THIS book is designed especially for practical use in pathological laboratories, both as a guide to beginners and as a source of reference for the advanced. We believe that the book will also meet the wants of practitioners who have more or less opportunity to do general pathological work.
Every autopsy presents for solution a problem which may be simple or complex. The known quantities are certain clinical symptoms and physical signs; the unknown quantities are not only the gross and microscopic lesions that may or may not have given rise to the symptoms and signs, but also the etiology of the lesions and the order of their sequence. The solution of the problem often requires the highest skill in post-mortem, bacteriological, and histological technique, but in its solution lies the fascination of pathological work.
It has seemed advisable to us to present, so far as possible, a consecutive statement of the methods employed in solving the various problems that arise, so as to avoid the repetitions that necessarily occur when the three usual divisions of the subject are separately considered by different writers. It is hoped that this method of presenting the subject will bring the student to the realization that the mechanical performance of a post-mortem examination and the inspection of the gross lesions constitute usually only the beginning of the solution of the problem, which should be investigated
bacteriologically, histologically, and chemically as far as our present knowledge will permit.
We should particularly advise the routine bacteriological and histological examination of the more important organs in all suitable cases. Naturally, the autopsies in which the lesions are due to a single etiological factor are the most valuable and instructive for a clear understanding of the pathological processes present.
Besides the methods of post-mortem examinations and of bacteriological and histological investigations connected with autopsies, we have added the special methods employed in clinical bacteriology and pathology.
In the parts devoted to Bacteriology and to Pathological Histology we have not endeavored to make an exhaustive collection of methods and formulæ, but rather to select those which have been found of the greatest service in practical work.
To Dr. A. H. Wentworth, Assistant in Children's Diseases in the Harvard University Medical School, we are indebted for the sections on the Blood and on Malaria, and for the notes in regard to Lumbar Puncture.
POST-MORTEM EXAMINATIONS.
Introduction, 17.-Instruments, 18.-General Rules, 21.-Suggestions to
Beginners, 23.-Private Autopsies, 24.
1. EXTERNAL EXAMINATION OF THE BODY.
Inspection of the Body as a Whole, 26.-Special Inspection of the Different
Parts of the Body, 27.
II. INTERNAL EXAMINATION OF THE BODY.
Opening of the Abdominal Cavity, 27.—Inspection of the Abdominal Cavity,
29.-Opening of the Thorax, 30.—Inspection of the Pleural Cavities, 31.—
Opening of the Pericardium, 32.-External Inspection of the Heart, 32.—
Opening of the Heart, 33.-Removal of the Lungs, 37.-Organs of the Neck,
39.-The Abdominal Cavity, 40.-The Spleen, 41.-The Gastro-intestinal
Tract, 41.-The Liver, 44; The Kidneys and Adrenals, 45.-The Pelvic
Organs, 47.-Removal of the Brain, 50.-External Examination of the Brain,
55.-Section of the Brain, 56.-Virchow's Method, 58; Pitre's Method, 59.—
Removal of the Spinal Cord, 60.—The Eye, 62.—The Ear, 63.—The Naso-
pharynx, 64-Examination of New-born and Very Young Children, 65.—
Restitution of the Body, 67.
I. BACTERIOLOGICAL APPARATUS.
Steam Sterilizer, 70.-Hot-air Sterilizer, 70.-Blood-serum Coagulator, 70.—
Gas-stove, 71.—Test-tubes, 71.-Hypodermic Syringes, 71.-Cornet Cover-
glass Forceps, 71.-Dropping-bottles, 71.-The "Platinum Wire" or "Loop,"
72.-Bacterial Filtering Apparatus, 72.-Wire Baskets, 72.-Tin Cups, 73.-
Thermo-regulator, 73.
The Preparation of Test-tubes, 74.-Preparation of Culture-media :
Bouillon, 75; Glucose Bouillon, 76; Agar-agar (Plain), 77; Glucose Agar-
agar, 79.-Glycerin Agar-agar, 80; Gelatin (Plain), 80; Glucose Gelatin, 81;
Blood-serum (Löffler's Mixture), 81; Litmus-milk, 85; Potato-cultures accord-
ing to Bolton, 85; Dunham's Pepton Solution, 86.—The Filling of Test-tubes,
86. Sterilization of Culture-media, 87.
IV. THE METHODS OF STUDYING BACTERIA IN CULTURES.
1. Cover-glass Preparations from Cultures, 98.-The Staining of
Spores, 100.--The Staining of Flagella, 100: Löffler's Method, 102; Pitfield's
Method, 103; Bunge's Method, 103; Van Ermengem's Method, 104.— -2.
Methods of Obtaining Pure Cultures, 105.—Method of Isolation of a
Bacterium in Pure Culture from a Mixed Growth, 107: The Plate Method of
Petri, 110; Esmarch's Method of Roll-cultures, 110.-The Determination of
the Motility of Bacteria, 111.-3. The Inoculation of Animals, 112.-
Guinea-pigs, 112.-Rabbits, 113.-Mice, 115.—The Care of Animals, 117.—
4. Cultivation without Oxygen (Anaerobic Cultures): Method of
Liborius, 117; Method of Buchner, 119; Esmarch's Method, 119; Bouillon
Cultures under Hydrogen, 119.
V. BACTERIOLOGICAL DIAGNOSIS.
Staphylococcus Pyogenes Aureus, 121.-Staphylococcus Pyogenes Albus and
Citreus, 124.-Staphylococcus Epidermidis Albus, 124.—Staphylococcus Cereus
Albus and Flavus, 124.-Streptococcus Pyogenes, 124.-Pneumococcus, 128.-
Gonococcus, 130: Special Culture-media, 131; Serum Agar-agar, 131; Urine-
Serum-Agar-agar, 132.—Micrococcus Tetragenus, 133.-Diplococcus Intracel
lularis Meningitidis, 135.-Bacillus Diphtheriæ, 137.-Bacillus of Typhoid
Fever, 141: Differential Diagnosis between the Bacillus of Typhoid Fever and
the Bacillus Coli Communis, 143.-Bacillus Coli Communis, 145.-Bacillus
Tuberculosis, 148.-Spirillum of Asiatic Cholera (Comma Bacillus), 152.—
Bacillus of Anthrax, 156.-Bacillus Pyocyaneus (Bacillus of Green Pus), 160.
-Bacillus of Influenza, 162.-Bacillus of Glanders (Bacillus Mallei), 164.—
Bacillus Proteus (Proteus Vulgaris), 167.—Bacillus Mucosus Capsulatus, 168.—
Bacillus of Tetanus, 171.-Bacillus Aerogenes Capsulatus, 173.-Bacillus of
Malignant Edema, 175.-Actinomyces, 176.
General Considerations, 178; Cover-glass Examinations, 180; Preparation
of Cultures, 180; Animal Inoculations, 181.-Suppurative Processes, 181.—
Erysipelas, 181.-Peritonitis and Appendicitis, 181.-Pleural, Pericardial, and
Joint Exudates, 182.-Anthrax, or Malignant Pustule, 182.-Diphtheria, 182:
Special Methods of Staining the Bacillus Diphtheriæ, 184.—Influenza, 185.—
Examination of Sputum for Tubercle Bacilli, 186.-Tubercle Bacilli in Urine,
188.-Surgical Tuberculosis, 189.-Cultures from the Blood during Life, 190.-
Gonorrhea, 190: Method of Staining for Gonococci, 191.-Gonorrheal Con-
junctivitis, 192.-Pyosalpinx, 192.-Cerebro-spinal Meningitis, 192.-Glan-
ders, 193.—Tetanus, 193: Method of Isolation, 193.—Asiatic Cholera, 195.—
Typhoid Fever, 198: Isolation of the Typhoid Bacillus from the Feces, 198;
Capaldi's Culture-medium, 200; The Blood-serum Reaction in Typhoid Fever,
201.-Rabies (Hydrophobia), 201.-Leprosy, 203.-Actinomycosis, 203.
Introduction, 204.-Laboratory Outfit: Microscopes, 204.-Freezing Micro-
tome, 206.-Celloidin Microtome, 209.-Paraffin Microtome, 210.-Paraffin
Bath, 210.-Vulcanized Fiber, 211.-Knives, 212.-Running Water, 213.-
Slides, 213.-Cover-slips, 214.-Staining Dishes, 214.-Metal Instruments, 215.
-Bottles, 216.-Examination of Fresh Material, 216.-Indifferent Fluids,
217.-Macerating Fluids, 218.-Examination of Fluids, 218.-Injections,
218.-Cold Injection-masses, 219.—Warm Injection-masses, 219.—Fixing Re-
agents, 220.-Alcohol, 222.-Zenker's Fluid, 223.-Orth's Fluid, 224.-
Flemming's Solution, 224.-Hermann's Solution, 225.-Pianese's Solution,
225.-Rabl's Chromo-formic Acid Solution, 225.-Corrosive Sublimate, 225.—
Formaldehyde, 226.—Boiling, 227.—Müller's Fluid, 227.—Marchi's Fluid, 228.
-Erlicki's Fluid, 228.-Decalcification, 228.-Directions for Using Nitric
Acid, 229.-Phloroglucin and Nitric Acid, 229.—Picric Acid, 230.—Trichlor-
acetic Acid, 230.—Imbedding Processes, 230.—Celloidin, 231.—Imbedding
in Celloidin, 231.-Imbedding in Paraffin, 234.-Serial Sections by the Celloidin
Method, 237.-Serial Sections by the Paraffin Method, 239.-Staining Solu-
tions: Hematoxylin and Hematein Stains, 239.-Carmine Stains, 244.-Aniline
Dyes, 245.-Diffuse Stains, 249.-Combination Stains, 250.-Pianese's Staining
Solutions and Staining Methods, 250.-Orcein, 253.-Iodin, 253.-Lugol's Solu-
tion, 254.—Acid Alcohol, 254.—Aniline Water, 254.—Carbolic-acid Water, 255.
-Mayer's Glycerin-albumin Mixture, 255-Clearing Reagents, 255.-Mount-
ing Reagents, 258.-Metallic Stains or Impregnations, 258.—Silver, 258.
Gold, 260.-Osmic Acid, 261.-Staining Methods, 262.-Nuclear Stains,
265.—Alum-hematoxylin Stains, 266.—Aqueous Alum-hematoxylin; Delafield's
Hematoxylin; Ehrlich's Acid Hematoxylin, 267.-Mayer's Hemalum, 268.—
Heidenhain's Hematoxylin Stain, 268.--Carmine Stains, 268.-Aniline Dyes as
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