pMlUnn M. M Vff<- 
Ubl? hiETipluiu, IC; ktV^'pI^rUi'. !>' 
•»■»tnlPil imviha »r ?ii. tcwlfl^ 

KUi(r«Baic, l-t: ap^iB^ *uJiini4 «f , 
n; iptirrlc. tl: iporw^ruin»- 

lion \.t. IT, nUmEn« «t St, 18. M: 

tPil-bmtbu« (111, IE>- 
Uni^rinitm mJl mmmujitL 10: 1h ftm^ 

iLCJi. 3W, 
Im^iia ■^rn|f•^f>flL TU; lb pstumAiurli. 

TV: In YAtlaik. n. 
n»tUldlB. Iflp 
llbrffltn, 1ft 
PflulfLrift, a. 
niiimiin, Oaro^ii. uf riT. U: »p*ibA, 

iitr uf, 13, in UFlua, tMt for. nC- 
TiBB^dln. »7. 
Un-kpt. T«t-iiibo. tb. 
ltd Rik^ti I ]i- ei'lli [x\ nütunm. I4S, MS- 

ttahejE»!. 1X1: «rjiLninf of. IcJ. 
TEuw.^tl. fcofilluir of, U, 
HkikIh miiipifli* ffniviiy. a». 
ItL'cliTiicinti'i npi>nfjiiua far frtviUi- 

i>oint itl i>luu<i, III- 
lUilnnm n:>lMliiB, HÜ. 
Ucu'i- Jucm'i AJbuiuqar. DotUii'« U»! 

fof, IW 
Ulrdrrt'D inHliod Car CabVKl« buflli 

mic, '?bli>n>foriii trrt fcr, IW; roiHT« 

liui«q in h^^n^ tilt. Oucftlo'* iwl 

fnr. !«¥■; in «puniiA. TXi; P«ct*fi- 

hufff'a tnl fofp ADC; Rak*nb»b'B 

to« I rnr ,1111^ 

Tllthfii'ifh hiruial^blii. MS. 

n^llnrp (ni^K'<atlob. fcüt* Lu. 1ST. 
lirilnibifi In t'rn tiit: fn •piitiiDn, O^j 

In urLiir. L4<aL tvf, Stl- 

filanaruli bto«o. e4iitr«ft ttAtaifiC 
wkb, O. 



bltwdpTATrt of. 19: ICTi 
«wntliu er. Itr i1«]iniiMirmtl«D vT. 
lU- b#mi(ol>lti-fi of. 1^1, l&i 

Ui: oxdiun HlbtoiQB la. m^ 
nUfLfimriHiHi, 14, tt; In uqMraii«' 
flulAii^ M; la ffCrH. 10; In c*«- 
tflo mtoBU, W: In uriiia^ $a. 
UToDil, aLkAllDltf af. IS. ADlbnx b* 
riih IB. irt: «nirriLCBFioD öl. Itl 
gbjiD^w «r l4 dlBBu^ JOt; CAnr 
roL'p cTTtttJ* In. VJtn colon »■- 
tllll lo, 1^: oalnrlDf flUt<«P« in 
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fur, 1^. ItpttMT (iBf^iLll Id. 107, 
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lobluu III, lU. mPoiDcrirB la, 
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innnBf7, In iptitiinj, 714; rva«l, 
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tia rt tTh. 

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la. IT». 

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CuiB-BUOTp »S- 

i'BjHiilPB^ KtUiB'a. fnr Bl1tiimL(i 1% nrlni^ 

C-irboiriicDfliE Bolution. M, 19. 

c^^rwllD aoJd in urta«. I«l for, llL 

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turn. rm-. iq Mudiii4t tm. tm. 

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Lti (qqttlljir ubiio«««. Ml' in urlxi«, 
KO: In tuLb^ m. PLiiiuia« nr. 

C«r*M«| kbn*«a, «laiao nibkua t«, 
40; (ttin^rti «piunl ipunuur« In, 

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hjwa Id. ina: nn'[}iiKn, uk 

ittmofiobin la, Ifili i|r«atflp (rmv 
Itr Pi blood JD. IM, •iiiD'il brturru' 
Lion In, rm. 

Chntent Aaliitli^ii, i^nmmiL tanrllll tti. flL 
178^ I*c» Lei, K7T. 

G])oi«r« bftaiili, Tmutmion 9(. 7ci: iii- 

ktnoala o(, ?1; DgBa^ni'lJuobBr- 

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CTiol**tBfln'MlJri»Wn rii f.'flci, »1 
CThftrlniil« viLlt. «iHlDlaillffB nt, Mr 
ChniriLitthi? iitifiTktl4>n. I. 
Chr>mnlln irABiilH lo rabLnrlAJ pnjA- 

kltn. IUI, 
CTiTltirlH, VIS 
Clll4U4 «plUlcllUD la BLiUllID, £0A» 

Lrim, m. 
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[?lunn[ii^d fni!*], 1?, 

I^»i-eil, rfmJn^ IT: f<liiinpi«4. It: dlpLo-^ 

17: la oral cvrltr« MC: ptukai-, 

17: uirm-. II. 
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bkiol, in. Is cjvt^ti«. SH. la 

f^loni^v, b««irr«D, ■nw^rnfic«« of, 30 

CDlciuiuriPh nr ^Biocrrik, io. 

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" IffnifAriit«« "1 
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r\iluin*IU, «t 

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lU. Tl- ;<U. 30-,, m, ITK 
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itldb^. 3tt' la «pqiun. M9, 
OMidvftHr. AV^ X 
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Omtni<i-*uliita^ W^ 

CiopAiba botaiTDp Ufl* of, 13. 

riap>4Dll'a Motülut dttb. IM. 

i3arK. mlrjvivwiiQ obmriT« of. II. 

Oontn orlioL4«A U «»1111111), U, IM, 

Ck>rp<i>cl«, rrvaailan of f«4. Itt: 
rh&£ivo vt Iu illi4.>4Hs W. ruuul- 

a of nid. IU; dmtrrf, r« Mood-. 
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Itt: r»4. orira «f. "1: hIliaiy. 

VbHji. nomillnjT i4, IB: m^fniKOiilr 

«■■T<ii«i0i.oa tl. 133, [81« "L«ao9' 
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TuruVi. 1^. 
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wbll« btoo*! pfllK 1^ 
0>rrf-ft1uw 'v'"'"'^'!* ^' btictprliii 31. 

or b]i>od. fMi 
n>wn' Billig «I&m]D4tl0Q Bit, tti. 
('Pin-lauir, W. 
OHlInln In urLb'. Ul, 
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Cr^npou« I'lirvacp'^EiU, phevrnvtHUillliu 

ir. !ft, Jjn: rriciinToroc^ui in, 4C^ 

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biiirvbixi. la >puc«Dii. ML 



ChBFwl UHbu, m, tM» MT, tu». 

Kx lit, UL nu: lo iKuk-mic 
084, Itlj In iHua. tS; In flfcrl^ 
■DIM broDitiJlb. 108, tn «pulam, 
kML tl«, Its. £f[; DAtiirn r«. Ki». 

•kokvi^b. ^10. ui. t». at. »t, IM» 

ML Vfc la «eEiiD<4ocjiia flUiHt 191. 
!• ätDlAUB. >M. ttS: la liwbTa. 
Xlt; 111 uvAiiHu-CTfit dii]<1, St. lb 
■milun, StC. m; IB EcrrftUUr pyifa. 

Ml JO, »(. EKk W, W: la w< 

4«U«, ttlt IbTh» 3». 
bwutaMlfl. Ul, Bt. SM, SCL M4. J». 

I« rnw^ tTG: In cob«lJUr rfwi, UC; 

Id vrin«. M4. 

indD, u:: ;(iv: ax ufidd, u& 

urin*. lU 

trnvlt]. tut HP. In» Id urliH. ttt- 

r«hifBijii(a ttt buim^ 10. ST. 

IV, aiab. 3>, lA- 34^ uU. K 

m, m t^uum. ±01. JOT, >ll, m, 

ijTcfic ALbumlnDrla, SM. 

CrUiA«'« fur voUooLiJiii ujlnarr vIL 

■mt. t(7 
CrLlDlrviAt In urine, ru>. UA 

flU- Ilvl4 «f, nu; ivDitlJur. dutd 
of. JIA. 

Cf •L^i.'iivLU «lluluav. 111, 

(^tib in iiniip. EJ- 

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OL MS: t^HTTtiLlJnr illniiKiiit« i>r, 
Kt; fubHTiTfiEHr, uriuH in, SCS, 
nrlQ« tn. »i». »«. M, 

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lo fputunLn SL. 
Dftpa'a Q*iDo-allull[Dtff. IK; tfrna- 

■löblDomrCrr. 1A 
UHlitnftl cfElv ■uminmiiDB far, i^. 
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PiWiw falllnlorqn. M 



OtttmM anllltai. 111. 114: »FbtiniliiurEA 
U, >I4: b1«f^'UstlD- m-. Bwritr*« 

•imr )B ttnofl of. 1J4; uno« eq- 

ni. ni: viiiiADtoBi blood i«i 
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iVUpbncin. fyllDdvp, 4: VifibarnX top 

m«, 4: fri^ oMaeUDiD« la. 4- 
1X«rrb«4, CHblii'Cbiiio, uffvlllul« In 
ttaiiDAlit let, iim; in lufiBiv. 
«k1C4< UollL»« lo. W: Wi'B^rifc 
In. Stli Dnrraua^ tf<v« Ld jTJ, 
tUBBtr, flf loNnt«, l9^r** lb. tf, 

l)l4*^fc«£lwD Id undo, m. 

DlffuK DVpbrllljip vriat in. Mb 
Dlc««tVin, l»iinn>jfaBl4 in, L77; Brfi1«i4. 

iHta lor. K*i «URb lent for. a<l< 
Dtaii<tbTl-iiDldO'«u-t4iuot leii lor 

flCI. Mfl. 
[>U'l>^'i<^'lH- dLDiCntnLi vt. tiT. 1<'U<4' 

rttiwim Ifl» iSl- ■tr»>^tnrnr(i in, ». 

faaiiiiJi, n; fatfrirf' or. <i; in tiiocKl. 
iti. In ttuluEb. IM: ■UJulog af, 
74. lno«rri^üo» cf, to kolcDAl«. 7C. 
mplHoctJ, IT. 
Dlfrl»occu» («nofrbtn». 4L 
IftijiKcollaUFla. 41. 
B»iDfi,U4ii, It; «umvAiion «fp He 

■UIDIDC DI. «4, 
puuDMiAu 4U; In urlniiid fltiida, 
m. In oroii|jntio iiuodmoiila. 40, 
1Q neniaflLli^ tl. 

ntcbwfli^H flitti«» til armi ^r, u 

IMiHiaa, «rojiliHjrtpr*', uithm Ti»kUt 

Id. U, 
put. CnQlBlid'i «t«lDlnit, in, 
IMMam« liaHllcaKL l^ri, lanCMlBloro. 

ni: tnitnuD«!». 1*4. >i<, 
DUlonum tniimitabiuin, IZJ; av* et. 

In wnfi. i<", 175. 
DBKrkU'i fliJK« In aliUCVlD, SOI. tO, 

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Ouvnr. bATMIufl of, 90, 
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Lfyv«. iniEiii. udc ol, 11 
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Pbrpuar^rt« Lri, 3SA, bttDfltordln in, 
IM. lirEiiufTliaRLi:, Mi, UOh Ichor- 
04t, SfH. InQamcDflinpT', St; tr» 
nifoptHiinii, 'JMS; i^urnlcpt, SM^ rll' 
Ititm tumr>r rrll(1n^^lU id. IVT 

Farct, RlAiidpr« bb-1lll In. b». 

Pal iFi ii^na. ifi; ID nriidal«. »«: U 

r«cnii. ;c3; m uiHk, Aiuuiiut vt, IT?; 

Ib ■[PUtbni, SM. Hi; In urlnc^, 7i3. 
Fat'frjrBialB Id «ludiiMa. Wtti In «pu- 

iiim, tU: tn tnci«. M, 

Ptl^flraDiJla o&tli lq aivdutpa. ttfi-, (n 

ipuiuiD, ZHd: lu iirtu«. lU, a;4. 
Pailjr-ai^Ld KrjvUla, TOP; 1D aaalrlo 

ti^aviia, arhnrlrtn fictiÜDleLBll In, 91^ 

l'K'4, a'naomrr*i tu. l>: unaM 
Utacb In, IM. m: uAvi« 1a»Ml- 
coio« iD, fT(i; riBETEtftft in, sm^ m; 

biulaplvm lAKt;« ajfonn** Lb, Ki 
tMJi}-uuc]';rvDi>Tii iQ, Wi; bUlmbra- 
nilfliiin tp. UM: T>inrH* Jh. KT. IM. 
177; bvtbncr^aphaliH ata la. ftl; 
fvlpium oiBlalam, S(h: oartioaB^A, 
XIT.- oa**lik la» tPt; areaiDaaa« la, 
tri: Cbvcoc-LflfOKi ernialt u. 
ITO; «boUn bfeflllll in/tJT. «<; 
vholBiMrIs la, MS: fib»1«iKiB- 
tiiiiTVhin tn.M: ^iHinslum but^r* 
■tun m. M: ««l«« of, M7± bad- 
eivtiDd« liii >N: amuM U. a»i 

nEriUaJUl ctlli IBh Mta TB: tat I». 

to9. fudil^rrDiAuita tu, MS; fbno oiE, 
Id7: tnU'ilnhH In. VA fon^a^divl 
le. 2Ti: bnnftiuLiliu m, fjO^ b«B< 
arrhaiifv ^ifi; In tmyliPia JiT«r. xn; 
In an<li*l«t0iBlEUia, 2»; Ib bit*- 

tar of iDbtBiiiul iDuoiMa. irV: lo 
iliiLry i^oncWlhia, 7167: In daaatrat 
r«<uiD. Sn; In cbQEcn, tat, m, 
tri; In eDhti% iTi: in rannVH- 
linn, 3ttT, to dkarrh» *r t^hMdr«. 
17«: ia dr*rDirrT^ STL >16^ la *a- 
Lanili iDnmbrmacAL ^4^ IB 
brallb, Mft; lu l»'|>tLli] <:lcTlii4iif 
I7tr Jn irfrifiiji ritnrrtinlEi, AI; 
kB lleiUi, >7»: In lEiU-itlnal nfjrb. 
S47. J7l; In miMtJnitJ tu r>pnn]|oMi. 
Tii ID raLtiatlnal uloar. r7li Ib 1b> 
LiiBeiHc*pt>vii. 1TB. la Bcrvoui ilMr- 
rh»n, JTJ; LH ppoellHi, »73; tu p»#* 
tal ar^h^llH» an, Ip «dOirurr dUr* 
rb«<. ni; TO mihoiC Inrnf. ip: 
IftfUBAflB la, tri; Ivii»aj1f4 Is, 
1^: ta'ruLoma tnimcum liu ibf, 
itl: mllk-ncDttaDtj ld, iCb: ttioca 
Id. KT. >7>i n«, luUfrHL^LD-äLirta Ib, 
na, xfu; niutr»! unir-Uiin i>haiit>Ti»ia 
In. 2iKi^ VAi'urlB Id. I7i>: p^rvAitoa 

in. ?7i); piiH m. :7.^. arn: qUocUEy 

Df, 147; ronrlJoii oFh }flT: "rlc«- 
■TBtni-" In, 3«T, ^7, hIu In, 3ti; 
ählifa lini^llliiii In, 77'!; ■tnF«ti-T«m- 
Dftut« In« tl9. air«^o<cDe| la,, XV; 
tJbEiln antlnula In. ITD; Wnlii 
«nUum iu, jfTU: tluVB-thlw4a Ul. 
270; ir](-hi»<7>-iJbii]ii« In. STO; vlcb* 
'<Tm>u[kB la rri: incl* «boaphat* 1^ 
W: igbrrUp badlll lu. STl, l;«; 
trpniil bPfltli In, f[3E. TT] ' «flP^ 
tir. HS^ :rH0t<alU la, »Bk 

Pphlin«'! ipai for »iiiAr la ufliu. tll. 
333; tolueiDD. HC 

^rrmoutailon leal far «inr in urla*. 

piHvi't li^lurWTic, STT, 

I^BUd ArvncniEW, nmfMim in. Tis. 

P4V«r, «*U«e-auEUbnai tiaf<atU4 Cif. DI, 

loi; maiarj«]» «n, :ai, «uirua. 
paT■■»^B at. vi v»-. racurrasL bm- 
riiiuui 0(*f<rTikvi«ri In. Sl; lerlun 
piruii* ar. M, mf; irnplnil. rtara- 
■11» t>i. ««. loa: t}Tho>4. r«4 IB, 
JTi, IIa. :77, 

Fihfln tp ■EUtaiD, tM: Ib vrfrun Ml. 

Plbrlpom bran^fllM. Chmvafa at»« 
tall Eh. ?«; npumm Id. 100. IM. 1»l 
TiAEula ia ipumm. IWL 
Ihrf-a^li in t[iii|iim. 23^ 
riLutla Dincfvtm, IE4; lanirulntB 
bifi-iin^a, 114. U0\ Ib uRb«. l£b. 



wrin* iQ. tit,. 
FUmi, fliHloa eF. »j blovA-, aULnU* 

«r. lU. 
mtior i»l t«r bila In qtliia. M, 

fiLtEiilJtiu uf I'uUur« lucdt», tt^ K. 
lii-ln» fl[l]iiPTTn*-nt nf nlrTOUViiAi »- 
f^Li*l(j|] fuucl, 14, 
Iiljtrinn nt ii(wr]ni<i(iiL ;», Ü 
KlufwlLA, hftclariiJ. 14: *tvnL Vl 

p«Ur. U; iWuiDi oi, n. 
Plftval^iLtK lOe; In ^»nilolaut utnl^ 


n«v, «. 

(^wd'n^Djfiani* Id fVPiH, »ft: ln ar^rn^ 

raTti^n hodtu Lb ■pulurn. tltt, 1^4: ld 

yorvoAi idtPtlBntloD ot Mood, W, 
FpfbihIId ■« PMfibt, U: Id idi[^. *pv 
for, >T1. 

VET; In uriP*. >*t. an 
PrAbbftp PBeainH«F*ui. «Ol In »pin 
1100 0Vl4. 9>*-. la ivutum. :jA, 
«Kfl bBoilla» In MDOdn JtT 

U. TIB, 

rm ai^M«. C4fitit«'P*[>n tHi f^r. K^, 
linntbcr«! t>4l for, 04: ioitUltl- 
vliUii [<j«l Fur. ttl; inpfBoMa i>ai 
for SUh 

m* fkt lo MdAftf«. at: hci, «i- 

■MloD 0t, ST, 

FraavlnC'pplnl of falood. I4T; of UrTnir. 

i): lA bloE>d» 1ST: pli^ror^ririla »> 
hiyan, M. 
Irnit-QWTIBH IT: -ttrpb», rr. 

P^Nj1'^4 ||L«rk4l( of «lADlfK t^ 

lhPH4. W, i&; HUI, O. l«> 
lU; Unttli. M, I4L 

Q^ttbH't M*la rvr lutKKl' »4K1IM. lA 
iäh]]'bBjt4liior, TirtSroEni ot luvirund 

iKid If], m 
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»•i IwlMhrli butfMla I«, «, 

tpmum Tn, vMs BL 

Outnq airopbT' ktiavD» dC fr*« IICI 
Id. Mt c«0«;«f; IworrlHla la. 
ITT; 4l0BHb «FvMVl« 1«, SO. 

toauAU^ ■tBfBiDDiua pV nil ki; 

«*^nn of fw HCl la. »; iilf«r. 

vuvilft, atbl* bbl4«in«>OB^ ML. 
wWdflTi Uli £r ftiTKiiTiin in ■riBB, 

OvMJb DatntBl cn*dik Drtrvnila« nt. 


Uta*. B3. 

OtrattakilDtt «f bacterid 1& 
numu'a mtuutd for «uinlDt mftUrini 


OlftBdtri btetlTut, it: FUlMtfiflit» <>(. 

M» la ti-ikturriH JiC» tfi^nlriA at, SD. 
tfllnnda. ruriciTiii itf nEitii^n^-n rlrh. |4[i- 

tli<, of «iDDMCb, ^1'-; fil^rU. 24^, 
UlotmUii Id urtaii (nt for, Ziui, 
niauirti |qiiu««or:l iv. 11. 
01 a« ^« nirpHHil*« In ^^uAin^m. HA, 

GlrcerlA M f^u'tiit, IS, 
(ilt«>Btiriii, mtiiinniLTfi, £■?. 
ciEjtftifi^nU' n^'iii tn tinaa. 111. 
cjHDihu-ivo«ii][i44^b dItDr uvE (ur bllt 

In iirlnf (iil 
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uoiaboru I LafiDod fur ■tuninc biooa. 

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orui taiUj. £«: In uria«, MO, MT, 

S^if, aWninc of. 4C. 17. 
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ebATiD ur, ;ni: ntvimibruui. 44. 

urlDfl Id. Ifl 
ChtEiurtheii] iihtv4ii Jii urlfiti. JTl- 
r-nw(^Tt'* hfnnilnMhini'.rvp. ]i| 
(Ir^na^i attio tor tu^tprln, H. bafUrU 

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c3r4qiiUr f4A4 [d vrlnp, xn. 
limiuiPEJi^u, ccimiJtJ. »iKmncaor« ft. 

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rifb'iv lai «IfTDtDlarr. im: M4ln- 

«phTtle. 1». 1«D^ ibutHll, m. nttt 

mptllllc. IS. 100; pLfmBBL la (an- 

«Illar AbvOHi, 3«l; nr funv*». la 

■iivtuui. tit. 
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lum ObtFBiA^ri. B; tar aulalaf 

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BB; for ipKlflc Er4*Uf «f lilMd. 

n«iriiiir-4rDp «ukiuro, II- 

llaLE»TJi L4h:IIIiiii uT, 04, 

{iDUDtLuK 9l, 140; 4«itiD]i>lrBdoB «i 

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Hna in lUiniajE, A 
IMlar^fl tc«( fnp «Iharnln In iipIa«^ Wt 
UmaeiDp i»^ tlcrcvuflt &T^ brdn»- 

PbMnlP. I»i rvrfii»*4, lit 

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iHBBtoidta «rnula Id «ludM««^ M: 

Iv, B — > tn; Id vputum. HI, tH. 

m. 9M, m: in UinitlUr *^««■k 

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MwiBininrpliyrifi in <tiiih X« 
lUvalAiTlia. II; X>irll<ti'i^ iU, 
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b»iU«bte In. m: dli<B«i» oi. 

ltflBi«i|iitniwa^ m> in. V4: in «rlniL 

U«4 Iff. INs 

HntlD iryBUli. M 




IXasitoalDbla» 13D; Httcnflllfifi of, 1M 
l*L IlX Mi In utmJA. IM, IW, 
ttt nlilDroiiiH IM: r*du?4d, LlB> 

HiBDifillublnBialH. iHl laUtntlUmt 
at: pAnirnial, W; uriut ip, t;s. 

Q«taDBl«bi40Beict, Dftr«'!^ lA 

Oovtr««, 111. 

HMBDKiobiiiiinii, 1M, >aa, ft«, 
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lliniTHTTnri_ ■bcinioDH mtiniDKiion «c, 

IHl IdUaUbaT. fH«« Ir. SflT. 

BiBiarrtiula ii"bTL'1U>. atlam lb. Kl. 

ti«pati<7 eirrhAW*, rn.->'i la, !7V 

nap« «MfUAU, 1)3. 

alD(iiu1o «oLO la unup. 39). 3a. 
irll'a inllti ■pihuvlu«. STT, 
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XocikJnlm, Mtlln{H?(H!FLr, ID l|fUt4ID, fSS, 

11epp'*'A«Ti'T'* f*^ lor tuvw iQ Lirmo. 

H^n*. fHl E>load-a*ll* ol^ 1BL 

llol-^ BUrilliW. 3i 

Hrpt-vntar fUnaal, »- 

KjAlmv t4«U la iTlatt >K 

flytjrwMgria acitf, uwnoi of Cm, SiJ: 
■t a tvuvat. U: BHplLo pnp«rU4< 
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for, KU; BrBlQoAncA ot, in>, 

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I j>'Iiv'rin>i>1i7. mrdLkCp ultD« Ul, Kl. 
irnibm of cdoIO«. Ns_ 
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lnhtfrvui «uiiaEF*, BH, 
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nutA in, j:i, 

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In4li'hii Ih urlnn. W7^ Snfi, 

larflcmidrla, 3M^ 

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lutfiBiiC*, «iLDiiQH dlarrliea ol. lecei tQ. 
nTrJi; »In budUlu IiIh ft- 

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rviiH itin fii: ■puiuin id, iBi^. Ui 

talHÜDni, Dilicvd, BlreplcooQCUB PTflC- 
turs iDt SH 

InOftmiBbforv IvurocvtoJil'. nut u re ct- 

InfliKiriia bhAlllu«^ Tfl: pqlt.ura nr, 'K: 
Ln jptitun, fl I1&; «WitlDr vf. T7, 

tDfuHirla ID UKO. I«: U CftMB« £7^ 

tnAAblnUu) cf hL«t*TliL m, 13. 

IntPMU^a. oUlntarr trJabtua. lU 

TntflillDt, ftbuorptloq T»t, lakU Tar. MS, 
Cdlarrh «fi rK4« la. tTQ, ITS; dla- 
^mn« fmiVp «aiDl»tlAn af. inn, 
httiDarrbBSv tna. f««M In. uvt; 
iiiiif»Di m^mbriiDD ot. i^Si otCttm 
mimuva» in. »: ^mrBf1b>t Id. I07, 
370; irlclilu* la. lit, «oiou ta. 

tDälb ■* m rH4DBU lit 

r«« ilU|iTirBrDii. i; «Dj*MlADfl hi, l 

Irod «tlarld rraOUoli in unc^ KT. 

Jna rcAouon id Butan, B9^ 
iMh-nn», M. 

J«S*'> tmv tor Indlcm )ii urlo«^ M. 

Joint ■fuirf», 17 

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BMlia in DUi^ m. 
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ruinlcaUi* La. tt 

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loid. lU: OMMfat'a diHAH €r. 

oatHliu ta, iTI; EviitnUoii* 

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tubomilHla of. m; tuawn t4. 
Sii: WBiiorrt taöitLc4L Ut^ vbcir. 

WU IfiM ml« "Vp^brtElt.") 
KlfffrT'p biitrifbl mr^Juiu fur tuur>coc< 

XUmffffi^r'« ail int for K>*irto dmUI- 

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rf. In r«arrl/i rjiprinntra, AJ; bi«u 

fbf. !6a 
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t^Eftl'i jii:b1uüb tDtU tXt. 
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i: liDmriil««. ); mlrrmfiuiif^ f^o 
et, 1. I. 

bttnar. bull^ut af. M. In liIo«(L iSt. 
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t4i. tn iruluvoarr ^u^rvat, H. 

In «prrEum, Itl^ nt; la UmallUr 

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ufin*. nExitini^iiDt* Df. M, b«v< 

pfai^t^ m. i^hBfiffii ta, icd: 

cORrulx crdBulbrH m: nuntfnc 
nr. 1^: vo«4iiopbltK\ \>A. In ffi«*^ 
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lin. mij pcüircpbiii«. U): pvr- 
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l,L-ui-Di:fih«m.iB. itt^ 'S«0 "LmLb- 

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m. to Ellti1}(ll*rlL 111 tD PTT- 
sI^bUb, lH; In CBilrle CBBOtP. lit; 
Id lobtr iiQtümanU, IM; la ID«* 
iBTl*, lli:^: ID EDBMIB« Ui; Ifl 



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nferiTx. iTii, iti p[i*Tiit<rAl fmrpr» ^Hl; 
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liDB, L«l; Id RpBii. i»\i ta MUpca, 
UV: In ivbtrcaluLk. l«; |p luW- 

!ulia lojrvLtüüa, IS», Lu ijvlio^d 
kivvr. 1»: ID TüHolit 11?: Lnftio-^ 

QflturB or, DO; xnUolackc turm, 
1^: pbrtlolDfie form. iT?: r«r 

»iJuaL, ITU 

tiQi^L« Qtll* [dl iTSi £lj4r«4trri i^L 
n»: illi»rp<n-|-Hyil«ii cTyitiU* Ln 

ITS: Dunbrr at [«utooyt«« liu 100, 
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fumafaiiiian of iivor and tbio^n in. 
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"Lldftfa »mum, ItfJ^ AT. 


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Ilnn. )2: r«h<Jo4'4uniiiL fur dtipfi' 
11i<tlH Iw;l]]ua, ?3. dIfliElicHit bit 

cUiu«, Ti: moFdiDi for ntcttn, ai 


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Lour oKif'uii dL 71«: nniDoua ar, 
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t,yapbttKrl*m, larc*. 133: bidiJI. m 

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HAlBfl^ ID« uu SUV I «wit la. Ill; pank- 

•lu« Tn, n, m. U»: »ailna or 

■HMqalto la. M, 

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UAliMnant puttul«, aaani Mcllll la. 

Vflltwr. M4h 

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l|4«a|a*, hstoeruwla lo^ Iti. 
M*fitkbLm HMire »T nicmnw^ I- 
Uv^ii. bload'V'fura. W, nutP4«n|. M. 
" >1fifuA& br*0 " otipikf oi »wütt^M, M. 
MfcarnbiatU in Mood. IW 

KmBiomi apUrLr^uin, lOT; la item, 
MntuibtJr catijLjiod», «luAAloi U. JH. 

I WrlJUurlJL m. 

ilulO la, tOit at: dluluuctiiu Ib- 
lnir']:nlBiHfl lo. 41. |U; I'rioliarA 

' diplctvccuft rn. 11. 394i kuconr- 
mii m. thj; cQcumotocfua id. ml 
lubcraular. »(iirfttdd Bul4 In, VH- 

MvuLhAvWvuii« ju Liuoil, V: m BtlUftif 

d'nm prnikin. :iku. 
MviA^buruin in DiHrittt-djpti iliiM« )M\ 
Wi-U(>lioipbDrlo f:lü trtt Ivr olbuiala< 

in urüB«, Hfl. 
ll*tJi*iDO|lab]it la urlDt, 94. ■pcvuain 

or, Uli. 

MvlQriüarlDbluurlo. MJ. U4, 

Vi^Ilifld, BhvJvn't. for (41i«kU b^^UEL 


BaIUti'*, tot colftla cuitu» of liif- 

I'TiA. as, 

Cuplawilix't. for fmn|-iiiB tuftULu^ 

DBtamuD^ t^r UtfrFri* («cll^l. 61. 
D*(i«1na'#. fpf pmi^iil» la millc, KI. 

I/uijIihth - irunFtof - Krrjun^llUB'K. for 

rhcili'H titJtkllEi 71. 
E)ibii[:|j K, £i>f Hibuniin Jii ürinr. loi- 
>:ainifoh>, rop lit.('l>'P<ai puJlurn, '«. 
UwAM-:]|ovffr*'4. f*«r Ktt*KrK OlvULIU. 

OLpdibi&a for BUipLbf BtlBrUr pftra^ 

CfililbnFii'i, fnr Malnloff blood, 1U 
Ojjiu'i, Toi ■t4iiiliiii buUirl^ 34, 
OiiDrli#r», ror »tiiuinf btriari^ U. 


MI: rvr 

lUirifTi TIC h !«('•. far ni<pBlo, 

kr<«ifl4 tra^lLf at blood. lA 
kkniijnr-r- for JiiiBtriQ djoiiiur. Mt 
Knfb'Rbrll?b, ror ilAJiiIni lab«r«l«^ 

bAcini, ta, 
IrfuhiOBb^. rsr BiAlniEit blood, it/i 
M^nii^ri. fftr dtivtiiluii vi bjdrttiva 

Strand. Va. 
Ilar'f, tot «(AlnlaK »pore«, CA 
ll'UUt>, for «lAiolPi lUAluUl poro- 

HE*«, IUI 
iLonuoovalLi'*, fur tultiCui bliKid. 

RubvitBAK't. tit Uric otid. m. 
»uiJAii'B. far «laivra« bBcilJUi., UL 
riPOuiitht'a. lor ■»cell'] grotilr of 

blao4. m 
StiDUlQK'«. fo^ drr nalddB of bl«4. 

atTBUBB-i^ tor lictU feria, TU. 

TOf>r«t'B, fvr rto* h/dPBVblariv oaldp 

TrwiunrotlX tor Bucn« b*«LlliiB. 

VVidRwnn-i. lot l«flle «dd, »1 
Vu Xvi«1'b^ tnr iBbtr*]» btdiU, I». 
TvriRbE> fw auliiiua blood. ICd> 
ZirMX for BULvi*« luhv^tB MbcJIk 

Mfltbyi-THikM iHi rar cth btdnomrto 

MkracocsL 11. «t. 

UKtiH^ftCAiu iDl/ftMlrnltrlB, Id vtsla« 
■ltU| Mii Uli-ftmn lB t^lUD^ 
M. Mi; orv* in aribi>. Mk 

WlfRHTtB« In bleot lU. 

MictaflQMtr *r*»iML «. 

llJcro-oWBtno Ub1ö«C W 



tin iKTun of. i; lubr-munk vf. 

Mli'riwpvr«!! fdrfur. Id 
MLIk. lainiiae at t>E in. TH: *«ouot or 
pnutil» fn, >^; «»■■^Ln lit. tit'. 

4f. Vff; ftrnifeTiit lii, i««( far. TTH; 
tifdroDia ^iPTHJild lu. i^E far. taa. 
rjiimon. •■AmiDkIMB ot S7S: -mil' 

117 111, }»; iut«relc E>*cim la, »0. 
">l4tf- t^hAiinokB," Ms 
Mitv. Ujilr-u>c. M. licli-H H, 

»ac« In. B, 
Klsiura. LiQdwtr'A mftcnflii. tu. 

MoIOb. 14. B. BT. tu: rtilirvHUoa «r> 

Mol'tulaJ- concrntimioH at MiM^. 1*-; 

UAtNr'i mcfboij far hUIqIdi «porM. U^ 
MoElLkiLUiii luuUK'.VBUtn. itkrftMH* la. 

UnriAnnHMvlK In ]^uiii>nilii VH: In 

mUAdan in, 
Koot«^ i«t for »njtir La uriov. J14. 
Hnbui nrhfftiiEl, Uv, )»« iiIbo ">«- 

MoMnnt. I^fflsr'«, tor flu>|la. n. 
MirrlE>Vu4. IcUi^uefliAl* tl, m. 

Monti'« I4af ror Ciirir in urin*, ASO, 
Uarvor'« (HI fvr brtrficlitorlc ■jtM, A'. 
Iduvquklo id4 iDatwl4. t<, rt-MM» t/U 

(d flUrlBii*H lib 
HolbtT-Bttl of li*ct<rl«. IT' 
Ualllltr ot bnr-ti'T%t, 14; M «ij>mBfl1, 

•Ht f«r- an. 

*'Uatii|ifiil «ipiintoniElaq" la t>nini-hl- 
JflDCor Donrtnb1ft>r 0. ILI, Id •bulutti. 

Bfupn», tu. (»-I - HuriLjf Urni- 

UuoouB mrnkbranv uT «t*>pli««U'i S44^ 

lEitrtiEiniiL Vir^: nT mnuiB. ^4; «r 

pU*rrriT. iHv of <tDiii««b) tUi *f 

miixui'. ;«, 

Uii4)g» LQ r«i^r4, ^iTTh ;TS. m; in C*>trlc 

Matf« *ollUii('«, 10^ 
Hutirlrt rriclii0». Ill, 
Miifcp |pi ni>rr» k[i t«»*, Mft, JTO 

Mr«iin aro^M* in •rii*'^"'^ ''0'^ 
Vj'4lnrrtAii, «iJalni of, I7f. 

NtIi)i(bbllD In urln«, but far. tlO. 

N«i<lMiij'» ciirtral-ruf'IiHLii voLutlcfb. H. 
Ni>i»«<r, RnTirki-PHi^Mt 4ir. II 
H«ninu>drii. IDI; «ke« of. IIO. 
K«]]>lMraft. Pinji1iiii4 In, aJfC: milmfi' 
VJtrT. iputLiiB ta. 337, 3HI^ urla« i». 

>JapbpE<l«. a^iul*. urln« in. t&t, knutv 
liBinarrltaAir-. utEoii In, JC4-. ncvltf 
ni>'^l>Ainr>i''liBirip. urln'* In, KUj; 
c*r4L»T. urine In, Ml; cbronli; 
ii»nw>rr6*tie. iirmn in, ui; eöponlft 
iri Ten till kl» unnn lo. >ll: «btnoi«, 
urlu* lb, JAO; erroBvpr Is» W^ 

OiffDv*. uridv IL MO; «IIBI l>i 

Ncn«« 4l«trttB. Bnt« la« tfl 
>*t imcfoi6H»r, t 
Nvbtfvl 4l#[iUB DiiiMbBft* L> tatn. 

Mi; IB vrlBt. to 
KtuinJiuiJBu «f B«tn*M nwO^ II. 
7<c«tn»liTllc «Un In «vutuia, M. 

■TBBiiki^ ta. un 
!n»UiiH, w<iuaa«f, c:, 

Mirk- ki'ld t«L fuf •ithiWUi Jr; ttna». 

3!, J« 
dlruli^ujul rnAilluii. n. T)r 
KiTfnBA.rnlnt r*4^r^Aii fa »bvl*r%. t1. 
Norm&l toluiioii. %t. 
NornifiblBitL Ik«. 
N«»pi*«, daubii, li inpU. f, 

Numrnuliir tpvt«, tVL 
.Nulrlfni MK'- (irTL»rBÜOb OT & 
DicdiD, n;traiiän «F. n» tt, Itoul', 

». LruiffliiititoB of, 0; pr*»*^- 

Hon or. ri; iiQiiii, sa 
f<7laudT'B f»*! fur ptfiiicaurlB, n>; fur 

frbvrtiluior. nmpi-B lutidi, a. 
plwFmMvr Bpirilluio, H; «lalMiif af.v. 
gblHtlm. i; Bpwbr«iiuUi^, I. 
bfllBU T4ftPllB, IL 

Cridlum «rhlmiiit, M>; in mat» Mt Ih< 
btidilfr, »: lu f^mbral Bbae*!^' 
»II In Jiit<-4(ji>«, 90. \a onl WTltr, 
7U: In i>diniPD*ry At)ti>«aa. Wt; la 
r^Ji«! «[PB^rfH, M^ III fulfil, Ml 

1)11 u*i Tor tumr mnmu/, tk 

OllRn»or>Api'na^B, OUhiiuvLa pt. 1173. 

QtLf i^TiEimji'miLii f»Tinit. «rhartfiM 
^'MatHifiJl In, tl: kai-irtillui litnl- 

ritai Ibf «St 
i-kvkly, munlnktlDQ of. ¥!&: nr^l 

iDi 9*h, (oaor«ciTai In. IÄ: |#|»- 

Cbiiirii in, uit fiiiTiiim aLhin4D» Id. 

SMi. «HHIlH ID, J4fiL 
nrnjtul^ HLild'*. tailiuUiftD of, IHl 
Oreaotinl 4«ilirrian(B En uiiEi«. IJL 
OtiOlC iLiM, Dsr or, Lu Qiicrvwop». |^ 
(■•tiMnirviiciH l*u«nrrtaiiii in Un; 

•U|iijrl0«*iwuk pTujffffiH lB, 37 
CitaumnBu \a prtnuiaat novailm. 

OtH. mib'TcliL hm-DJAt^Mfc. 1S3; »t 
DBniBladfL 110: i^bfuiIIb. lll^ lot 

vn. jTi, uOi pwBHiic. iB fwd, tn^ 

IT] : pRmit*. in uriDt. Kia 
OvAftun 4>vftL4, «balvntarta la, ttt; 4«J- 
lalO miMn In. VI. Huld «f. V). 
Gliipr"'tf t'tkrimtFi«« ^n. H; m*m- 
bviBln IB. 33ft 

Uirtn, brondiPB. for kBiteriB, n, 
O'tnlAlaJav. N. 

Ox. nd blud-fvllii Df, IBt 

f^ullt «eld la iiHiB», m. 

OialurlB, flliiD^nfAQo* «-r. Kft, 

lliTi»! Ill i1'''«-lDfirni-ni ^r Tfirt«r|iL Tti 

In Fi-i>rv fnniuLlan. 17 
(iiTliriqiiiilubiu Ul iirlD«, XK. 
Onrttri* vfumlQuUrlB, IW. HO: W 

foe«, XTO, 

ru:krL-caO(l. IT. 

PBplll« nlronDITBllAl». %IU dUfBCBML 

»Hi fLiWitdriDn. M«, 



l-itniilt«. BDimal, n; Id r«eM. HO; Id 

Bdliliu, IIKl 'a Btomub cOdUPIk, 

xaiUrLn, its- mUrik-aulumbitt rflrm 
Dl, IJÜ, aunrljiii romi «1. luZi tor- 
(Ui> fnrm i>f. 14>:^. ira|'Er.4l tota at, 

10:. autbiiut d1- 1M. [» 

ta. Ml 
ftiuiypaDid bfttfllCiiB In bifxA. Itt- 
Pftricut «clii or ■[ijiaafL. :tt 
Pi(ti«K«Bi« bAfiunn, IG. n, SU; in 

fi'i-i-i. XH, Ju urliiv, AM. 
P«nirMlliiET> EUqnim, O- 

PffDiotilr nmi rihTi UM Cor itlnliaAl 

Tt^iu, ial fvr. MS, 

t^Clo tUhdi. M&. 

Pvpiuu. u«| fthrp M4, »)] Lfl «lint, 

IMI for. M. 
Pvplonurib, W9i pr«CflnLc. NA 

ParlcvdiUi. pDvimmHfli Id. «>. 

h^ppiianiil*, iMfUfnodoetrl In, *> 

P-nl^Lititillt. Li^u<:ij<;¥tJMlB Lu, IflS. 

Ivrinnncni ■ijnfnc, 11- 

Plrnli^luu» ftHviDlB. blood To. iVt. 101, 

boD^nmrmv id, j6s. dlco^-plaiiM 
In, ItfT: rBti»v* dIh 11^: ottfb^niK 
«f. IflT, cualitLtLibuva lO, IW. S««- 
rl1«iB In, ifU: Fitmni^isiilii ijt. 1« 
«■tmarfomk (d. IM: jj4IIl1Iu<'>(4 
■It in, JK 

ppri<i»4«. tit. 10M "^huvptbC 

fflTM fUlfunt. tf, r?- 

Pbtlrukofrri LnL lor bllf, 10«, 

iTtirrvr^ LbHttfrtiu tMirlllua df« 74; r«- 
«tflLcD of. S3^ 

plumit. TDvrcUH TnrmtfriSB d|. HI. 
lubvroulbiiri of. S4'; uJor of, ■pu- 

Luui lu. at. 

Vlwri'^] IB uru«^ Wt 

ruvui>^i>iiLii»LBiA «oivttDk. nT' 
j'hKniiifiufAvuaitt enrviait le arm* 

nrln*. UT, 
?bl<rui>D««ja itfc>Uitt«, put !■> Al 
I^lAmdurlQ-ia^MLLlli tnnt TCT ttmO llj- 

rtioiiib«i* or iin« iM inicB«Mft u 

rbo«»b,4la« In »ln«v M 

nitiirnba ptibiiL «. 

AtbteiB. «U*il(^ i^p* lu ■puiaiu «r 

aa i^r« "TuiinrmMifL. I 
I^kJolotflg «Ibvniiiurt^ M. 
L*]c^rf-44id («M for bIIpuidId Ia iftop^ 

F^«ioc«nnia •*l4(loD. Fr(f4l4k4*T^ K 

Vlimuutl«! of imvlqiUda«^ l». 

Pliva«(-C4ll* Ik viKym, fH ttfli ^far- 
DiMlM br Ikl^Uv^*. I'. -Kr*iml'« m 
iDn«nF»r ■b>i-H«. r4«. ir> ijrlnA Ml 

"TKullfiaa^ ««Ufih. ipuldm Lu. tl*. 

I'tiynmiii vpnmlctr, mlr^PHporoD rur> 
fur ta. n 

riunh totcml«, tadt'lilui vL 77. 

Plumule D4lJ>rM. tni1<Pi]*iiniia fom 
or. W: >«UvD-«iitUlnnB] torm nt, 
im: «uvBfiDot fopm 4>r. w. luiir- 
lab ^rD of. m-, rtn« Farn of. IM; 

i*raiw norm «I- tor «lAtmiif ar. 

PlUUEOlVillu U- 

Plal« rmlmrv. ». K. r. 

riBiDiotf. Mwd'. 113. vovitiiui ot lie« 

«InmnnKiPvlinn nr, 10« 
l^trruriL. r«relB0iD& al. tiudat« tp, S84. 
PleuntiB. Mfto^ocuMB ic. tt: cnnimd- 

O9O0UI <B, to, 
riUfA, OIlLrluL*. Lu »tiuluo^. Sai, Stf. 

PutMmAlurla, UacHIui lutll» atrocvcd 

III, !tt. 
Piivifiui>bAc11Jui Id cnupvt pd«uiihhiIiu 


PntuiDDcaflaua, rii11lv&11«B Af 41; In 
i:<p'i-l'rv4^»hiH[ fiiviiiüBiüt. «, »4. tu 
rnmirnnrtim 40: in npiititm^ Üir; 
■talALai «r, 41 

PaffUUObl«, CI-DLIpDMH, IpucurTUMlB iQ. 
IW; pACuinubnfillui H, S; pbcii- 
UKOfVU» lu, 40, »puluoj lu. tMi 
iDtAT. InaxriDui» in, IW 

pDfuaoBoravL^Hila. U. 

PoikLkfarifliif«, UT, II»; Ju »oomi^ 1W. 

PolMijiiur. farFtva maiiai.i4l. IM, snl' 

tiKinii], Vila« iJi, UT^ ItIulaIh Q'lP« 
D, S!,t 
Polar «aflrllii, )& 

I^DlVflBlVilMK Aü; 

PAjarlf4lfiiQ irnL fi>r atbinnJ« la urlB*. 

30!; fur lUKHF in uriijp (.11 
Pi>]y^>)rvri)4lnpLlttc ^i^nobciniUaB «t r*d 

bLOaa-rDrvui*L,'li'*. tvi*, 
Pi>1rriioriibf»nu''l"ir UucocfU*i. 1X1. 
Polrnuolr«f lau.'4t»'jtr«, la. 

PUVl>|-B0i.>d» 111 VuUlL«, lo. 

Pomiv» 'li«infil4iJa, MH. 

PiftiiAHlviu bniujlil Jn (iria*. Jtl; lit* 
<3rBi* cj» n rTM<B(- if: iivilitt, fa 
Vfin«, lm f«f. Sil , ■uJt'liif^fauA»- 
««■CK^MDId 141 lor jilhijtiiln Id 
vtId*, ttf. 

PdUEo Enlturv tt butttli. n. 

PTKlpltlD rHDllDD fU blOvl 1«, 

IVvtfnfenor. IntwrVoala In. Itt. 
PTlfr^ary ■fiarnin. biaa4 iii^ iW: ham«* 

ilobln lA. 14i; tMvlfl« craillr of 

libMKl la, la '^ 

PrcioMiri, r^n« in. ttt; pui»0MV* lb. 

PrD«La||td<K. plffmaatilFiTB of. ni. 
PTMnatlv« crruklOuft anviuiiL bItiDil 

ID. lc; I4UBH ai. lAH 
Pm«p4«b. I«1 fvr. >U, m ufLD«, (*«4 

Enr, nA 
P»iAa1«Ml«a, llMlcb»'i trT«Ula Ift, 

t^VUiii dtfMriaei, tflMa f 4P, Ml 

Pr«lt4V>lua Ünaal, t*. 

PrvEni bwtUui, l#7. Uff, Ml; la bjavd, 

Ittj lb nriBB» Uff, H»^ 
^^tOifl*. IT. 

Pr«bt'|ul<« apul4in In »JtiDi^ ttt. 
PMidttd'i-bibtrl« Ijadlll. IX 

Panitfci1*i]lia«ia, 111; B«^aiu1*fr rt*- 
Bio lo. IB4, 
|$Mitbfrtl* luellll IB «naiumH td. 


PDtrpvral f-irr, lr«t«c^LUala U, Ul- 
Puln paupfi-KiL^ v& 

Polmofrur abaeraa, BpubaiD la, EH; 
cbaJiac#nn la, vn-. ftmtliitdiD ta, 
0»tMll it wvmnta, lift 
o4f B4. o^ivm «n, St 
(«a^rvn*, ctrroniorioa ta. IM, iDfLc 
Uirlt buDiulLi in, lb; o^ivEa ip, 




Poimnnu-f Itfarrl^on, ümr-IaIqh 
Olli* Vfl, Ht- 
nrooai*. n. 

luhiireiiiQkiB, «Tvtus In, ft» |8aA 

"TuUmdluBis" wid "8p<i[dBin"i 
FOPDiEir*, HfiktiKl. In nmnnii in man 
V([ najd lü, tu. ■■ chluFO*]* 
IK: LA BMIBlDKlIll. Ml, 

Put* «ultufB of buurti, 1ft. 

Pun iiDin*(vr» SVT-' 

>^urloi la iirin*. «iftiiUllDD «f. Mt. 

I-IU^ IK; U IHK, m> 7191 Id pbiC«' 
nosfiua nilrltf^ SI; la ula«, 

Ut-, la ivmH. au. 
I'lii-^'noCl In Monil. \tl 
ViiMitlvt BullcLiJUi^ ui(brti tool LI is. 

Puind b»bof]^E>'. tjiulum la. tl»- 

Px»)](JB. di9i<r*iitial dlnanDai« uf. BMi 

u(ii]< lu. Zw. MO. 
Firtnikvf^rhlU, tirlna la. Mt, 
|*ybEi<rriirUic UKlhod ttf Vp^Tlfla fF**- 

K) lit UltoKl, >£L 
r^lariv vJuOl 1U 
rjLvrhii. tftrffatfOM at vtoiBbiih «an- 

ItBia In, IM. 

gutliutivff i*«t fnp ftltnimln in unn». 

■M, »1; Tor LidriHMcirlcr acid, ZM. 

»T luUe uiJ, ^ttu: for iUtu in 

orint. iii- 
QuuUtHtm t»c for ultFuniia in urtn*. 

SI; tf»r b^driHiUanq Hi', BI; ter 

fur^ua Id una«. MT; f4r iiufm la 

urin«. tii, stK lor «rvo. Sfl: nr 

UV«rtJUl TWof. DftfAUE« Of, >K IUI. 
^ami&H'i (»t far lUmHib oaaivaU. 

tuEi>H iii, iti: In iiool*. Si: iivti- 
la« ur M^ 
KttKtivü. AKcLuiiaiLliita. u; iturcuDdj. 
la arlD«. >3B; t^iiAtDm, TL, «li^iD-. 
la uni4. B»; Hbrllub'a i>ji}ii>kd, 

bar^L'a iron ablorJrl ic dinlHitca 
m/'iiiriJi, H^t. tiruborWiOal, p4: 
Ifljloi, Ti, TU; iFoftT 1" ipuiuBi, iM: 
ulUudrutbl, Tl» T^. iiti/>jfm-iui]4jl, 
in Phnlpri. ll: l^»ifl/.r'ii D pr*-- 
cIplUD, (ar 1il4Qdp UCV, Rda<-Dtei'b'4t 

In iirfiip. 3»: tTt>boid> UL im. 
WlinI, a. 
RcAttut. KEirlkifLiX für Ljiitjuli fvrvr» 
^1; Kfhacb'iL far AltiiimlB In 
uriiti-, <iül. JartBMii'*. tor torB>«I'n 
In inilK TiJiL-. TimHUArr, II: po^Kr. 

RtfiuiD. cjipcr «r I«ipfl It», i^; ioo»- 
COi^'U" 111. <t •VpTlMl» r**ii»iu. I7H 

ÜBcuirrul fCTpj, ]roi^nr./li»la la, ||l - 
■piriiMrn nln^rnii-ifn In. 11- 

SlcA ^luul furiPLiiFli^. l3Di altr.r«rloii 
f]f, in 4ia'4fe*v iDTi ani'mii^ dfc^ii- 
VFVll'kD nr. LFtS: mimt^nn nf. 1U: 
rrv[iAii0n ^F, i.^ , «utqinallQi] of^ 
Uli; 1n iiiutirii. Zir.', S1H, nu**!!»- 
«('4, Itfln^^. oIitDK. lUj nf bcrw, 
Vti: at ui. IM, uriirin vl. tn. 
prii^fltjfnmBiDphilJfl iici||Dn"riiclDiL of, 

]^9H iitiiijiEi>; or iri^j. »Liiiiikd, ioü- 

(g#» aim " KrjlEirorjl*« '*i 

liAdimd ttiBimUji. 1>1: bvaoslvlilaii 

ItMial ■bKint otdhiui t-ibii^iMit tn. VO] 
4>AttB. ■»rDldr^ica of, ao; »«Itl« 
calcart lA, BK; tiiCDT««^ alofl»*« > 

ar. s«. 

U«(iiiB(. u«l for. Ml. 

II#iroTibllFrFlJ|Ptl ibarcAi, ^ll. 

lUut^'a n«iki)4 tat »UJuin« a&Urtal 

Mruift«; in, 
lUmnut^lCI«. kVfOertoJiiB In. itl- 

itnniiv BUDiKfitoL tu. 4I> ■iippur«- 

r<Li('uiiiaiibu. iiiLitffrb«^. 44; JtmMef 
rnici in. iiT 

lILbliarb In uflbH], l4«t fte. UOl 
Kic« tioili» ID i]>iJturD, 19» 

l^intiaiHfi*\t't BlAlo tkir L>Jw<l. IM, 
kntB alKifr, i-lfllnlELnffil:^ iif. tt- 
fUl■B^E■•r.^'« rc4ClJijr> lu vrlae. SM| 

bttf mr t>ll0 in iirlBi^ U. 
RuMlBkBn'i «ri«Uim*l«r. M. 
RttBÄri mnboa tor mffKiti« tae^1u^ 

ßuptar* bC klda«j, orlb* tn< M&> 

B*whftroD>«« «arvTWa. tf. 
MiifTrJio ««14 In una«, uvt lor. Jia 

Hftllvarr «oppntrl«*. Nl^ 

Sftl^vikl'« uUfifH-ladal rrvcllDCu Id 

chalpra. T]. 
SftUl WAE. for flMlrlc. oiatnitr« s^ 
nalti lo ffai^ !f9, 
RuitAfila Id urinA, <h| r<ir. tia 
:lHprBlih)-L«i. r«vultji(^r«. IB, 
HftRiD« aunntti id sfltirlfi «Dti«! 

tVDtrlrmi in tianikcli oiuTmlX ! 

Wrtvlilrw, »I, 

^alir. TiiI4)uIh( h«runcloliln_ Ht. 
Ik&rUtIn«. tvuvocT^UifTa iJi, lll^ VCCOV^' 
lHar>ml lifitK^tivM la, &. 

eotaittoori'^ it^- 

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