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CHAPTER Ⅰ THE MOUTH23

Saliva and Sputum23

The Saliva23

Functions of Saliva23

Secretion of Saliva23

Characteristics of Normal Saliva24

Digestion of Starch25

Indications for the Examination of Saliva25

Collection of Saliva25

The Examination of Saliva25

Normal and Pathologic Findings of Saliva26

Chemical Methods27

Pathologic Conditions of the Mouth29

Oral Lesions29

Ptyalism31

Xerostomia or Aptyalism31

Stomatitis31

Vincent＇s Angina33

Thrush33

Pyorrhea Alveolaris33

Leukoplakia34

Miscellaneous Conditions34

CHAPTER Ⅱ THE STOMACH35

Physiology of the Stomach35

Stomach Contents38

Test Meals39

Examination of Stomach Contents45

Normal and Pathologic Findings After a Test Meal46

Acidity Curves56

Acidity Curves After an Ewald Breakfast56

Acidity Curves After Other Important Test Meals59

Additional Examinations of the Stomach60

Motor Power and Emptying-time60

Absorptive Power60

Size and Position61

The Phenolphthalein Test61

Gastroscopic Examination61

Chemical Methods61

Qualitative Analysis61

Quantitative Analysis67

Gastric Diseases76

Peptic Ulcer76

Carcinoma of the Stomach77

Acute Catarrhal Gastritis78

Chronic Gastritis78

Achylia Gastrica79

Gastric Neurosis79

Syphilis of the Stomach79

Gastro-intestinal Syndrome Complexes80

Hypersecretion and Hyperchlorhydria80

Atony of the Stomach80

Acute Dilatation of the Stomach81

Chronic Dilatation of the Stomach81

CHAPTER Ⅲ THE DUODENUM AND RELATED ORGANS82

Duodenal Contents82

Duodenal Fluid82

Pancreatic Juice82

Bile82

Indications for the Examination of Duodenal Contents83

Contraindications for the Collection of Duodenal Contents84

Collection of Duodenal Contents and Bile84

Examination of Duodenal Contents and Bile86

Normal and Pathologic Findings of Duodenal Contents87

Chemical Methods94

Qualitative Analysis94

Quantitative Analysis95

Special Analysis97

The Liver99

Functions of the Liver99

Bilirubin and Its Decomposition Products100

Functional Tests101

Diseases of the Gall-bladder110

Jaundice or Icterus110

Cholecystitis112

Cholelithiasis112

Catarrhal Cholangitis113

Suppurative Cholangitis113

Diseases of the Liver113

Cirrhosis of the Liver113

Carcinoma of the Liver115

Abscess of the Liver115

Acute Yellow Atrophy of the Liver115

Acute Infectious Hepatitis115

Diseases of the Pancreas116

Carcinoma of the Pancreas116

Acute Pancreatitis116

Chronic Pancreatitis117

Cysts of the Pancreas117

Pancreatic Hemorrhage118

Calculi of the Pancreas118

CHAPTER Ⅳ THE INTESTINE119

The Feces119

Composition of Feces119

Indications for a General Examination of Feces119

Indications for a Search for Parasites and Ova120

Collection of Feces120

Examination of Feces120

Normal and Pathologic Findings of a Stool Examination121

Intestinal Parasites Most Commonly Found in the United States124

Classification of the Parasites to be Discussed124

Discussion of Intestinal Parasites127

Endamoeba histolytica127

Endamoeba coli，Endolimax nana，Iodamoeba butschlii，and Dientamoeba fragilis136

Trichomonas hominis136

Giardia lamblia137

Chilomastix mesnili138

Isospora hominis138

Balantidium coli139

Taenia solium140

Taenia saginata143

Diphyllobothrium latum143

Hymenolepis nana145

Echinococcus granulosus146

Fasciola hepatica148

Clonorchis sinensis148

Fasciolopsis buski148

Paragonimus westermani148

Schistosoma haematobium149

Schistosoma mansoni149

Schistosoma japonicum149

Ascaris lumbricoides151

Enterobius(Oxyuris)vermicularis152

Necator americanus153

Ancylostoma duodenale155

Strongyloides stercoralis155

Trichocephalus trichiurus157

Trichinella spiralis158

Chemical Methods160

Qualitative Analysis160

Quantitative Analysis161

Intestinal Diseases167

Appendicitis167

Diarrhea168

Chronic Constipation168

Carcinoma of the Colon170

Chronic Ulcerative Colitis170

Acute Enteritis170

Amebiasis171

Bacillary Dysentery172

Chronic Enteritis172

Mucous Colitis172

Dilatation of the Large Colon173

Intestinal Obstruction173

CHAPTER Ⅴ METABOLISM174

Review of Carbohydrate Metabolism174

General Considerations174

Carbohydrates in the Body175

Glucosuria177

Glucose Tolerance Tests178

Variations in Glucose Content of the Blood185

Disorders Involving Carbohydrate Metabolism186

Diabetes Mellitus186

Benign Glucosurias190

Diabetes Insipidus191

Hyperinsulinism and Hypoglucemia191

Chronic Adrenal Insufficiency192

Subcutaneous Epinephrine Test192

Four-hour ACTH Test193

Water Test193

The Sodium Deprivation Test195

Galactose Tolerance Test197

Review of Nitrogen Metabolism197

General Considerations197

Non-protein Nitrogen200

Urea and Ammonia200

Uric Acid204

Creatine and Creatinine207

Excretion of Nitrogenous Waste Products211

Amino-acids212

Plasma Proteins212

Review of Fat Metabolism213

Plasma Lipoids in Disease215

Review of Organic Acid Metabolism216

Review of Mineral Metabolism216

Review of Acid-base Balance of the Body223

Regulation of Acid-base Balance224

Acid-base Composition of Blood Plasma229

Review of Water Metabolism231

Basal Metabolism234

Principle of the Test234

Preparation of the Patient234

Technic of the Test for Patients Fifteen Years of Age and Older234

Technic of the Test for Infants and Children Under Fifteen Years of Age237

Essentials for the Approval of a Basal Metabolism Report238

Factors Influencing the Basal Metabolic Rate238

Pathologic Conditions Influencing the Basal Metabolic Rate240

Value of the Basal Metabolism Test241

CHAPTER Ⅵ CHEMICAL ANALYSIS OF THE BLOOD242

General Considerations242

Collection of Blood243

Possible Causes of Hemolysis243

Containers for Blood Specimens243

Blood Required for Analysis244

Anticoagulants and Preservatives246

Separation of Plasma or Serum247

Apparatus Required for Blood Chemical Analysis247

The Calibration of Micropipets249

Visual Photometric(Colorimetric)Analysis250

Objective Photometric Analysis253

Objective Photometers255

Spectrophotometers256

Scale Readings on Objective Photometers and Spectrophotometers257

The Use of Standard Solutions and Calibration Curves257

General Formula when Readings Are in Terms of Optical Density258

Calibration Curves259

Flame Photometry262

Ultramicro Methods(Refer to This Page for Detailed Index)263

Common Sources of Error in Clinical Chemical Determinations265

The Significance of Numerical Reports266

Methodology267

Analysis of Blood267

Index of Blood Chemical Analyses(Refer to this Page for Detailed Index)267

Summary434

Summary of Blood Chemical Analyses435

CHAPTER Ⅶ THE KIDNEYS440

The Urine440

Routine Examination of Urine441

Normal and Pathologic Findings of Urine442

Kidney Function Tests454

General Considerations454

Value of the Various Kidney Function Tests454

Technic of the Various Kidney Function Tests455

Comparison of Findings in the Various Renal Function Tests467

Diseases of the Kidneys467

Nephritis467

Nephrosis471

Uremia474

Acute Congestion of the Kidneys475

Chronic Passive Congestion of the Kidneys475

Amyloid Degeneration of the Kidney476

Renal Tuberculosis476

Pyelitis and Pyelonephritis476

Renal Calculus(Nephrolithiasis)477

Hydronephrosis477

CHAPTER Ⅷ CHEMICAL ANALYSIS OF THE URINE478

Qualitative Analysis of the Urine(Refer to this Page for Detailed Index)478

Quantitative Analysis of the Urine(Refer to this Page for Detailed Index)478

CHAPTER Ⅸ HEMATOLOGY542

A Review of Normal Hematohistology542

The Origin of the Blood Cells542

Recommended Nomenclature in Hematology543

Formed Elements of the Blood562

Monocytic Series552

Granulocytic Series553

Lymphocytic Series555

Erythrocytic Series556

Thrombocytic Series556

Site of Hematopoiesis556

Fate of the Blood Cells558

General Procedures559

Method for Obtaining Blood Sample559

Examination of the Blood561

Hemoglobin561

Hemocytometer567

Erythrocyte Count570

Sedimentation-rate573

Mean Corpuscular Hemoglobin576

Color Index576

Mean Corpuscular Volume577

Volume Index577

Mean Corpuscular Hemoglobin Concentration579

Saturation Index579

Mean Corpuscular Diameter580

Mean Corpuscular Average Thickness581

Leukocyte Count582

The Stained Blood Film585

Wright＇s Method585

Special Staining Methods590

Anomalies of the Blood Cells592

Anomalies of the Erythrocytes592

Anomalies of the Leukocytes594

Bone Marrow597

Outline for Examination of the Bone Marrow605

Diseases of Erythropoiesis606

The Anemias606

Classification of the Anemias607

Microcytic Anemias608

Hypochromic Anemias608

Iron Deficiency Anemias608

Iron Metabolism609

Morphologic Characteristics610

Hemolytic Anemias618

Macrocytic Anemias618

Cellular Deficiencies618

Cellular Factors Not Yet Elucidated624

Normocytic Anemias624

Sudden Blood Loss625

Incfeased Erythrocyte Destruction625

Blood Volume633

Hemoconcentration638

Hemolytic Anemias641

Intra-corpuscular Defects641

The Hemoglobinopathies643

Extra-corpuscular Defects658

Determination of Blood Groups663

Blood Bank Procedures688

Deficient Erythrocyte Formation692

The Polycythemias697

？ypersplenism699

？iseases of Leukopoiesis701

Leukemoid Reactions701

Eosinophilia701

Basophilia703

Lymphocytosis703

Monocytosis707

Non-specific Leukemoid Reactions707

Bone Marrow Stimulation707

Extramedullary Hematopoiesis708

Leukopenias708

Impaired Formation Predominant708

Increased Destruction Predominant710

Hematopoietic Neoplasms714

Leukosis714

Acute Leukemias715

Subacute Leukemias718

Chronic Leukemias718

Miscellaneous Leukemias720

Atypical Forms of Chronic Leukemia720

Plasmacytic Myeloma721

Lymphoblastomas725

Follicular Lymphoblastoma725

Reticulum Cell Sarcoma726

Lymphosarcoma726

Hodgkin＇s Disease726

Lipoid Histiocytoses726

Lipoid Histiocytosis727

Gaucher＇s Disease727

Disorders of Hemostasis731

Sequence of Events to Repair Damaged Vessel731

Preliminary Diagnostic Procedures731

Bleeding-Time731

Coagulation and Coagulation Time732

Clot Retraction733

Capillary Resistance733

Classification of Hemorrhagic Disorders735

Disorders Primarily Affecting the Vessel Wall735

Bleeding Associated with Reduced Number of Thrombocytes736

Classification of the Thrombopathies738

Bleeding Associated with Defects in Blood Coagulation741

Phase Ⅰ—Formation of Thromboplastin741

Phase Ⅱ—Formation of Thrombin744

Phase Ⅲ—Formation of Fibrin744

Laboratory Tests744

One-stage Prothrombin Time744

Thromboplastin Generation Test747

Two-stage Prothrombin Test740

Thrombin Generation Test751

Prothrombin Consumption Test752

Modified Prothrombin Consumption Test753

Disorders of Phase Ⅰ(Hypothromboplastinemias)754

Deficiency of Thrombocyte Thromboplastin756

Deficiency of Antihemophilic Globulin756

Deficiency of Plasma Thromboplastic Component756

Deficiency of Plasma Thromboplastic Antecedant757

Deficiency of Hageman＇s Trait757

Disorders of Phase Ⅱ(Hypothrombinemias)757

Hypoprothrombinemias757

Stable Factor Deficiency750

Labile Factor Deficiency760

Bleeding Associated with Circulating Anticoagulants760

Disorders of Phase Ⅲ(Hypofibrinogenemias)765

Congenital Afibrinogenemia765

Constitutional Fibrinopenia765

Acquired Fibrinopenia765

Disorders in the Fibrinolytic Mechanism766

Parasites of the Blood767

Malarial Parasites767

Borrelia Recurrentis767

Trypanosoma Gambiense768

Filaria Bancrofti768

Trichinella Spiralis768

CHAPTER Ⅹ IMMUNOLOGY AND SEROLOGY770

Immune Bodies771

Reactions in Which Immune Bodies are Used772

Agglutination Tests772

Widal Test772

Other Agglutination Tests775

The Isohemagglutinins782

Precipitin Tests782

Identification of Proteins782

Diagnosis of Echinococcus Disease784

Tests Based Upon Immune Bodies of the Third Order784

Complement Fixation784

Wassermann Reaction785

Complement-fixation Test for Syphilis(Kolmer)787

Other Complement-fixation Tests799

Additional Tests for Syphilis802

The Kahn Precipitation Test802

The Kahn Test with Spinal Fluid800

The VDRL Slide Flocculation Test812

The VDRL Tube Flocculation Test819

The VDRL Spinal Fluid Test820

The Treponema Pallidum Immobilization Test821

CHAPTER Ⅺ CEREBROSPINAL FLUID823

Physiology of the Cerebrospinal Fluid823

Composition of the Cerebrospinal Fluid823

Indications and Contraindications for Collection of the Cerebrospinal Fluid824

Routine Examination of the Cerebrospinal Fluid826

Normal and Pathologic Findings of Cerebrospinal Fluid826

The Cerebrospinal Fluid in Disease842

CHAPTER Ⅻ TRANSUDATES AND EXUDATES843

Collection of Fluids843

Routine Examination843

Findings of the Examination843

Synovial Fluid845

Disease Processes Associated with the Accumulation of Transudates846

Disease Processes Associated with the Occurrence of Exudates847

CHAPTER ⅩⅢ GENERAL BACTERIOLOGY848

Collection of Specimens848

Bacteriologic Technic851

Examination of Specific Materials854

Bacteriologic Diagnosis858

The More Common Bacteria as Classified by Bergey888

Fungi and Yeasts893

Technics Used in Mycology906

Special Preparations and Examinations910

Sensitivity Tests for the Antibiotics917

Antibiotic levels in Body Fluids920

Preparation of Culture Media924

Stains and Staining Methods943

CHAPTER ⅩⅣ THE SPUTUM952

The Sputum952

Important Contents of the Sputum952

Indications for Analysis of the Sputum952

Collection of the Sample952

The Examination of Sputum952

Routine Examination of Sputum953

Normal and Pathologic Findings of Sputum954

The Sputum in Disease963

Acute Bronchitis963

Chronic Bronchitis963

Putrid Bronchitis963

Fibrous or Plastic Bronchitis963

Bronchiectasis964

Bronchial Asthma964

Bronchopulmonary Lithiasis964

Pulmonary Tuberculosis965

Acute Lobar(Croupous)Pneumonia966

Bronchopneumonia966

Influenza967

Pneumoconiosis968

Pulmonary Abscess968

Pulmonary Gangrene969

Malignant Disease of the Lung969

Chronic Passive Congestion969

Pulmonary Edema969

Infarction969

CHAPTER ⅩⅤ SKIN TESTS AND OTHER BIOLOGIC EXAMINATIONS971

The Schick Test for Antitoxin Immunity to Diphtheria971

The Dick Test for Susceptibility to Scarlet Fever973

The Schultz-Charlton Reaction；the Rash Extinction Test for Scarlet，Fever975

Tuberculin Reactions975

Tests for Hypersensitivity979

Passive Transfer981

Nasal Smears for Eosinophil Count981

Reaction to Horse Serum982

Frei Test for Lymphogranuloma Inguinale982

Intracutaneous Test for Argyria983

Skin Test for Lead Poisoning983

Skin Test for Echinococcus Infestation(Hydatid Disease)983

Skin Test for Trichinosis984

Trichophytin Test984

Brucella Skin Test985

Skin Test for Chancroid985

Test for Coccidioidomycosis985

Test for Glanders985

Test for Histoplasmosis986

Test for Trichinosis986

Test for Tularemia986

Test for Mumps986

McClure-Aldrich Test(Intradermal Salt Solution)987

Smallpox Vaccination988

The Rabbit Test for Pregnancy(Schneider Modification of the Aschheim-Zondek Test)988

The Frog Test for Pregnancy990

The Spermatozoa Count901

CHAPTER ⅩⅥ LABORATORY METHODS IN PEDIATRIC PROCEDURES994

The Stomach994

Methods for Study of Gastric Acidity995

Interpretation of the Findings of Gastric Analysis997

Demonstration of Tubercle Bacilli in Gastric Contents998

The Duodenal Fluid998

Cystic Fibrosis of the Pancreas999

Screening Test for Fibrocystic Disease of the Pancreas999

The Celiac Syndrome999

The Stool1001

Points of Special Interest1001

Normal Stools1002

Factors Influencing the Character of Normal Stools1002

Findings of Stool Analysis1003

Stools in Specific Conditions1004

Constipation1004

Diarrhea1004

Intussusception1005

Pyloric Stenosis1005

Congenital Atresia1005

Stricture of Anal Canal1005

Hirschsprung＇s Disease(Megacolon)1005

Celiac Disease1005

Pancreatic Steatorrhea1006

Acute Intestinal Indigestion1006

Marasmus1006

Cholera Infantum1006

Bacillary Dysentery1006

Epidemic Diarrhea1007

Pellagra1007

The Urine1007

Kidney Function Tests1013

Blood Chemistry1015

Cerebrospinal Fluid1018

CHAPTER ⅩⅦ TROPICAL DISEASES1020

Tropical Diseases1020

The Important Protozoa of Man1020

Bacterial Diseases1021

Rickettsial Diseases1021

Virus Diseases1022

Dysentery1022

Kala-azar1022

Cutaneous Leishmaniasis(Oriental Sore)1025

Mucocutaneous Leishmaniasis(Espundia)1026

African Trypanosomiasis(African Sleeping Sickness)1028

Chagas＇Disease1030

Malaria1032

Blackwater Fever1040

Relapsing Fever1040

Yaws1042

Pinta1044

Infectious Jaundice(Weil＇s Disease)1045

Granuloma Inguinale1046

Cholera1049

Rat-bite Fever1050

Plague1051

Tularemia1052

Brucellosis(Undulant Fever)1053

Typhoid Fever1054

Leprosy1054

Typhus Fever1055

American Spotted Fevers1056

Scrub Typhus(Tsutsugamushi Disease)1057

Q-Fever1058

Trench Fever1058

Bartonellosis(Verruga Peruana and Oroya Fever)1059

Yellow Fever1060

Rift Valley Fever1061

Dengue1061

Sandfly Fever(Phlebotomus Fever)1062

Other Virus Diseases1062

CHAPTER ⅩⅧ MILK AND WATER ANALYSIS1064

Milk Analysis1064

Collection of Sample1064

Chemical Analysis1064

Bacteriologic Analysis1068

Bacteria Count1068

Coliform Count1071

Hemolytic Streptococci1072

Tubercle Bacilli1072

Brucella1073

Bacteriologic Testing of Infant Formula1073

Efficiency of Hospital Sterilization1075

Water Analysis1075

CHAPTER ⅩⅨ HISTOLOGIC TECHNIC1080

Index of Staining Technic1080

Index of Fixation and Sectioning Technic1082

Index of Supplementary Methods1083

Index of Solutions and Stains1083

Fixation and Sectioning Technic1085

Staining Technic1090

Supplementary Methods1123

Solutions and Stains1124

CHAPTER ⅩⅩ LEGAL MEDICINE AND TOXICOLOGY1137

General Considerations1137

Essential Factors in the Diagnosis of Poisoning by Clinical Findings1138

Diseases Simulating Poisoning1138

Clinical Symptoms Associated With Poisoning and Various Diseases1138

Collection of Specimens1140

Blood Stains1141

The General Search for Poisons1141

Preparation of Specimens for Analysis1142

Poisons Which are Volatile with Steam1142

Metallic Poisons1148

Alkaloids and Other Organic Poisons1150

General Tests1151

Strychnine1152

Atropine1152

Cocaine1152

Opium Alkaloids1153

Nicotine1153

Barbiturate Soporifics and Analgesic Drugs1154

Barbiturate Drugs1155

Other Neutral or Acidic Organic Poisons1156

Salicylates1156

Aniline Derivatives1156

Caffeine1157