A NEW INSTRUMENT FOR SIMPLIFYING THE SUTURE OF THE PERITONEUM AFTER LAPAROTOMIES. BY H. TUHOLSKE, M.D. Occasionally, more often in men than in women, the closure of the abdominal wall, because of muscular rigidity or tension, inefficient anaesthesia, or protruding viscera, becomes a matter of difficulty and delay. As a valuable help, this instrument, simi lar in shape to the elevator, used in vaginal hysterectomy for the protection and elevation of the anterior vaginal wall has been constructed. The blade is introduced, covering, protecting and crowding back the protruding viscera. The sewing is done from above downwards; the length of the blade, the angle of the handle allows an assistant to handle it; it is slowly withdrawn little by little as the sutures are introduced. It surely has in our hands been of valuable assistance. A SIMPLE STAIN FOR MANY PURPOSES.* Keep on hand, BY E. F. TIEDEMANN, M.D. A 1% solution of methylene blue (Höchst medicinally pure) in pure methyl alcohol. A 1% solution of pure eosine (Grübler) in pure methyl alcohol. Mix equal parts of the two solutions. The stain is at once ready for use; no precipitate forms if the ingredients are pure. It keeps indefinitely. In this form it is a saturated solution of the dyes; for some purposes it is advisable to dilute the stain with pure methyl alcohol. To 20 c.c. of the stain 10 to 20 c.c. of methyl alcohol may be added. I have obtained the best results with the methylene blue "Höchst med. pure," but have also had good results with Merck's medicinal methylene blue, Ehrlich's rectified methylene blue, and methylene blue "B patent." The purity of the methylene blue is the most important factor; when other brands are used precipitates form and the stain soon becomes useless. We have so many good blood stains that there should exist good reasons for introducing another. The stain here described is easily prepared, keeps well and furnishes quickly reliable and good results. The stains in common use such as Wright's and Jenner's are not easily prepared and when bought are often not reliable. It is therefore an advantage to be able to prepare quickly a stain which accomplishes equally good results. Method of use: The stain is adapted best for cover glass •pecimens. For staining blood, very thin even smears are made. *Read before the Alumni Ass. of the Washington University Medical Department. After drying in the air, the cover glass held by a good coverglass forceps is flooded with the stain. This fixes the blood in onehalf to one minute. If the stain is now immediately washed off with distilled water, we find that the fixation is perfect; the red cells are stained a faint pink, the nuclei of the leucocytes deep blue, the platelets a faint blue, malaria plasmodia light blue. The granules of the leucocytes are stained faintly. Often this degree of staining is all we require, and it can be obtained in one minute. If the stain is allowed to act for one to two minutes and is then slowly washed off by adding distilled water drop by drop until the stain is all gone we get the following results: Red cells pink, nuclei deep blue, platelets blue, eosinophile granules pink, neutrophile purplish, mastcell granules a deep dark blue; malaria plasmodia and bacteria blue; protoplasm of lymphocytes blue, of mononuclears light blue. If a deep stain is desired, allow the stain to act one minute; then add five to ten drops of distilled water drop by drop; allow this to act for three minutes, and then wash thoroughly with distilled water. This gives the effect of Jenner's stain. I examine the specimen mounted in water, first with a medium high power, then with the oil lens. Only when I desire to keep the specimen I dry it and mount it in balsam. I have used this stain for several years; it was first prepared for a neutrophile stain because it was so difficult to make or buy a reliable Ehrlich triacid stain. At first I dissolved the dyes in absolute ethyl alcohol; this fixed too slowly but the staining results were good. For the last three years I have used methyl alcohol to dissolve the dyes. If the ingredients are pure, the results are always good. It is best to use distilled water; with tap or well water the results are usually, but not always, good. Methylene blue, especially in combination with eosine, is a very sensitive, tricky and notional stain. Uses of the stain: Besides its use as a blood stain I have used it very extensively for staining pus and other exudates, sputum, urinary sediments, and as a general bacterial stain. Pus especially is stained beautifully; the bacteria in pus are brought out very sharply. It is an excellent stain for most bacteria. I would especially recommend it for the gonococcus and the other pyogenic cocci, and for the diphtheria bacillus. It brings out sharply the metachromatic granules of the latter and hence facilitates the diagnosis. Use for bacteria stain: Put a small drop of distilled water on a perfectly clean coverglass; introduce into this the bacteria, stir and spread the drop. Allow to dry in air; without fixation flood the specimen with the stain; allow this to act for one-half to one minute, wash off stain by adding distilled water at first slowly, then more rapidly; mount and examine in water. I reserve for a future article a more extended description of the use of this mixture as a stain for bacteria. Modification of the stain for malarial blood: The simple stain, stains the larger forms of the malarial plasmodia very distinctly light blue; but the small hyaline forms, especially of the estivoautumnal form are not stained sharply enough because the chromatin is not stained. It is, however, very easy to obtain a chromatin stain in the simple mixture by adding a very small amount of aqua ammonia fortior, and placing the mixture in an oven at 37° for a few days. Take, 10 cc. 1% methylic sol. methylene blue, 20 cc. pure methyl alcohol. Add to this one drop aq. ammon. fortior, place in incubator or carry in inside pocket for a few days. Stain 1 minute, add 5 drops of water, let it act for 3 minutes and wash thoroughly. This produces very nearly the effect of Wright's stain. The chromatin of the plasmodia is stained red; the nuclei of the polynuclears are stained purplish blue, the neutrophile granules very distinctly purplish; the nuclei of the lymphocytes are reddish purple; the platelets show a red center. Bacteria are stained blue. As the chromatin dot in the hyaline forms of the plasmodia is stained a deep red, they are easily seen. This is a great help in looking for them during the first few days of an estivo-autumnal fever. In conclusion I will say that the general practitioner will find it a great convenience to be able to accomplish so much with a single stain. |