II ill 
 
 
 K&RiMI mil 
 
 . ^IBEN. 
 
 
 
 
 
 
 i i 
 
THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 
 MRS. PRUDENCE W. KOFOID 
 
GTJSTAF VON DUBEN'S 
 
 TREATISE 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 S&itjj 71 (Bngrabings. 
 
 TRANSLATED, WITH ADDITIONS, 
 
 BY 
 
 Prof. LOUIS BAUER, M.D., M.R.C.S. Eire., &c. 
 
 NEW YORK: 
 JOHN WILEY, 56 WALKER STREET. 
 
 1859. 
 
Entered according to Act of Congress, in the year 1S59, by 
 
 JOHN WILEY, 
 
 In the Clerk's Office of the District Court of the United States for the Southern District of 
 New York. 
 
 K. ORAtGHKAD, 
 
 Printer, Slereolyper, and Kleclrotyper, 
 
 Carton Uuiltimg, 
 
Vb 
 
 TO 
 
 J. MARION SIMS, M.D., 
 
 THE FOUNDER AND SURGEON OF TnE WOMEN'S HOSPITAL OF NEW YORK, 
 
 IX APPRECIATION OF HIS SURGICAL INGENUITY, AND HIS NOBLE QUALITIES 
 
 AS A GENTLEMAN AND A FRIEND, THESE PAGES ARE 
 
 RESPECTFULLY INSCRIBED BY THE 
 
 translator. 
 
 356f 
 
PREFACE 
 
 The microscopical diagnosis, by Gustaf von Dueben, has 
 acquired in a very short time an extraordinary popularity, and 
 this fact alone is a sufficient evidence of its practical usefulness. 
 
 The want of so brief and practical a manual in German lite- 
 rature for the student and practitioner, has induced Dr. Tutschek 
 to translate it. In Germany it has also been received with 
 general favor and approbation. The German translation has 
 materially enhanced the value of this little book by supple- 
 mentary additions, derived from the progress made in microsco- 
 pical diagnosis during the period intervening between its first 
 publication in Sweden, and its subsequent translation. 
 
 "With the desire to render this compendium accessible and 
 serviceable to the profession of this country, I have undertaken 
 its translation into the English language, and feel persuaded that 
 it will contribute to increase the already existing interest in 
 microscopical research, and aid in realizing the diagnostic value 
 of the microscope. 
 
 As it is designed for incipient microscopists, I have taken 
 pains to render it comprehensible by plain language, and have 
 as much as practicable evaded the use of technical terms. 
 
VI PREFACE. 
 
 In conclusion, I must acquit myself of the pleasing duty of 
 acknowledging the meritorious labors of Mr. Thomas Cuzner, a 
 young artist of New York, who has furnished the carefully 
 executed diagrams that illustrate the text. 
 
 LOUIS BAUER. 
 
 Brooklyn, August, 1859. 
 
CONTENTS 
 
 PAGE 
 
 INTRODUCTION, 1 
 
 I. THE SKIN, 9 
 
 1. EPIPHYTES, 10 
 
 (a.) Trichophyton tonsurans, ib. 
 
 (b.) Microsporon Audouini, . . . . 11 
 
 (c.) Microsporon menta.gr ophytes, . . . 12 
 
 (d.) Microsporon furfur, 1 
 
 (e.) Achorion Schbnleinii, ib. 
 
 2. Epizoes, 15 
 
 (a.) Sarcoptes Hominis, 18 
 
 (b.) Acarus folliculorum, 21 
 
 (c.) Infusoria, 22 
 
 II. THE BLOOD, ib. 
 
 1. FORM AND AGGREGATION OF THE RED CORPUSCLES, 24 
 
 2. RELATIVE NUMBER OF MICROSCOPICAL ELEMENTS OF 
 
 THE BLOOD, 25 
 
 (a.) Preponderance of Elementary Granules, . ib. 
 (b.) Abnormal Preponderance of Colorless Blood 
 
 Corpuscles, ib. 
 
 (c.) Change in the Number of Red Blood Cells, . 26 
 
 3. FOREIGN ELEMENTS IN THE BLOOD, ib. 
 
 (a.) Epithelium of Bloodvessels, . . . . 27 
 
 (b.) Pus, ib. 
 
 (c.) Cancer Cells, 28 
 
 (d.) Hmmatozoa, 30 
 
 III. THE MILK, 32 
 
 1. THE RELATIVE PROPORTIONS OF THE MILK CONSTI- 
 TUENTS, 33 
 
IV CONTENTS. 
 
 2. ABNORMAL SUBSTANCES IN THE MILK, . 
 
 IV. VISCERAL EVACUATIONS, 
 
 A. THE ORAL CAVITY, .... 
 
 (1.) Normal Contents of the Oral Cavity, 
 (2.) Abnormal Contents of the Mouth, 
 The Aphtha? or Soor, 
 
 B. LUNGS AND SPUTA, .... 
 
 (1.) Catarrhal Affections of the Respiratory Organs, 
 (2.) Croupous Affections of the Respiratory Organs, 
 
 Sputum Pneumonicum, 
 (3.) Vomica? and Tubercles, 
 (4.) Gangrama pulmonum, 
 (5.) Accidental Elements in the Sputa, 
 
 C. 02SOPHAGUS, STOMACH, AND REGURGITATED MATE- 
 RIAL, 
 
 (1.) Pyrosis and Green Vomit, . 
 
 (2.) Vomited Material in Cholera, 
 
 (3.) Brown and Black Emesis ( Coffee-Ground-Uke 
 Material) in Cancerous Diseases of the Sto- 
 mach, ..... 
 
 (4.) Vomit of Fermenting Substances, 
 
 (5.) Eat in Vomit, .... 
 
 (6.) Accidental Substances in Vomit, . 
 
 D. DISCHARGES PER ANUM, F.ECES, 
 
 (1.) Pus in Faces, .... 
 
 (2.) Blood in Faces, .... 
 
 (3.) Gelatinous, Mucous , and Rice Bodies, 
 
 (4.) Pseudo-membranes, Exudations, Scabs from 
 Typhus and Tuberculous Ulcerations of 
 Follicles, and Fragments of the various 
 Structures of Intestines, .... 
 
 (5.) Changes which certain Articles of Food sus- 
 tain by the digestive Process, 
 
 (6.) Entozoa, 
 
 (7.) Infusoria of the Intestinal Canal, 
 
 (8.) Fat in Faces, .... 
 
 (9.) Accidental Components of Faces, 
 
 E. THE UROGENITAL ORGANS, 
 
 (1.) Organized Substances derived from the Uri- 
 nary Bladder and the Kidneys, ib. 
 
CONTENTS. V 
 
 PAGE 
 
 (a.) Urethral and Vesical Catarrh, . . . 64 
 (b.) Catarrh of the Uriniferous Tubules and 
 
 <k Bright $ Disease" ib. 
 
 (c.) Fat in Urine, Galacturia, . . . . 67 
 
 (d.) Nephritis suppurativa, . . . . 68 
 
 (e.) Cancer and Tuberculosis, ib. 
 
 (2.) Accidental Organic Elements in the Urine, . 69 
 
 (a.) Echinococcus hominis, ..... ib. 
 
 (b.) Strongylus gigas, 70 
 
 (c.) Spiroptera hominis, ..... ib. 
 
 (d.) Infusoria, ib. 
 
 (e.) Cryptococcus cerevisice, . . . . 71 
 
 (f.) Sarcina (Merismopcedia) ventriculi, . . 72 
 
 (g.) Hair, ....... ib. 
 
 (3.) The Male Genitals, ..... ib. 
 
 Spermatozoa, . . . . . . 73 
 
 (4.) The Female Genitals, 74 
 
 (a.) Menstrual Discharges, .... 75 
 
 (b.) Lochia?, . . , . . . . ib. 
 
 (c.) Fluor Albus, Leucorrhcea, ... . . ib. 
 (5.) Inorganic and Crystalline Constituents of 
 
 Urine, Urinary Sediments, ... 76 
 
 SEDIMENTS OF SOUR URINARY FERMENTATION, . . 78 
 
 (a.) Urate of Soda, ...... ib. 
 
 (b.) Uric Acid, ib. 
 
 (c.) Oxalate of Lime, . . . . . 79 
 
 (d.) Cystine, 80 
 
 SEDIMENTS OF ALKALINE FERMENTATION, ib. 
 
 (e.) Phosphates, • ib. 
 
 (f.) Urate of Ammonia, 81 
 
 (g.) Carbonate of Lime, 82 
 
TREATISE 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 INTRODUCTION. 
 
 The great progress of Medicine in the present century is pre 
 eminently the work of microscopical research. Our knowledge 
 of the elementary structure of organisms is exclusively based on 
 the Microscope, and modern Physiology is its obvious result. 
 Again, the latter furnishes the essential premises to Pathology. 
 
 That organic chemistry has materially participated in this 
 advancement cannot be denied, however imperfect its contribu- 
 tions may hitherto have been. But the microscope has, in prac- 
 tical usefulness, obviously excelled the chemical re-agents both 
 in precision and facility. 
 
 The exaggerated hopes placed in the infallibility of the micro- 
 scope have certainly not been realized ; for its application has 
 its optical limits, beyond which its scientific and practical utility 
 cannot be extended. To place implicit reliance upon the micro- 
 scope, to the exclusion of other channels of observation, would 
 lead to as much error and disappointment as would its total 
 neglect. 
 
 Whatever may be the present imperfections of Microscopy, 
 and the errors propagated by this method of medical investiga- 
 tion, its usefulness has been fairly demonstrated, and its practical 
 results are such as to invite the continuation of further researches. 
 
 Every method must naturally be defective at its beginning, 
 and become gradually perfected by constant practice. The mi- 
 
8 INTRODUCTION. 
 
 croscope, however, as well as the method, has, nevertheless, 
 already attained an influence on the development of natural 
 science far beyond original anticipation, although its use is of 
 but comparatively recent date. 
 
 In both Histology and Physiology the microscope has firmly 
 established its superiority. Through the medium of these fun- 
 damental branches it has benefited medical science at large, and 
 of late it has begun to lend its material aid to Diagnosis. Pos- 
 sessed of accurate knowledge of the anatomical elements in 
 health and disease, the microscope will frequently assist us in 
 disclosing obscure or otherwise imperceptible morbid changes. 
 Sometimes it may delude and give rise to erroneous inferences, 
 although the observer and the instrument used may be more at 
 fault than the method. Yet more frequently it will reveal the 
 true state of elementary structure and its deviation from the nor- 
 mal state, and thus aid and correct our pathological knowledge. 
 
 The object of this Compendium is a brief compilation of all 
 microscopical facts appertaining to medical Diagnosis, excluding 
 all that is doubtful or hypothetical. And for such a compen- 
 dium there is yet room in medical literature, notwithstanding 
 the works of Hoefle, Beale, and others, which are either super- 
 seded by new discoveries, defective in their illustration, or too 
 voluminous. 
 
 Minute technicalities, and detailed chemical analysis, have 
 been excluded as not strictly belonging to the subject, although 
 the author is fully sensible of their general importance ; for 
 satisfactory and correct conclusions can only be drawn from the 
 controlling combination of all recognised methods of investi- 
 gation. 
 
 The following general rules for microscopical examinations 
 may be found useful : 
 
 1. The various parts of objects, presenting marked differences 
 even to the naked eye, should be carefully examined. 
 
 2. Each examination should commence with as low a power 
 as the object will permit, and the latter should be retained in as 
 natural a position as practicable. The power should then be 
 gradually increased, and even the highest should be tested, if 
 the size of the object will admit of it. 
 
MICROSCOPICAL DIAGNOSIS. 9 
 
 3. Different specimens of the same morbid material should be 
 successively placed under the microscope, until conclusive results 
 have been obtained. 
 
 4. The objects for examination should be fresh, and should 
 be observed in different conditions, so as to determine what is 
 normal, morbid, or accidental. For the same reason false light 
 and focus may be used in order to discern optical delusions. 
 The greatest cleanliness is indispensable. The object-glasses and 
 lids are' best cleaned with soft linen and chamois, and should be 
 examined for dust and fibres before being used. 
 
 5. The objects should be neither too large nor too thick. 
 
 6. The best light for microscopical examinations is derived 
 from illuminated clouds, or a clear northern sky. Argand's 
 lamp and sunlight may also be employed, when mollified by the 
 interposition of a plate of ground glass. 
 
 7. At the first examination of wet specimens, the same fluid 
 should be used with which they are naturally surrounded or 
 endowed. 
 
 8. The following re-agents should always be kept in readiness 
 for use: distilled water; concentrated and diluted acetic, sul- 
 phuric, and nitric acids; caustic potash, sulphuric ether, and 
 oil of turpentine. For ordinary purposes these will suffice. 
 
 9. To the observer it is to be recommended that he make 
 drawings of all objects, note down their size, character, position, 
 the magnifying power employed, etc. In doing so all the details 
 will be better understood and remembered. 
 
 I. THE SKIN. 
 
 The results of microscopical Examinations in general upon 
 the structure of the Skin,the classification and diagnosis of cuta- 
 neous diseases, as well as its importance upon Therapeutics, belong 
 to Dermatopathology, and are, therefore, no subject for our con- 
 sideration. This essay has to deal with microscopical Diagnosis 
 only. In this respect the microscope is invaluable for the per- 
 ception of certain Parasites, vegetable and animal, infesting the 
 skin and causing certain forms of cutaneous affections. 
 
10 MICROSCOPICAL DIAGNOSIS. 
 
 1. EPIPHYTES. 
 
 A great variety of vegetable parasites of the lowest tribes have 
 been observed upon the integuments, but comparatively few only 
 are of pathological importance. Most of them seem to have been 
 deposited by mere accident. Thus for instance Trichophyton 
 Sporuloides of Robin, observed in the secretion connected with 
 plica polonica. Beschorner's very careful investigations into the 
 nature of this endemic disease have removed all suspicion as to 
 its communicability either by the said alga or the presumed mor- 
 bid secretion. The Tricophyton ulcerum found in an atonic cari- 
 ous ulcer by Lebert, and the otherwise most remarkable Aspergil- 
 lus species discovered in the aural cerumen by Mayer and Pacini, 
 seem to be of no greater importance. In fine, the Puccinia favi 
 maybe mentioned as occurring upon the epidermal scales mfavus 
 (Ardsten). Yet all these parasites present no other practical inter- 
 est than their accidental or harmless existence upon the skin. 
 Very different is it with those described hereafter, acting, as they 
 do, as direct causes of cutaneous diseases, entering the follicles, 
 the folds or wrinkles of the skin itself; irritating the latter; 
 destroying the hair bulbs and eventually the hair itself, unless 
 counteracted in an effectual manner. 
 
 (a.) Trichophyton tonsurans. 
 
 This parasite belongs to the class of fungi {Robin), and its name 
 is derived from "trix" hair, and "phyton," plant (Malmslen). 
 The adjective tonsurans is figuratively chosen, on account of the 
 specific peculiarity of the parasite in destroying the hair in the 
 centre of the scalp, like the tonsure of monks. The disease 
 caused by this tribe of Trichophyton is named by Cazenave 
 " Herpes tonsurans ;" by Malmsten, " Rhizophy ion Alopecia ;" by 
 Mahon, " Teigne tondante." 
 
 Both Boeck and Hebra are of opinion, that Puccinia favi and 
 Trichophyton tonsurans are, pathologically speaking, the same 
 parasites, and that the effects of both differ only in degree and 
 not essentially. 
 
 The scalp, affected with this disease, exhibits one or more 
 
MICROSCOPICAL DIAGNOSIS. 
 
 11 
 
 round, dry, grey, and slightly elevated spots, that seem to be 
 thinly covered with fine dust. These spots are either bare or 
 occupied by a few — mostly split — hair-stumps, and generally 
 encircled by young hair and a moist, yellowish-brown ring. 
 A magnifying glass will show a considerable number of hair- 
 stumps, broken off above the skin, their ends 
 divided like a brush. If a portion of the 
 grey dust is scraped off and put under the 
 microscope with some hair-stumps, it will be 
 noticed, that the former consists of epithelial 
 scales and fragments, besides innumerable 
 spores of Trichophyton. In the interior of 
 the hair-bulbs crowds of irregularly grouped 
 spores (Fig. 1, a a) will be observed, which, 
 however, occasionally join each other like 
 strings of beads (Fig. 1, b). Their pressure 
 upon the bulbs is so great, as to atrophy and 
 destroy them. Where the sheath of the hair, 
 and consequently its resistance, terminates, the 
 parasite bursts the hair-cylinder and spreads 
 luxuriantly over the surface. The hair is 
 thus broken off and a fibrillated stump left, 
 which in its turn is destroyed by direct pressure inside of the bulb. 
 
 Trichophyton tonsurans consists of exquisitely minute spores of 
 0*003, 0-008, 0-010 Mm. diameter, each endowed with either 
 nucleus or macula, some being constricted and branched, others 
 putting forth regular buds. The spores located within the hair- 
 bulbs are flattened, evidently from their mutual pressure, and the 
 restraint of the fibrous sheath. Being, however, relieved from 
 local restraint and subject to the action of distilled water, they 
 distend to a globular form. 
 
 The sebaceous material of the follicles should first be dissolved 
 by oil of turpentine, and a power of from 400 to 800 should be 
 used for their examination. 
 
 Fig. 1. 
 
 (b.) Microsporon Audouini. 
 A fungoid growth of the same class and tribe as the former, but 
 
12 MICROSCOPICAL DIAGNOSIS. 
 
 of distinct botanical species. The disease caused by this vegetable 
 parasite bears great resemblance to herpes tonsurans, both as to its 
 seat upon the scalp, as well as to its symptoms. It differs, how- 
 ever, widely from the latter in its rapid development and the de- 
 struction of the hair. Cases are related in which the disease, in the 
 short space of from three to four days, had produced bare spots 
 of from three to four Cm. in diameter. It is, therefore, considered 
 a distinct morbid species, and severally termed Phytoalopecia 
 (Gruby). Vitiligo (Cazenave), and Porrigo decalvans (Bateman). 
 
 According to Robin the spores of Microsporon Audouini are 
 round O'OOl— 0-005 or oval 0-002—0-008 Mm. in size, conse- 
 quently smaller than those of Trichophyton. They swell con- 
 siderably in water. Moreover, the Fungus exhibits numerous 
 undulated and branched fibrillae, forming anastomosis and a 
 complete network, within which the spores are placed. This 
 network has its seat upon the hair, surrounds their stems about 
 2 Mm. from the epidermis, fastens itself about the hair and 
 breaks it transversely off. Gruby opines, that on the average 
 about eight days suffice to break an ordinary hair ; thicker ones 
 resist longer. 
 
 The microscopical examination of this parasite, the power to 
 be used, and the rules to be observed, are the same as with 
 Trichophyton. 
 
 (c.) Microsporon menlagrophyles. (Ch. Robin.) 
 
 This parasite possesses almost the same botanical character as 
 Microsporon Audouini, exceeding it, however, in the size of its 
 spores, filaments, and reticulated anastomosis. The Micr. men- 
 tag, originates in the hair follicles, outside of the hair bulbs, and 
 is distinguished thereby from Micr. Aud., which encircles the hair 
 above the epidermis, and from Trichophyton tonsurans, which 
 grows within the hair bulbs. 
 
 Hitherto this fungus has been found in Mentagra (Sycosis 
 menti) only, and Gruby ascribes the contagiousness of this dis- 
 ease exclusively to the parasite. Kuchenmeister is inclined to 
 believe, that the Mentagrum of Martial and the Pudendagrum 
 of Pliny, so frequent among the ancient Romans, originated with 
 
MICROSCOPICAL DIAGNOSIS. 13 
 
 Miscrosporon ment. These cutaneous diseases bad their seat 
 between the chin and genital organs, and consisted in nodules 
 and tubercles, and were of decidedly contagious character. 
 
 (d.) Microsporon furfur. (Ch. Eobin.) 
 
 Microsporon furfur constitutes both the infectious and color- 
 ing medium of Pityriasis versicolor, and has its seat between the 
 epidermal scales. In carefully scraping the so-called liver-spots 
 and subjecting the substance thus obtained to a power of 400, it 
 will be readily noticed that it is made up of corrugated and folded 
 epithelial layers with interstitial groups of spores (Fig. 2) and a 
 delicate network of fibrillar (Fig. 2, a, b). 
 A more distinct view, however, may be 
 obtained by a drop of Solutio potassae 
 causticse, which renders the epithelium 
 transparent without injuring the parasite. 
 The latter then exhibits numerous deli- 
 cate fibrillar of 0-001-0-002 Mm. diame- 
 ter, branching and anastomosing with "^J 
 each other. Some are quite hollow (Fig. Fig. 2. 
 
 2, a, mycelium) ; others contain nuclei and spores (b, receptacula) ; 
 others again show cell-articulations of 0*006 Mm. Between the 
 reticulated meshes the spores are imbedded. The latter are per- 
 fectly round, refract the light strongly, contain a delicate nucleus, 
 measure from 0*001 to - 002 Mm., and show two contours with a 
 false focus. 
 
 A patient afflicted with Pityriasis versicolor, for four succes- 
 sive years, exhibited the small multangular bodies (Fig. 2 d) in 
 great numbers, amongst which, however, only one specimen of 
 Puccinia favi was found. 
 
 (e.) Achorwn Schonkinii. (Remak.) 
 
 This fungus belongs to the class of Arthrospores, Tribus 
 Oidiei, and forms, according to Link, a species of its own. 
 
 Bassis first directed the attention of the renowned Schonlein, 
 then Professor in Zurich, to the Muscardine of the silkworm, 
 
14 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 which proved on careful examination to be caused by an 
 Achorion fungus. The analogy led Schonlein to extend his re- 
 searches to Porrigo favosa, suspecting the same Achorion to be 
 the cause of that most abject cutaneous disease. And after a 
 long search with an imperfect instrument, Schonlein finally suc- 
 ceeded in discovering the parasite (1839). Since then, encou- 
 raged by Johannes Midler, the Achorion has been repeatedly the 
 subject of careful investigation, the results of which have been 
 every way corroborative of Schonlein's statement, in honor of 
 whom this epiphyte has been named after its first observer. 
 
 The seat of Achorion Schonleinii is chiefly on the scalp, but in 
 solitary instances it is found on other parts of the body, such as 
 the finger nails (Meissner). Its transmissibility has been posi- 
 tively demonstrated by inoculation (BemaJc, Bennet), even upon 
 an apple (fiemak), and Bennet has also observed it upon rats. 
 
 The most correct description of this achorion species has been 
 given by Robin, to which the author can add nothing but con- 
 firmation. 
 
 i According to Wedl this parasite originates in two ways. 
 
 The ordinary growth is from 
 the epidermis. Upon the 
 delicate epidermal scales a 
 very thin, mostly transpa- 
 rent, layer of exceedingly 
 fine amorphous molecules 
 is met with, which is the real 
 matrix or stroma of the fun- 
 gus (Fig. 3). From this layer 
 the Mycelium (Fig. 3, a) puts 
 forth its equally wide, unarticulated, curved, and hollow fibrillin 
 of 0-003. Mm. diameter. Often, the cylindrical cavity extends 
 into the branches of the Mycelium, but occasionally their cavity 
 is found to be separated from that of the primitive stem. Another, 
 but very analogous, part of the fungus are the receptacles (Fig. 3, b), 
 fibrillar of different sizes, less curved and unbranched. 
 
 The smaller Myceliurn-fibrillae have only towards their ends 
 one or two incipient spores, whilst the larger fibrillae are filled 
 with more developed ones, imperfectly separated from each 
 
MICROSCOPICAL DIAGNOSIS. 
 
 15 
 
 other by contraction of the fibrillre. Their size varies from 
 0-005 to 0-007 Mm. The third degree of development, or third 
 part of the Achorion, are the spores themselves (fig. 3, c), 
 either spherical in shape by - 003 to 0*007 Mm. in size ; or 
 oval by 0"010 Mm. in length. Quadrangular forms with 
 subdivisions may also be noticed. Moreover, they contain 
 occasionally numerous exceedingly small granules with mole- 
 cular motion. 
 
 In the larger and spherical spores there is one nucleus, and 
 in the oval ones there is generally one to be 
 noticed on either extremity. The examination 
 should be made as previously suggested, and with 
 a power of 400 to 600, although the larger fungi 
 may admit a much lower power than that, and 
 have actually been seen by a power of 150. The 
 exceptional growth is in the shape of isolated or 
 connected spores in the hair follicles, gradually 
 encircling, and finally perforating the hair bulbs 
 (Fig. 4). 
 
 As has been already stated Achorion Schon- 
 leinii is now admitted to be the ostensible cause 
 of Porrigo favosa, the medium of its transmis- 
 sion. Relief from this disease demands the total 
 eradication of the parasite. 
 
 2. Epizoes. 
 
 The same remarks appertaining to the various Epiphytes, 
 observed upon the human body, are applicable to animal para- 
 sites. Among the latter there are specimens which have not 
 the least pathological importance, being either accidentally de- 
 posited or attracted by uncleanliness. Pulex irritans, Phthirius 
 inguinalis Leach (Pediculus pubis Lin.) Pediculus capitis and 
 vestimenti, belong to this category. 
 
 Older medical writers have variously alluded to and described 
 a disease under the name of Phthiriasis, alleged to be caused by 
 the presence of a peculiar species of pediculus (tabescentium), 
 and even, of late, several cases have been related, purporting to 
 
16 MICROSCOPICAL DIAGNOSIS. 
 
 confirm the ancients. Among others, an instance has been put on 
 record by Dr. Ekmann of Calmar (Lak. Sallsk. Forhandl. 1851). 
 However this may be, it does not seem as if in modern times a 
 disease had been observed even approximately corresponding 
 with the description of our professional ancestors, to wit, for- 
 mation of small tubercles in which pediculi generate and mul- 
 tiply to an unlimited number, resisting cleanliness, baths, etc., 
 and gradually leading to tabes and death. Some later observa- 
 tions under the head of Phthiriasis indicate the nature of the 
 error formerly committed, and it is now well understood, that 
 the parasitical Arachnoideae of domestic animals transmitted to 
 the skin of man will produce effects very similar to those 
 ascribed to that disease. Thus Vogel (Path. Anat. pp. 414-15) 
 relates as fact, that the various acarus species of horses, dogs, 
 wombat, cats, rabbits, camels, etc., have produced cutaneous 
 eruptions upon the human skin, not unlike Scabies, and Bory 
 de Saint Vincent has described a peculiar acarus which was ob- 
 served in great numbers on a woman without transmitting the 
 infection to her husband. Furthermore, that the same acarus has 
 been seen by Busk on the foot of a sailor. There are, however, 
 indefinite representations, relating to cases in which parasites 
 had infested the skin by accidental communication with animals. 
 More positive is a case of Phthiriasis observed and related by 
 Simon of Berlin. 
 
 A woman, despite the strictest cleanliness, and the application 
 of remedies, had suffered for a long while from numerous small 
 animals, very like the pediculus tribe. The parasite, when pro- 
 perly examined, was recognised as Dermanyssus avium, a pecu- 
 liar acarus of birds, derived in this instance from chickens. 
 Still more decisive is the case of JSrdl, which could have been 
 much easier mistaken for Phthiriasis. In examining some cuta- 
 neous nodules, not unlike Molluscum contagiosum, Erdl found 
 them to contain Dermanyssus. Nitzsch presumes, that this 
 parasite can enter the skin of birds, and believes to have once 
 observed this fact in a green-finch. 
 
 But all this tends to demonstrate, that the louse-tribe lives 
 upon the human skin, and not within its texture. 
 
 For comparison, however, the diagrams of the various pedi- 
 
MICROSCOPICAL DIAGNOSIS. 
 
 17 
 
 cuius species, and the Dermanyssus avium have been annexed 
 (Figs. 5-8). 
 
 Fig. 5. Fig. 6. 
 
 Pediculus vestimenti {female). 
 Fig. 7. 
 
 Pediculus capitis {male). 
 
 Fig. 8. 
 
 Fig. 9. 
 
 Phthirius jnibis. Dermanyssus avium. 
 
 Dr. Lorentz Tuischek, in conforming to the author's opinions, 
 adverts to the so-called harvest-flea (Leptus 
 autumnalis, Fig. 9), living on dry grass, 
 berry bushes, etc. Coming in contact with 
 the skin, they bore themselves in with their 
 heads, and cause itching, nodules, pustules, 
 and even superficial ulceration. Prof. Em- 
 merich could discover no ducts under the 
 epidermis, and John is convinced that this 
 insect inserts itself into the skin but for a 
 day or two, and leaves it again sponta- 
 neously, without further consequences. Lep- 
 tus autumnalis can be readily diagnosed by its yellow-reddish 
 color. 
 
18 MICROSCOPICAL DIAGNOSIS. 
 
 There are, however, two parasitical Arachnoids, deserving 
 special attention. One is the known cause of Scabies, and the 
 medium of its diffusion. The other has been often observed as 
 a resident of cutaneous follicles in Acne pustules, although its 
 pathological relations have as yet not been clearly determined. 
 
 (a.) Sarcoptes Hominis. 
 
 (Figs. 10 to 13.) 
 
 The ancient Arabs seem to have had some knowledge of this 
 parasite. Later zoologists have sometimes adverted to and 
 described this arachnoid. Linne received it in his Systema 
 Naturae, and gave it the name of Acarus exulcerans. From 
 numerous references, it can, however, be demonstrated that little 
 was known of its significance in regard to the human body, 
 until Renucci, the Corsican, in 1834 disclosed the mode of its 
 detection in the skin. Since then Sarcoptes hominis has been 
 the subject of numerous investigations, and both its natural and 
 pathological history have been ascer- 
 tained to a rare degree of perfection. 
 The fact has thus been established be- 
 yond dispute, that the presence of Sar- 
 coptes, or its sub-epidermal duct, are 
 the only pathognomonic or reliable evi- 
 dences of Scabies. In infants, or patients 
 of delicate epidermis, these ducts can 
 be easily found; not so in persons of 
 advanced age, or laborers, whose skin 
 has, by exposure, become firmer or dis- 
 Fig. 10 colored. The principal seat of the para- 
 
 site is the hand (in 80 cases of every 100), but rarely on the foot, 
 axillary cavity, and trunk (20 cases of 100 — Bourguignon). The 
 ducts can best be seen and examined between the fingers, or on the 
 volar surface of the wrist, the skin being there comparatively 
 more delicate. Frequently they can be seen with the naked eye, 
 but more readily with the aid of a magnifying glass. The ducts 
 appear as slightly curved and elevated lines of lighter color 
 than the surrounding skin ; sometimes with a bluish tint, 
 
MICROSCOPICAL DIAGNOSIS. 
 
 19 
 
 Fig. 11. 
 
 and as if filled with water. Their length rarely exceeds a 
 few lines. At one extremity 
 of the duct there is mostly, 
 but not always, a small vesicle 
 or papula, and this is the place 
 where the Sarcoptes enters. 
 The other extremity termi- 
 nates in a whitish point — 
 which is the animal itself. 
 
 With an ordinary or cataract 
 needle, the duct should be split 
 towards its blind termination. 
 On withdrawing the instru- 
 ment, the parasite mostly ad- 
 heres to the point of the needle, 
 and when placed upon a black 
 object, its locomotion may be 
 discerned. 
 
 In this simple manner Sarcoptes may be found, and thus 
 a reliable diagnosis secured. 
 But for the study of the natu- 
 ral history of the parasite the 
 method of Eichsladt, Hebra, 
 and Gudden should be adopted, 
 which consists in the removal 
 of the epidermal wall of the 
 ducts. For this purpose the 
 skin should be superficially 
 raised in a fold, and removed 
 either by a pair of bent scis- 
 sors or a sharp knife. The 
 object is then spread upon a 
 glass plate, the raw surface 
 upwards, and thus gradually 
 suffered to dry. So prepared, the object should be covered with 
 concentrated mastic varnish, and examined under the micro- 
 scope. The duct is then perfectly transparent, and its contour 
 extremely delicate. 
 
 Fig. 12. 
 
20 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 Fig. 13. 
 
 The ducts contain female Sarcoptes only. The males reside 
 in their immediate vicinity (Worms); shine 
 through the skin, and require, on account of 
 their lesser size, the use of the magnifying 
 glass. The male Sarcoptes causes less reac- 
 tion of the skin than the female. To bring 
 the former under the microscope the method 
 of Eichstadt is indispensable. With a power 
 of from 150 to 300, the locomotion and the 
 anatomical construction of the parasite can be 
 readily observed. The largest ducts are oc- 
 cupied by and filled with impregnated female 
 Sarcoptes, ova, and excrementitious matter 
 (Fig. 13). They measure \ Mm. in length, 
 and i Mm. in width, are of an oval form, with a flat belly 
 (Fig. 11) and a convex spiny back (Fig. 12). 
 
 The head is short-set, has lightly dentated jaws, upper and 
 lower lips, and eight legs, of which four are near the head, end- 
 ing in sucking cups or discs, and four more posteriorly inserted, 
 each terminating in a bristle. 
 
 Both size and shape vary according to the parasites being 
 pregnant or not. The male is smaller (j Mm. long, \ Mm. 
 wide) ; his hind legs sit closer to each other, and two exhibit the 
 same discs as the forelegs (Bourguignon, Fig. 10). It is further 
 stated by the same author, that the males are not so numerous 
 as the females (1 to 10), and that their mode of life differs from 
 that of the latter. The locomotion of the male is more rapid ; he 
 creeps along the skin, and is capable of boring himself in, within 
 the space of 15 minutes ; digs no passages, and during the night 
 leaves his hiding-place and visits the females in their respective 
 nests. 
 
 The contagious nature of Scabies depends on the transmission 
 of Sarcoptes of both sexes, or of a pregnant female, from indi- 
 vidual to individual patient. It follows conclusively that a 
 single virginal female or male Sarcoptes would not lead to a 
 perfect form of itch, and hence the diagnosis might find some 
 difficulties. For, as already stated, the non-impregnated female 
 Sarcoptes makes but a short duct, and the male none at all ; and 
 
MICROSCOPICAL DIAGNOSIS. 
 
 21 
 
 a most careful examination of the whole body with the aid of 
 a magnifying glass, is often necessary to find the parasite. Bour- 
 guignon suggests, with some probability, that Prurigo may be 
 occasioned by single individuals, and Boeck of Christiania 
 describes a crustaceous form of Scabies, characterized by thick 
 whitish grey and hard scabs upon red and excoriated skin, extend- 
 ing even to the nails, in which he found numerous dead Sarcop- 
 tes, ova and excrements of the animal. Similar instances have 
 been recorded by Fuchs, Rigler, and Rebra. 
 
 (b.) Acarus folliculorum. (Simons.) 
 
 (Fig. 14.) 
 
 Demodex follic., Owen ; Macrogaster platypus, Miescher ; Simonea 
 follic., P. Gervais ; Steazoon foil., E. Wilson. 
 
 This parasitical animal was dis- 
 covered about the same time (1842) 
 by Henle and Simon, and subsequent- 
 ly described in Johannes Muller's Ar- 
 chives of Physiology. At first it was 
 found in the inflamed sebaceous fol- 
 licles of the skin (acne), but subse- 
 quently in healthy follicles also, in 
 which they seemed to be perfectly 
 harmless. The question as to its 
 morbid effects upon the human skin 
 has as yet not been decided, although the case related by Rernah 
 {Kuchenmeister, page 377) seems to indicate that the Acarus fol- 
 lic, under favorable circumstances, may now and then become 
 the cause of morbid action. 
 
 Most frequently the acarus follic. is found in the follicles of 
 the nose, lips, forehead, cheeks, the external meatus of and 
 behind the ear, the chest and back. 
 
 A well-developed follicle should be forced out, the sebaceous 
 cylinder spread on glass, and observed with a power of from 
 150-300. They can be found most easily in bodies by taking 
 vertical sections from follicles. Their form and the number of 
 their feet vary from three to four pair. 
 
 Fig. 14. 
 
22 MICROSCOPICAL DIAGNOSIS. 
 
 (c.) Infusoria. 
 
 Of these microscopical epizoes a great variety are found in 
 wounds and moist places of the skin. Their presence, as far as 
 our present knowledge goes, has no pathological interest. 
 
 II. THE BLOOD. 
 
 (Figs. 15, 16.) 
 
 In the fresh blood three microscopical elements are discern- 
 ible, namely, the red and white corpuscles and molicular gra- 
 nules (fat, protein ?), identical with those on chyle. One would 
 suppose that a fluid so generally diffused throughout the body 
 as the blood, from the fact of its being in constant contact with 
 the various tissues and of its simple organic constitution, would 
 readily participate in the morbid changes of the body, and 
 therefore furnish an auxiliary basis of microscopical diagnosis. 
 This, however, is not the case. In rare instances has the micro- 
 scopical examination of the blood heretofore led to reliable 
 results." Rudolph Virchow, Julius Vogel, Bennett, and others 
 have, however, lately, successfully commenced establishing a 
 pathology of the blood in which the microscope has taken a 
 prominent part. 
 
 Before entering upon the exceptional changes which the 
 microscopical elements of the blood may undergo, it will be 
 desirable, first, to allude to the changes of blood when exposed 
 to atmospheric air out of circulation, as being of great importance 
 in both diagnosis and medical jurisprudence. 
 
 Above all, it is important to make out the presence of blood 
 and its changes when dry. All microscopical examinations of 
 blood require a magnifying power of 400 and reflected light. 
 Blood serum or sugar-water are the best mediums for dilution. 
 
 Some hours after a meal the red blood globules preponderate 
 considerably, whilst the white corpuscles and granules show a 
 numerical increase immediately after food has been taken. By 
 some authors it is furthermore stated that the white corpuscles 
 
MICROSCOPICAL DIAGNOSIS. Z6 
 
 augment daring gestation, in Chlorosis, and after copious Haemor- 
 rhage. The normal proportion between the white and red 
 globules is said by Donders, Moleschott, and Kollicker to be 5 
 to 2-000. 
 
 When seen edgewise, the red blood corpuscles exhibit a bicon- 
 cave shape ; whilst flat, they are without exception circular in 
 form, of 0*005 to 0*007 Mm. in diameter, opaque, light yellow, 
 and without a nucleus. Within focal distance they appear to be 
 clear and transparent; without their correct focus, dark and 
 opaque. In the newly abstracted blood the red globules join 
 each other, assuming the shape of a roll of coin (Fig. 15, c). If 
 a drop of blood is permitted to dry * ,_ <s _ 
 
 upon a glass plate, the red corpuscles U©^ Jf3P l@9 
 
 part from one another, first become ** " 
 
 larger and flatter, show within any (P ^^ " Q 
 
 focus a central nucleus, their margins /-©<? gp<? @©^ 
 shrink and become crenate (Fig. 15, d). Gqq ^&K 
 
 Water will restore their original form, fig. is. 
 
 unless they have been too long in a dry state. If fresh blood is 
 mixed with a liquid, which does not dissolve its red corpuscles, 
 the latter will, by absorption, distend to a globular form and lose 
 their color (Fig. 15,/); they burst, however, very soon and 
 crumble to molecules, or they shrink, become darker and 
 crenated. The latter is the usual condition in which they are 
 met with in haemorrhagic extravasation and dysenteric discharges, 
 etc., and also in bloodstains. If they have not lost their hsema- 
 tine, they may yet be recognised by adding water. But, if the 
 red globules have for a long period been in a dry state, all organ- 
 ization disappears, and all that remains is a little pigment. The 
 latter may justify the supposition of blood, but cannot be taken 
 as positive evidence. 
 
 Of late Funke and Kunde have tried to appropriate the 
 blood crystals for differential diagnosis, yet their meritorious 
 efforts have thus far been without practical results. It should, 
 however, be borne in mind, that under certain physical and 
 chemical conditions and changes of the blood red crystals will 
 form. 
 
 The colorless corpuscles are the identical chyle-corpuscles, 
 
24 MICROSCOPICAL DIAGNOSIS. 
 
 O006 — 0*015 Mm. in size, and consequently larger than the red 
 ones ; they are moreover pale and 
 
 -C@ ® ® © fiaeIy granulated (Fig ' x ?' - a K They 
 
 '"'$& ViSSj r\ contain one or more nuclei, often re- 
 
 « a ® ^ cognisable without, but certainly w#A, 
 
 Fig. i6. the action of acetic acid (Fig. 16, b) 
 
 or solution of iodine ; their number in normally constituted 
 
 blood is but small and scarcely to be estimated. Their existence 
 
 seems to be ephemeral. 
 
 The elementary granules (chyle-granules ?) occur in the blood 
 under the same circumstances as the white corpuscles, both 
 physiologically and pathologically. The red corpuscles of man 
 and most animals differing in both form and size, their discrimi- 
 nation from each other in fresh blood or bloodstains offers no 
 difficulty whatever. 
 
 Simulation of Haemoptysis by staining the sputa with pigeon 
 blood, has thus been easily discovered by the microscope. 
 
 But it is far more difficult and frequently impossible to dis- 
 criminate animal from human blood, in old stains, for reasons 
 already stated. 
 
 The pathological changes of the blood, as far as the micro- 
 scopical elements are concerned, have been, as yet, but imperfectly 
 ascertained. All we know about them may be comprised under 
 the following heads : 
 
 (1.) The form and aggregation of the corpuscles. 
 
 (2.) The relative number of the microscopical elements. 
 
 (3.) Foreign constituents. 
 
 1. FORM AND AGGREGATION OF THE RED CORPUSCLES. 
 
 It has been stated by Torneroth, Ilmoni, and others, that in 
 Typhus and Tabes the red cells change their contours, become 
 wrinkled, crenated, and shrunken. We are not prepared to say, 
 whether this is an invariable condition of the red cells in the afore- 
 said diseases. In Asiatic cholera, however, these changes are often 
 observed and have been attributed to the reduction of serum. 
 In Purpura and puerperal disorders, the ordinary conglomeration 
 
MICROSCOPICAL DIAGNOSIS. 25 
 
 of the red cells in rolls has been found absent. It is yet doubtful 
 whether this observation is of any pathological value. 
 
 2. RELATIVE NUMBER OF MICROSCOPICAL ELEMENTS OF THE 
 BLOOD. 
 
 (a.) Preponderance of Elementary Granules. 
 
 These molecules, as already stated, are very numerous after 
 meals, long fasting, the use of spirituous liquors, and in certain 
 physiological conditions, such as pregnancy. They are identical 
 with lymph-granules, and essentially consist of fat (protein?). 
 A very large number of these granules are found in the so-called 
 white blood (Leucasmia, Galactaemia, Lipaemia), also in the blood 
 of drunkards, and in patients afflicted with Bright's disease. 
 The granules are chiefly in the serum on account of their 
 lightness, and they impart to it a milky and turbid appearance. 
 Their presence in the blood indicates imperfect Hsematosis and 
 assimilation, and, perhaps, inefficient purification of the blood by 
 the secretory and excretory organs. 
 
 (b.) Abnormal Preponderance of Colorless Blood Corpuscles. 
 
 This is almost the only important change in the relative 
 proportions of the microscopical elements hitherto ascertained 
 with any degree of certainty. In 1845 Rudolph Yirchow 
 examined a corpse of a person who had died under circum- 
 stances not satisfactorily ascertained. The liver and spleen were 
 found to be hypertrophied, and the blood exhibited an enormous 
 number of white cells. He termed the disease "Leucasmia." 
 In the same year Bennet of Edinburgh observed a similar case, 
 and considered the colorless bodies as pus-corpuscles. Since 
 then the same author has published an essay (1852) in which he 
 admits those corpuscles to be an ordinary anatomical element 
 of the blood, and denominates the decrease of their abnormal 
 numerical proportions Leucocythaemia or white cell blood. 
 Other inquirers have since affirmed the discovery of Professor 
 
26 MICROSCOPICAL DIAGNOSIS. 
 
 Virchow, and at this time a large number of cases are od 
 record. 
 
 Virchow, who has since turned his first observation to profit- 
 able account for both Physiology and Pathology, holds — and 
 with him Bernhardt — that Leucaemia and Leucocythaemia are 
 not synonymes for the same disease, the former representing a 
 real dyscrasy with structural alienations of spleen, liver, or the 
 lymphatic glands and subsequent morbid nutrition, whereas 
 Leucocythasmia is a mere transitory increase of white cells and 
 mostly physiological in character (pregnancy). 
 
 The only diagnostic criterion of Leucaemia is, therefore, the 
 permanent excess of white corpuscles.* The comparative num- 
 ber in all known cases has been various, but never exceeded the 
 number of the red corpuscles. A simple puncture of the needle 
 into the skin of the patient will furnish sufficient material for 
 examination, and a power of from 200 to 400 should be em- 
 ployed. 
 
 (c.) Change in the Number of Red Blood Cells. 
 
 In his valuable treatise on the various changes of the compo- 
 sition of the blood, Prof. Julius Vogel has invited attention to the 
 vacillation in the number of red blood corpuscles. But in the 
 absence of a reliable method of counting the haematine corpus- 
 cles the terms of Poly- and Oligocythaemia used by Vogel have 
 not as yet acquired practical usefulness. 
 
 3. FOREIGN ELEMENTS IN THE BLOOD. 
 
 There is no longer any doubt as to the occasional appearance 
 of foreign material in the circulating blood having indisputably 
 been observed at post-mortem examinations. Hitherto, however, 
 these observations have had no diagnostic and practical applica- 
 tion. 
 
 * A case of Leucaemia, lately under my charge in the Long Island College Hos- 
 pital of Brooklyn, exhibited at one time almost exclusively white corpuscles, and on 
 subsequent examination never less than A ^.. — B. 
 
MICROSCOPICAL DIAGNOSIS. 
 
 27 
 
 (a.) Epithelium of Bloodvessels. 
 
 Epithelium cells of bloodvessels, Fig. 17, have been found in 
 the so-called heart polypi, and Jos. Meyer has 
 seen them in the circulating blood of a frog. 
 
 Yirchow has observed oblong epithelial 
 cells, containing fatty and pigment molecules 
 in bodies which had died from intermittent 
 fever and cancer of the womb. Meckel has 
 seen pigment cells ; Donders, oblong cells with- 
 out pigment, in the blood of patients afflicted 
 with puerperal fever, considering them the 
 epithelial lining of bloodvessels. With the 
 aid of Donders the Author has observed both oblong Epithelium 
 and an excess of white corpuscles in such patients. Vogel speaks 
 of caudated cells in a body which died from pyaemia, caused by 
 onychia, and considers them to be epithelial cells.* 'From his 
 own observations the author accepts the views of Donders 
 and Vogel as to the nature of those cells, being the Epithelium 
 of bloodvessels. Their diverse forms are confirmed by histology. 
 Where pigment is so abundant, as in the blood, it cannot surprise 
 us that we occasionally meet with it in Epithelium also. 
 
 Both Donders and Vogel suggest the feasibility of the epi- 
 thelium in the current blood, where it causes obstruction, Throm- 
 bosis, and the formation of abscess of bloodvessels, so frequent in 
 puerperal and pyasmic fevers. This is a step towards the 
 mechanical causation of disease, which Virchow is zealously 
 trying to propagate in every direction. 
 
 For practical diagnosis, no positive result has yet accrued from 
 the discovery of epithelial cells in the current blood, but the 
 subject is evidently of sufficient importance to excite genera] 
 inquiry. 
 
 (b.) Pus. 
 
 Numerous and careful microscopical examinations of exqui- 
 
 * In the case of Leucaemia, already adverted to, I have noticed cells of different 
 size and shape, some containing fat granules or pigment molecules, others but one 
 nucleus. — B. 
 
28 MICROSCOPICAL DIAGNOSIS. 
 
 site pytemic cases have proved the fallacy of the theory that large 
 quantities of pus are absorbed by and circulate with the blood. 
 That which has been taken for pus cells was probably white 
 blood-corpuscles in unusual number. The best authorities on 
 Microscopy agree that between the white blood and the pus- 
 corpuscles there is no characteristic difference either in appear- 
 ance, size, or chemical reaction. Moreover, their size is not cal- 
 culated to obstruct the circulation, as has been hypothetically 
 supposed. 
 
 (c.) Cancer Cells. 
 
 For a long time it has been insisted on, that cancer cells enter 
 the circulation and thereby cause secondary cancerous growth. 
 The fact of their occasional presence in the circulating blood has 
 been indisputably established by such authors as Yirchow, 
 Bennet, Paget, Quekett, J. Vogel, and others. But the infer- 
 ence drawn from this fact has in no instance been borne out ; 
 for wherever the cancer cells had crowded together they had 
 obstructed the capillaries, cut off the circulation, and initiated 
 structural mortification, or, as Virchow terms it, necrosis. The 
 formation of secondary cancer seems altogether fabulous, and 
 devoid of anatomical evidence. Supposing the cancer cells to 
 have encroached upon the blood, their very size, compared with 
 the calibre of the capillaries, renders their arrest by the latter 
 both obvious and inevitable. They will at once become the 
 nucleus of a Thrombus, engrossed by fibrine, and thus cut 
 off the supply from the circulation. Before they could 
 organize their new bed of growth, their morbid effects, already 
 adverted to, would manifest themselves, and lead to the struc- 
 tural disintegration of parts thus impeded. The morbid effects 
 would be of the same nature, if the cancer cells had mixed with 
 the venous blood, since the portal vein, and the pulmonary 
 artery, form the same capillary network as the arteries in gene- 
 ral. Nor does the author share in the hopes of J. Vogel in 
 establishing a reliable diagnosis of cancer by a microscopical 
 examination of the blood. For it is to be presumed that the 
 blood of every patient afflicted with this malignant disease does 
 
MICROSCOPICAL DIAGNOSIS. 29 
 
 not carry cancer cells, and at any rate not in such abundance as 
 to exhibit them in every drop, and in all parts of the circulation. 
 Hence their absence would prove nothing, and their accidental 
 presence would only corroborate a diagnosis already clear by the 
 advanced development of the disease.* 
 
 * The author's arguments, though conclusive, and indisputably correct in many- 
 points, are nevertheless susceptible of correction in others. Prof. Bamberger's ob- 
 servations of fungiform cancerous growths inside of the hepatic and portal veins in 
 a case of cancer of the liver (Oestr. Zeitschrift fur pract. Heilkunde, 1857,'58), demon- 
 strate the feasibility of the cancer cells detaching themselves from their original 
 seat, and reaching the heart and lungs unimpeded. The existence of cancerous 
 tumors upon the walls of the heart, though of rare occurrence, has been recorded 
 by Rokitansky ; and I have lately observed a case of most acute and extensive 
 encephaloid disease, which seems to bear strongly upon the question. A young 
 man was attacked with encephaloid of the left testicle and spermatic cord, and had 
 both removed by Dr. Buck of New York. Three weeks after the operation I was 
 invited to see the patient, who then presented a tumor in front of the lumbar por- 
 tion of the spine, leaning towards the left kidney. Liver, lungs, and heart were 
 found to be intact. In a week the liver commenced to enlarge, and very soon bo- 
 came nodulated, lungs still healthy, and respiration perfectly easy and free. A fort- 
 night before the death of the patient the left lung became involved in its inferior 
 lobe, and from that time the disease extended gradually over the superior lobe and 
 the right lung. On post-mortem examination the chronological progress of the dis- 
 ease could be clearly traced in the various organs affected, by the size of the can- 
 cerous nodules and their respective degrees of firmness and softness. In the right 
 ventricle there was also a small tumor, organically and closely connected with the 
 septum. 
 
 On exhibiting the respective specimens to the Pathological Society of New York, Dr. 
 Crakowitzer justly remarked, that it had all the appearance of a fibrinous clot formed 
 after death. A careful microscopical examination by Dr. C. and myself revealed, 
 however, the true cancerous character of the growth, upon whose surface abundant 
 fibrine and blood corpuscles had been deposited. The pathogenetic progress of the 
 disease just related, leaves at least room for the conjecture that the cancer cells had 
 been transmitted by the circulation from place to place, until they at last reached 
 the lungs and heart. Another circumstance may be mentioned as likely to strengthen 
 this position, namely, that the right lobe of the liver, being more easily supplied 
 with portal blood, was comparatively three times as large as the left, and the can- 
 cerous nodules proportionately much larger and softer than in the former. 
 
 Another point in fact against the author's deduction is derived from the so-called 
 Ostoid. Instances are known and have been observed by Johannes Miiller, Ger- 
 lach, Schuh, Buhl, and others, in which, on the same subject, cancerous tumors had 
 formed in remote localities with the same structural stroma as the original disease^ 
 otherwise devoid of osseous material. — B. 
 
30 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 (d.) Hcematozoa. 
 
 In the blood of certain quadrupeds Entozoa are constant 
 elements. Thus Filarise in dogs, Strongylus armatus in the 
 horse, etc. The same has been said of human blood. Duval 
 professes to have seen Fasciolae in the portal vein. Most obser- 
 vations of this description are, however, not free from doubt, 
 mistakes being easily committed. Thus, for instance, a caudated 
 epithelial cell may be mistaken for Vibrio, aside from Infusoria 
 dropping into exposed blood when not carefully covered. 
 
 In disease it seems to be different. Brauell (Med. Neuigkeiten, 
 No. v., Jahrgang 9) states positively to have observed Vibriones 
 in the blood of glandered horses, which, though not directly con- 
 nected with the contagiousness of glanders, exercised, neverthe- 
 less, a marked influence upon its fatality. 
 Their presence was therefore of prog- 
 nostic importance. The observation of 
 Distoma haematobium (Fig. 18) in the 
 blood of dysenteric patients, by Prof. 
 Bilharz of Cairo (Egypt), is another 
 interesting fact in proof. This parasite 
 occurs in the portal and mesenteric veins, 
 less frequently upon the mucous mem- 
 branes of the intestinal tract, in the vas- 
 cular vegetations of the urinary bladder 
 (frequent affection in Egypt), and in 
 distended vessels close to the seat of 
 the dysenteric process. Within the 
 exuded material of the intestinal mucous membrane, the ova 
 and other curiously formed bodies of the parasite are imbedded, 
 exhibiting its various stages of development. 
 
 Distoma haematobium is from three to four Parisian lines in 
 length. The male, according to Bilharz, carries the female in his 
 canalis gynocopherus (Fig. 18, a, b, c), the latter protruding 
 (d, d) in part ; f, the opened fissure of the canal ; i, mouth disc ; 
 &, .belly disc for fastening ; g, ovum from a vessel of intestinal 
 mucous membrane ; A, ovum with a live embryo. 
 
 In his " Comment on Diseases in Egypt," Professor W. 
 
MICROSCOPICAL DIAGNOSIS. 31 
 
 Griesinger has, from a clinical point of view, described the 
 morbid processes engendered by this parasite — which he deno- 
 minates Distoma disease — and has thus made a practical applica- 
 tion of the discovery of Prof. Bilharz. The latter has recently 
 resumed the subject and enlarged on this parasite (which hitherto 
 was found in the portal, mesenteric, and hemorrhoidal veins, and 
 the venous plexus of the urinary bladder, whose ova had been 
 met with in the parenchyma of the liver, the membranes of the 
 small intestines, but chiefly in the submucous cellular tissue of 
 the bladder, the ureters, seminal vesicles, and of the lower portion 
 of the large intestine). And furthermore, he has considered its 
 relations to pathological changes and particularly to its influence 
 on vesical diseases and the formation of calculi — and thereby 
 rendered more complete his own, as well as the earlier observations 
 of Griesinger. He, however, no longer ascribes to this parasite 
 any co-agency in the causation of dysentery, which prevails in 
 Egypt — a question which had indeed been already settled by a 
 private communication of Dr. Sendahl (who was in Egypt at the 
 time — 1856) to Prof. Bilharz. Without more particular reference 
 to the two authorities named, we will mention, however, the 
 modus in which Dr. Bilharz explains the deposits of the ova in 
 the uro-genital organs, particularly in the polypous vegetations 
 of its mucous membrane, sometimes encrusted with urinary 
 deposits. He says, the male bearing an impregnated female in 
 his canalis gynocopherus, forces itself against the current of the 
 blood into the smaller branches of the venous plexus. "With the 
 aid of the sucking discs and minute bristles it works its way, and 
 deposits in the capillaries the ova, which are united into lumps by 
 a gelatinous substance. Passive hyperemia, stasis, and effusion 
 of plastic lymph ensues, the vessels burst, and thus the ova are 
 placed into the cellular tissue, from which they pass to the surface 
 of the mucous membrane of the bladder, or are discharged with 
 the urine. In regard to the general prevalence of this parasite in 
 Egypt, it is said to be very great ; so much so, that it may be 
 taken for granted, that one-half of the adult native population 
 (the Fellahs and Copts) carry either the parasite or its effects. 
 Out of Egypt, so Prof, von Siebold relates verbally, it has, thus 
 far, not been found. 
 
32 MICEOSCOPICAL DIAGNOSIS. 
 
 III. THE MILK. 
 
 Fig. 19. 
 
 The normal condition of Milk has been best described by 
 Lammerts van Bueren, whilst Donne" has most satisfactorily 
 ascertained its microscopical constituents. 
 
 The milk consists of the following : 
 
 1. Plasma. 
 
 2. Innumerable, spherical, opaque, and light-refracting fat 
 granules, and fat drops ; and 
 
 3. Milk globules, containing the former in an investment of 
 what is probably caseine. 
 
 In reference to the formation of milk, Lammerts van Bueren 
 has laid down the following tenets : 
 
 1. The milk globules generate in the epithelial cells of both 
 the lacteal ducts and terminal vesicles, but chiefly in the latter. 
 
 2. In perfect milk secretion both cell walls and contents of 
 the milk globules dissolve and join the plasma. 
 
 3. In colostrum this metamorphosis is not perfect. 
 
 4. The colostrum corpuscles generate probably in the old 
 epithelium of the lacteal ducts. 
 
 With these views the more recent inquirers coincide, amongst 
 others Kolliker. The accompanying diagrams have been taken 
 from women who had died respectively during, and soon after 
 childbirth. 
 
 Fig. 19, a-d the secretory epithelium of the mammary 
 gland : a, normal, i, incipient fat de- 
 posit ; c, increased fat-granules ; d, 
 fat-granules without nucleus ; e, milk 
 globules, spherical, containing fat- 
 granules ; f, the same with larger fat- 
 drops ; g, h, colostrum corpuscle ; i, 
 k, the same in a state of disintegration, 
 discharging its contents ; I, perfectly 
 Fig. 19. matured constituents of the milk, 
 
 isolated and confluent fat-granules and drops. 
 
 In reference to microscopical diagnosis, milk may become the 
 object of interest in two ways. 
 
MICROSCOPICAL DIAGNOSIS. 33 
 
 1. THE RELATIVE PROPORTIONS OF THE MILK CONSTITUENTS. 
 
 Since Donne, Zettwach, and Girard have ascribed to the col- 
 lostrum corpuscles in the milk obnoxious effects upon the suck- 
 ling, they have been the subject of close examination. It should, 
 however, be borne in mind, that a few collostrum corpuscles 
 physiologically occur in the milk for some time after childbirth, 
 without at all vitiating its nutritious or wholesome character. 
 But a large number of those elements would be evidence 
 of congestion or inflammation of the mammary gland. In some 
 diseases of nursing women, the collostrum corpuscles generate in 
 great abundance. Thus in rheumatism, exanthemata, and typhus 
 lactantium. In the last, according to Lehmann, are occasion- 
 ally found regular exudation corpuscles, with traces of fat- 
 granules. 
 
 The presence of collostrum corpuscles in large numbers is 
 important evidence of recent parturition, and therefore of great 
 moment in a forensic point of view. 
 
 2. ABNORMAL SUBSTANCES IN THE MILK. 
 
 It is said that after contusions of the mammary gland the 
 milk shows red blood corpuscles and fragments of blood-clots 
 and pus cells in incipient mammary abscess. We have never 
 observed those elements, whereas we have met in the latter 
 instance with collostrum corpuscles four months after confine- 
 ment. Nor have we any positive idea as to the obnoxious 
 results of those abnormal elements upon the infant. Their 
 observation may, however, assist in forming an early diagnosis 
 of incipient abscess. 
 
 In Wagner's Encyclopedia of Physiology we read, vol. i., page 
 470, "Sometimes the milk, after having been exposed to the 
 action of atmospheric air, assumes a blue, but rarely a yellow 
 color, beginning at the surface and gradually extending over the 
 whole liquid. When examined by J. Fuchs, he found infusoria 
 to be the cause of discoloration ; Vibrio cyanogenus being in the 
 blue milk and Yibrio xantogenus in the yellow. The infusoria 
 
84 ■ MICROSCOPICAL DIAGNOSIS. 
 
 themselves are stated to be colorless ; but they possess the quality 
 of discoloring milk. 
 
 In red milk C. Naegeli lias observed Protococcus. As far as 
 known cancer cells have as yet not been found in the milk ; 
 whereas mammary cancer occasionally gives rise to the secretion 
 of normal milk and collostrum. In a cancerous tumor of the 
 breast, removed by Dr. Svalin, the Author had an opportunity 
 of confirming the last-mentioned fact in addition to the deve- 
 lopment of milk secretion as demonstrated by Lammerts van 
 Bueren. 
 
 IV. VISCERAL EVACUATIONS. 
 
 There are three apertures for visceral discharges : the mouth, 
 the anus, and the genito-urinary openings. But the organs 
 whose products and educts are eliminated through these aper- 
 tures, are so numerous and so diversified, as to be subdivided 
 under different heads in their respective anatomical order. 
 
 A. THE ORAL CAVITY. 
 
 Fig. 20 to 22. 
 
 In this peculiarly constructed cavity open the salivary glands 
 and the lungs. By way of regurgitation the contents of the 
 oesophagus and the stomach may be returned under certain mor- 
 bid conditions. Although we may derive but little information 
 from the microscopical examinations of the normal contents of 
 the oral cavity, we should, nevertheless, thoroughly acquaint 
 ourselves with their appearance, in order to discriminate between 
 them and other accidental or pathological elements. 
 
 (1.) Normal Contents of the Oral Cavity. 
 The whole cavity is lined with pavement epithelium, con- 
 
MICROSCOPICAL DIAGNOSIS. 
 
 35 
 
 sisting of many super-imposed layers of large, roundish, poly- 
 gonal, more or less flattened cells, 
 inclosing one or two nuclei and 
 granules (Fig. 20, a). The epi- 
 thelium cells form the principal 
 and most numerous microscopi- 
 cal elements of the mouth. Be- 
 sides these cells, there are about 
 the teeth and at the base of the 
 
 tongue, when scraped with the scalpel, delicate fibrillse (Fig. 
 20, a ; 22, a), partly detached from and partly 
 adhering to a kind of stroma (Fig. 22, b), from 
 which they seem to originate. This is the 
 Leptothrix buccalis of Ch. Robin, a constant 
 alga of the filiform papillae. The dense epi- 
 thelial lining at the apex of the latter, forms 
 a cylinder upon which the stroma-like humus 
 is inserted (Fig. 22 b). 
 
 Between the filaments of the Leptothrix myriads of infusoria 
 reside and move incessantly. They are round, cylindrical, and 
 vibrionic. Among them there are also the so-called mucous 
 corpuscles (Fig. 20, b; fig. 21, a, b, the latter 
 magnified 800 times), rounded cells of 0-010 
 Mm. diameter, with from one to four nuclei, 
 more numerous after meals. Formerly they 
 were erroneously looked upon as the products 
 of the mucous follicles or salivary glands. Kol- 
 liker considers them, however, the products of 
 the irritated mucous membrane, as a kind of FlG - 22 - 
 inflammatory corpuscle, and in their microscopical character, 
 identical with lymph- pus- and white-blood corpuscles. They 
 have, moreover, been found throughout the entire intestinal 
 tract, and of late even in the peptic glands of the stomach. 
 
 Aside from the microscopical elements before described, it is 
 quite common to find in the mouth fragments of food, starch- 
 granules, muscular fibres, fat-granules and drops, also dust of 
 different origin ; in infants — milk, caseine, etc. We shall enter 
 more fully upon the consideration of alimentary remains when 
 
36 MICEOSCOPICAL DIAGNOSIS. 
 
 discussing the constitution of vomited material, and the dust 
 we shall comprise with the sputa of which it is an ordinary con- 
 stituent. 
 
 (2.) Abnormal Contents of the Mouth. 
 
 The abnormal contents of the mouth are, of course, of very 
 different character, and more or less of pathological importance. 
 We shall pass over the introduced substances, as not strictly 
 belonging to the category under consideration. 
 
 The so-called coating of the tongue consists of macerated, highly 
 developed, imperfectly detached pavement epithelium, with per- 
 haps some coagulated mucus. The brown tint of the coating in 
 typhus and similar diseases is made up of blood, derived from 
 the fissures of the dried mucous membrane. 
 
 Eulenberg speaks of a black coating having been caused by 
 pigment-granules of the epithelium. Inflammatory affections of 
 the oral cavity, whether manifesting themselves in the circum- 
 scribed form of vesicles or pustules, or diffusing over a larger 
 surface and different structures, are sufficiently marked by their 
 form and appearance, so as to demand the aid of the microscope. 
 The beginning of these affections is invariably accompanied by 
 an excess of mucous corpuscles ; its progress by the presence of 
 pus. When their seat is hidden from the eye as in the pharynx, 
 the microscope may be needful, when the pus-corpuscles will dis- 
 close the existence of an ulcerated "surface. The true nature 
 of one, heretofore obscure, affection of the mouth, has been 
 found out by the microscope, namely : 
 
 The Aphihai or Soor. 
 
 This peculiar disease of the mouth, which chiefly befalls infants, 
 but often extends to adults when reduced by protracted illness, 
 must, from the present scientific point of view, and in accordance 
 with Prof. Berg's opinion, be regarded as dependent on the pre- 
 sence of fungus (Oidium albicans, Ch. Robin) discovered by 
 himself, growing upon the mucous membrane and diffusing 
 between the epithelial layers. 
 
MICROSCOPICAL DIAGNOSIS. 37 
 
 Aphthae have consequently nothing in common with the various 
 forms of stomatitis. They are peculiar coatings of the mucous 
 membrane, comprising both the parasite and its immediate action 
 upon the latter. The coatings are of variable form and size; 
 white in the beginning and grey -yellowish in their progress; of 
 soft and cheesy consistence, delicate as the thinnest paper and 
 from that to the thickness of half a line ; rather firmly adherent, 
 but easily removed from, and without injury to, the subjacent 
 structure. The seat of the aphthae comprises the lips, cheeks, 
 gums, palate, tongue, phar} 7 nx, and oesophagus down to the cardia. 
 Eobin states that he found it in the stomach, even in the small 
 intestines and the rectum, whither it probably had been carried 
 with food. 
 
 Ed. Martin, of Jena, observed exquisite aphthae in the vagina 
 of a pregnant woman, who confessed that her lover (a miller by 
 trade) had introduced his finger, which was covered with flour- 
 dust. The infection had consequently occurred in a similar 
 manner as in infants who depend on mealy nutriment. It may 
 happen that aphthae and forms of stomatitis simultaneously occur 
 in a patient, but they have no etiological connexion and do not 
 depend on each other. 
 
 The direct consequences of aphthae, being strictly a local 
 affection and requiring local treatment only, limit themselves to 
 impeded sucking and mastication, and additionally to hoarseness, 
 if the epiglottis should be affected. 
 
 As already stated, this parasite vegetates upon the mucous 
 membrane and distributes itself between the epithelial cells, 
 whither it comes from the air, with food, the fingers, etc., giving 
 rise to the formation of lactic acid, reacting itself sour, and spon- 
 taneously discharging carbonic acid. 
 
 The diagnostic discrimination of aphthae from other diseases 
 of the oral cavity has no difficulty. Coagulated caseine may 
 present some striking resemblance with aphtha?, but its removal 
 from the mouth is sufficient to solve all doubts. On the other 
 hand true aphthae on the tongue, if not well developed, may 
 mislead to the supposition of their being an ordinary lingual 
 coating. An early diagnosis being of great practical moment in 
 all cases of doubt, the microscope should be promptly resorted to. 
 
as 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 In scraping the aphthous patches and in bringing the object 
 under the microscope, after add- 
 ing potash to make the epithe- 
 lium transparent, we find, besides 
 the latter, some hair, and other 
 accidental elements, the follow- 
 ing vegetable forms : 
 
 (1.) Spores (Fig. 23, a, a), round 
 oval, variously shaped cells of 
 0-015 to 0-002 Mm. diameter, 
 some of which exhibit one or 
 more nuclei with molecular mo- 
 tion, whilst others are entirely without them. The spores are 
 either free and isolated, or grouped with others, closely connected 
 with the epithelium. To all appearance the spores originate in 
 the 
 
 (2.) Receptacles (Fig. 23, b, b), tubular and articulated filaments, 
 which attain sometimes the length of 0*006 Mm. They firmly 
 radicate in the epithelial cells, with a kind of bulbous root ; their 
 articulations are of different size, and contain extremely fine 
 granules, sometimes in molecular motion. We also find very 
 delicate, granulated filaments, not unlike 
 (3.) Mycelia (Fig. 23, c), in lesser numbers. 
 Both kinds of tubular organs multiply by budding laterally. 
 A magnifying power of 250 to 350 will afford a general view 
 of the parasite ; its details require, however, a considerable increase 
 (400 to 800). 
 
 B. LUNGS AND SPUTA 
 
 Under sputa we comprehend every secretion of the air pas- 
 sages and the respiratory organs, raised by forcible expiration. 
 As the sputa have to pass through the mouth, they may inci- 
 dentally be the exponents of the normal and abnormal contents 
 of that cavity. On examining the sputa, great care should be 
 taken not to confound the microscopical elements of the two 
 anatomical provinces. 
 
 The presence of pus in the sputa, especially, may give rise to 
 
MICROSCOPICAL DIAGNOSIS. 39 
 
 doubts as to its origin in one or the other of these provinces. 
 Having already and repeatedly adverted to pus as a microscopi- 
 cal constituent in various secretions, we may at this juncture 
 enter more fully upon its microscopical considerations. 
 
 In order to be impartial we have copied and annexed the dia- 
 grams from Lebert, Henle, and Yogel (Fig. 24), which represent 
 the various phases and changes of the so-called pus-corpuscles. 
 In comparing these with the mucous and white blood corpuscles 
 (Fig. 16, 20, 6, 21), irrespective of the variable number of nuclei 
 and granules, we find no marked differences ; they being all of 
 from 0.005 to 0.010 Mm. in size ; more or less finely granulated ; 
 rarely without, mostly with, from one to four nuclei; equally 
 susceptible to acetic acid and other re-agents, otherwise pale and 
 of delicate organization. It is, therefore, quite impossible to 
 discriminate one from the other in an object containing two kinds 
 of these corpuscles. 
 
 The only basis of diagnosis is the number and locality from 
 which they have been derived. Thus, for instance, in the sputa 
 the number of mucous corpuscles is comparatively small and 
 scattered. Abundance and conglomeration of corpuscles, there- 
 fore, indicate pus. 
 
 Of pus-corpuscles we can recognise two stages of develop- 
 ment : the young cells, the corps- 
 pyoides of Lebert (Fig. 2-4, a, d, 
 g), and the matured corpuscles 
 (Fig. 24, b, h). In the former 
 the formation of nuclei and 
 granules is yet imperfect, and 
 the liquid contents preponde- 
 rate ; in the latter the corpuscles Fig. 24. 
 present themselves with an uneven surface, owing to their nume- 
 rous nuclei and granules. These are the characteristic pus- 
 corpuscles ; they are, however, found under circumstances which 
 do not admit of mistake. 
 
 In pus derived from an abscess or from copiously secreting 
 mucous membranes, granules will be noticed that present dark 
 contours and strongly refract light. Besides these, fat granules 
 are sometimes visible. Both may be isolated or comprised in 
 
40 MICROSCOPICAL DIAGNOSIS. 
 
 the pus corpuscles themselves. The presence of these elements 
 may be considered additional proof of pus, except when they 
 have passed the oral cavity, where such granules may exist as 
 residues of food. 
 
 If the examination of sputa leaves no doubt as to the presence 
 of pus, and furthermore, if the pus has not originated in the 
 choanse, or the mouth, we may rationally infer that an inflam- 
 matory affection of the respiratory organs is going on. The 
 microscope alone, however, cannot define the nature and the seat 
 of the affection. 
 
 But it is evident that microscopical examination will lend 
 valuable assistance to auscultation and percussion in specifying 
 the diagnosis. 
 
 In some cases the microscope alone may render diagnosis 
 easier, and indicate the character of the disease in the absence 
 of other guides. Hence its paramount utility. 
 
 (1.) Catarrhal Affections of the Respiratory Organs. 
 
 In either acute or chronic catarrh the expectoration comprises 
 pus. In the former the sputa are thin, frothy, viscid, and mixed 
 with small bluish lumps of gelatinous consistence. As micro- 
 scopical elements we find : 
 
 Pavement epithelium in different stages of developement — from 
 the mouth. 
 
 Cylinder epithelium from the nasal cavity ; occasionally ciliated 
 epithelium from either the latter, the larynx, or bronchia. 
 
 Oblong epithelium from the finer branches of the bronchi and 
 the lungs themselves. 
 
 Pus corpuscles, mostly of recent formation, perfectly spherical, 
 finely granulated, and through imbibition of fluid rather larger 
 than usual ; Exudation corpuscles, Fibrinous particles, and frag- 
 ments of the mucous membrane, as represented under the head of 
 pneumonic sputa. 
 
 Pickford states that he has seen pigmented cells in catarrhal 
 expectoration. 
 
 In chronic catarrh the sputa are now and then, as in the 
 acute form, thin and frothy ; but we notice an element highly 
 
MICROSCOPICAL DIAGNOSIS. 41 
 
 characteristic : namely, small bluish-white or yellowish-grey 
 lumps, exceedingly cohesive and viscid, adhering to the vessel, 
 and when immersed in water sinking to the bottom. 
 
 The microscopical forms, characteristic of those sputa, are 
 about the same as enumerated, though with a decrease of pul- 
 monary elements and an increase of highly matured pus corpus- 
 cles, and of fragments of bronchial mucous (basement) mem- 
 brane. 
 
 Dr. Black* relates the presence of urate of ammonia in the 
 sputa of capillary bronchitis and rheumatism ; of oxalate of 
 ammonia in Oxaluria ; of Cholestearine and Biliphaeine in 
 Icterus. Although these substances have no bearing upon the 
 principal disease, yet they indicate the complication of the latter, 
 and are therefore of semiotic interest. 
 
 (2.) Croupous Affections of the Respiratory Organs. 
 
 The chief characteristics of the Sputa in genuine laryngo- 
 tracheal or bronchial croup, are fragments of coagulated fibrine, 
 variable in size, shape, and firmness. Their appearance is so 
 conspicuous as to be rea'dily recognised by the eye. Besides the 
 pseudo-membranes the sputa have some elements in common with 
 pneumonic sputa, which will now engage our attention. 
 
 Sputum Pneumonicum. 
 
 The microscopical elements in this sputum are of a diversified 
 description, comprising the matured epithelium from the oral 
 cavity (Fig. 20, a; 25, n), young epithelium from the same place, 
 round, not yet flattened (Fig. 25, a), cylindrical epithelium in great 
 variety (Fig. 25, &), from the choanoe and pharynx, not unlikely 
 deprived of their cilia (Fig. 25, c). This epithelium is not always 
 as perfect as represented in the annexed diagram, but sometimes 
 broken down, thereby increasing the number of granules in the 
 pneumonic sputum. 
 
 * Monthly Journal of Med. Science, Edinburgh. Yol. 16. 
 
42 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 Epithelium from the second layer of the bronchia below the 
 ciliated cells (Fig. 25. d). Their 
 number in pneumonia, acute and 
 chronic bronchitis, is almost incre- 
 dible. When oval and less granu- 
 lated, the larger cells can be easily 
 discriminated from pus corpuscles, 
 whereas the smaller ones from the 
 finer bronchial tubes, and especially 
 when highly granulated, require the 
 agency of acetic acid for discrimi- 
 nation, their nuclei showing them- 
 selves differently from those of pus 
 corpuscles. 
 
 Pus corpuscles occur in all possible 
 forms, large, small, transparent, with 
 one or more and entirely without 
 nuclei; dark, granulated (a aspect 
 framboise' — Lebert), shrivelled, etc. 
 (Fig. 25, e). The lower corpuscles 
 of the group, after a longer sub- 
 mersion in distilled water, have been 
 subject to the action of acetic acid. 
 
 Exudation corpuscles (Fig. 25, f. 
 Inflammation corpuscles — Oluge). 
 These elements were first observed 
 in inflamed tissues, but since also 
 under other circumstances, from which it seems probable that 
 they are either conglomeration of fat (proteine ?) granules, or 
 fatty degenerated cells of tissue concerned in the decay. Those 
 found in the pneumonic sputum are in all probability the fatty 
 degenerated epithelial cells from the bronchi. The diagram (/ 1) 
 represents the cell in the first stage of degeneration. For analogy 
 we refer to the article on milk. 
 
 Fibrinous particles (Fig. 25, g, h), consisting of cylindrical casts 
 from the bronchial tubes, with embedded epithelial cells. The 
 diagram (Fig. 25, g), represents an object removed from the mouth 
 of a child suffering from capillary bronchitis ; h, from an adult 
 
MICROSCOPICAL DIAGNOSIS. 43 
 
 on the fourth day of pneumonia. These casts occur in some sputa 
 abundantly, in others scantily, for which we are unable to account. 
 The size of these casts is in proportion to the lumen of the 
 bronchial tubes in which they originate. 
 
 Fragments of the mucous membrane (Fig. 25, i). Although it 
 is yet questionable whether fragments of the mucous membrane 
 detach themselves and mix with the sputum of Pneumonia, we 
 have nevertheless observed rags and fragments, which correspond 
 so closely with the anatomical nature of the mucous membrane, 
 as described by Black, and are so much at variance with the 
 other microscopical constituents of pneumonic sputa, that we are 
 disposed to admit them as particles of that structure. In the 
 annexed diagram (Fig. 25, i) we have exemplified a specimen of 
 the said description. It presents no granules as in the fibrinous 
 casts, is flatter and more irregular in form. The sharp dots seem 
 to be young nuclei. (Black.) 
 
 Red Blood Globules occur constantly and in large numbers in 
 sputum ferruginosum. They are either isolated or joined to 
 each other ; in the latter case they are of irregular form, almost 
 quadrangular; some crenated, shrivelled, and partly decayed. 
 (Fig. 25, h.) 
 
 Red Flakes (Fig. 25, m), minutely granulated, of variable and 
 indefinite shape, consisting apparently of hsematine. 
 
 All these form-elements are to be found in pneumonic sputum, 
 however changeable in cohesion and density it otherwise might be. 
 
 We have purposely entered upon an extensive discussion on 
 catarrhal and pneumonic sputa, in order to exemplify the direct 
 utility of the microscope in defining both the extent and the 
 nature of the disease, and the structure affected. 
 
 In either Bronchitis or Pneumonia the physical signs are 
 pretty reliable clinical guides. ' But in lobular and occult Pneu- 
 monia the microscope is indispensable for early and correct 
 
 (3.) Vomica! and Tubercles. 
 
 If a patient applies for professional advice, who has passed 
 through Pneumonia, whose physical signs conform with the 
 
44 MICROSCOPICAL DIAGNOSIS. 
 
 anamnesis and the rational symptoms of progressive destruction 
 of the lungs, the diagnosis is extremely easy and plain. Not so 
 easy, by far, is the diagnostic discrimination of such cases in 
 young individuals, where all clinical methods of investigation 
 prove a chronic pulmonary Catarrh only. And in these obscure 
 cases, Prof. Schroeder van der Kolk has taught us to employ 
 the microscope to advantage. 
 
 Strange enough, though evidently useful in differential diagno- 
 sis, the microscope has been in this respect totally ignored. 
 
 According to our personal and extensive experience in 
 this point we can but affirm its high value in obtaining 
 positive results where all other signs are of a mere negative 
 character. 
 
 We know from pathological anatomy that, in Pulmonary 
 Catarrh, only the mucous membrane of the bronchial tubes, and 
 that but partially, becomes disintegrated. The same must be 
 said of acute Pneumonia on its resolution and return to health. 
 In none of these cases can other form-elements be anticipated 
 than those which strictly belong to the mucous membrane. And 
 experience has confirmed this expectation. If, however, Pneu- 
 monia assumes a chronic course, or suppuration has to perform 
 the office of removing inflammatory obstruction in the Paren- 
 chyma of the lungs, the disintegration goes beyond the mucous 
 membrane, and the microscope reveals the morbid changes of 
 all the structures involved. The same we notice in Tuberculosis. 
 In both eventualities we have to expect, and do find, in the sputa 
 the essential fragments of the bronchial tubes. Thus, for 
 instance, in Vomica we look for and meet 
 with elastic fibrillar in commensurate pro- 
 portion to the size of the "Vomica ; we indeed 
 never missed them under such circum- 
 stances. We refer our readers to the an- 
 nexed diagrams (Figs. 26, 27) as good speci- 
 mens. Fig. 26 was taken from a patient — 
 in 1850 — an inmate of the Seraphinian Hos- 
 pital of Stockholm. His case was set down 
 as acute Bronchitis, in which diagnosis all symptoms concurred. 
 There were, however, elastic fibrillse in the sputa, indicating 
 
MICROSCOPICAL DIAGNOSIS. 45 
 
 incipient Tuberculosis. Subsequent clinical observation has 
 since verified the correctness of the diagnosis. Elastic fibres 
 may be readily recognised by their regular, curved, dichoto- 
 matous, equally wide, sharply contoured anastomosing fibrillae, 
 still more distinct under the action of acetic acid. These fibrillce 
 are, therefore, the structural evidence of Vomica; their early 
 discovery in dubious cases is the basis of an early and correct 
 diagnosis. 
 
 Incipient Tuberculosis characterizes itself by a more or less 
 chronic Catarrh, its sputa comprising a large number of pus-cor- 
 puscles, oblong and round epithelial cells of the second layer 
 (Fig. 25, d\ representing at the same time the peculiarities of 
 sputa cocta. In taking, however, a small quantity of the paler 
 portion of the lumps and extending it very thinly on a glass- 
 slide, fragments of elastic fibrillae will be found with a power of 
 250. For obvious reasons we find these fibrillae much more readily 
 in incipient than in advanced Tuberculosis, because the disease is 
 of less extent and the Catarrh restricted to the bronchial tubes 
 nearest to the deposits. Both the morbid action and the bron- 
 chial secretion are limited. The small lumps then exhibit the 
 elastic fibrillae in the best, i. e. the least disintegrated condition, 
 being at the same time of large size, whilst in the advanced dis 
 ease the structural elements are broken up in small particles and 
 therefore less distinct and recognisable. 
 Fig. 26 represents the elastic fibrillae in 
 Tuberculosis of recent origin. Schroe- 
 der van der Kolk and the Author have 
 seen still larger fragments so as to ex- 
 ceed the optic field of the microscope. 
 Fig. 27, a, a, are forms observed in a 
 later stage of Tuberculosis, although 
 scarcely in consummate Phthisis. In 
 this as well as in Vomica terminating fig. 27. 
 
 chronic Pneumonia, the elastic fibres in the sputa are much 
 decayed, and therefore found and recognised with much more 
 difficulty (Fig. 27, b, c, cl). Their diagnostic importance decreases, 
 however, in reverse ratio as the disease advances. 
 
 In order not to confound elastic fibres with the fibrillae of 
 
46 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 linen (Fig. 28), silk (Fig. 29), or cotton (Fig. 30), their respective 
 diagrams have been annexed. 
 
 Fig. 28. 
 
 Fig. 29. 
 
 Fig. 30. 
 
 4. Gangrama pulmonum. 
 
 In well established cases of pulmonary Gangrene, the history, 
 the physical symptoms, the characteristic quality of the sputa, 
 and the peculiar offensive odor of the latter, as well as the breath 
 of the patient, are reliable clinical guides for diagnosis. Some- 
 times, however, as for instance in inebriates, a simple bronchial 
 Catarrh or Pneumonia may become associated with a foetid breath 
 and expectoration, indicative of Gangrene of the lungs ; and in 
 other instances the sputa may become discolored either acciden- 
 tally or intentionally. In cases thus doubtful, the microscope, 
 discreetly applied, will facilitate diagnosis. The sputa derived 
 from this disease exhibit, under the microscope, the fragments of 
 pulmonary structure, elastic fibres, particles of the mucous mem- 
 brane, decayed epithelium, granulated cells, misformed pus cor- 
 puscles, black and other granules, and amorphous material. The 
 elastic fibres in gangrene of the lung are usually very short but 
 numerous, so much so as to occupy almost the whole field of the 
 microscope (Fig. 27, c). 
 
 5. Accidental Elements in the Sputa. 
 
 The class of accidental elements in the sputa is rather large 
 and diversified. It comprises all sorts of foreign bodies (fruit, 
 kernels, and stones); also calcareous concretions from obsolete 
 
MICROSCOPICAL DIAGNOSIS. 
 
 47 
 
 tubercles, of which we have seen some in the form of minute 
 corals. 
 
 In this category belongs the case of Bennet, who found in the 
 sputa, and subsequently in the caverns of a phthisical patient, an 
 alg (penicillum glaucum), (Froriep's Notizen, 1843, vol. xxxiii.) 
 Again, the case related in vol. civ., p. 160, of the same periodi- 
 cal, in which large quantities of red hair were expectorated, and 
 on post-mortem examination balls of the same material were 
 found in the lungs, some of the size of a hen's egg ; and finally, 
 the cases of echinococci in either sputa or lungs, whither they 
 had been carried with the matter of a hepatic abscess. These 
 cases are, however, so exceptional as not to employ our time here. 
 
 C. ESOPHAGUS, STOMACH, AND REGURGITATED MATERIAL. 
 
 In the vomited material epithelium, from the mouth, the oeso- 
 phagus, and the stomach, is a constant element. The epithelium 
 of the mouth has already been the subject of discussion. The 
 epithelium of the oesophagus is in general the same as that of 
 the mouth and pharynx, namely, a continuous pavement epi- 
 thelium, but it exceeds the latter by its thickness and number. 
 At the cardia the pavement epithelium terminates. 
 
 Besides epithelium in the vomited material, there are nume- 
 rous mucous corpuscles, fat-granules, and fat-drops, and in fine 
 the residues of aliments consumed, the latter being, of course, 
 the most bulky part. 
 
 We annex, by Figs. 31 to 35, the microscopical diagrams of 
 various articles of food, in order to avoid error. 
 
 Fig. 31. 
 
48 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 ®>: 
 
 
 
 Fig. 33. 
 
 Fig. 34. 
 
 1. Muscular fibres (Fig. 31, a, b, c) in a more or less 
 
 advanced state of digestive 
 change. 
 
 2. Starch granules of 
 rye (Fig. 32). Those of 
 wheat do not exhibit the 
 same variety of size, and 
 have rarely fissures or 
 impressions (hilus) like the 
 former. 
 
 3. Starch granules of barley (Fig. 33) may be easily recognised 
 by their — in most cases — distinct hilus, their oval and irregularly 
 angular form, and the angular form of their granulated contents. 
 
 The granules of barley are comparatively smaller than those 
 of either rye or wheat. 
 
 4. Starch granules of boiled potato (Fig. 35) may be easily 
 discriminated from those of graminea? and leguminosoe, by their 
 size, as the comparison will show. The starch granules of rye 
 and barley, and the others, are taken with a power of 450, those 
 of potato with only 250. 
 
 5. Starch granules of peas (Fig. 34), changeable in form, 
 often ribbed and fissured. The granules are scarce and very 
 small. Doubts as to the presence of starch granules may be 
 easily solved by the agency of iodine. 
 
 6. Cellulose and particles of vegetables, cellular and fibrous 
 tissue of meat, are generally so bulky as not to require micro- 
 scopic examination at all. If some particles should be doubtful, 
 the statement of the patient will suffice to reveal their origin. 
 
 As to the different kinds of vomited material, and their micro- 
 scopic discrimination, but few are of particular interest. 
 
MICROSCOPICAL DIAGNOSIS. 49 
 
 (1.) Pyrosis and Green Vomit 
 
 The term Pyrosis, in general, comprises all disorders of the 
 stomach, associated with sour or bitter vomit, with frequent 
 eructation from an empty stomach. These symptoms may be 
 of very different nature, but mostly originate in chronic gastritis. 
 The substance raised in Pyrosis is generally a serous, opalescent 
 liquid, of sour or alkaline reaction, containing, besides the various 
 elements of food, but epithelial cells, and mucous corpuscles in 
 abundance. The chemical reaction of the vomited fluid being 
 of therapeutical importance, can easily be ascertained by litmus- 
 and curcuma- paper. 
 
 The green vomit, symptomatically connected with some dis- 
 eases, such as peritonitis, presents no peculiarity in a microsco- 
 pical point of view, and its color is solely derived from the ad- 
 mixture of bile, as has been shown by chemistry. 
 
 (2.) Vomited Material in Cholera. 
 
 The material raised from the stomach in this malady has 
 great resemblance to thin rice water. It owes this peculiarly 
 characteristic appearance to a large number of cylindrical epi- 
 thelial cells, crowding together in flakes— readily perceived by 
 the naked eye — or isolated. Besides these, there are mucous 
 and exudation corpuscles, and numerous granules in the liquid. 
 The presence of these elements in cholera evacuation has led to 
 the supposition of an inflammatory process (Pirogoff and others). 
 Time and further investigation only can solve this question. 
 
 (3.) Brown and Black Emesis {Coffee- Ground-like Material) in 
 Cancerous Diseases of the Stomach. 
 
 There was a time in which vomit of a black-brown substance 
 was considered the most reliable sign of consummate cancer of 
 the stomach. Pathological anatomy has taught us, however, 
 that this symptom simply means extravasation of blood into 
 the stomach. We may therefore expect, and we do actually 
 observe, the like black material in hemorrhagic erosions, in 
 4 
 

 50 MICROSCOPICAL DIAGNOSIS. 
 
 simple ulcer of the gastric coats, in the higher grades of acute 
 gastritis, in epithelioma, in cancer, and so forth. The micro- 
 scope has revealed red blood corpuscles, either in normal or 
 somewhat wrinkled condition, especially when they have been 
 in the stomach for some time. The dark color depends in part 
 on pigment granules, either free or inclosed by the epithelial cells, 
 most probably the simple result of the presence of haematine. 
 
 The hemorrhagic erosion, as far as we know, gives to the 
 vomited material no other microscopical criterion ; but in ulcus 
 ventriculi we have twice observed pus corpuscles. In one 
 case the quantity of pus was so great as to form a thick layer 
 on the filter. We have repeatedly adverted to the great 
 resemblance of pus and mucous corpuscles ; we have further- 
 more stated that the latter are constant elements of vomited 
 material, and we may therefore again caution the observer. Pus 
 can only be diagnosed when the number of corpuscles is very 
 large, when they agglomerate, and when they are constantly 
 present in the vomited material independent of meals and time. 
 
 In cancer of the stomach we have not yet been so fortunate 
 in establishing any reliable microscopical character. It might 
 justly be supposed, that if a cancerous ulceration communicates 
 with the gastric cavity, the structural elements of the disease 
 would invariably present themselves under the microscope. 
 This may even occasionally be the case, thereby rendering the 
 diagnosis clear and conclusive. 
 
 But for various anatomico-physiological reasons this expecta- 
 tion is rather uncertain : firstly, because there is no specific cri- 
 terion of cancer. Large numbers of nucleated cells of great size 
 and variable form, in comparison with the fundamental struc- 
 ture of their source, may be admitted as pretty sure indications 
 of a cancerous disease. Single fragments of cancerous tissue 
 cannot be admitted as conclusive evidence of cancer. 
 
 Secondly : It appears, even admitted that from a few scattered 
 cancerous fragments, a general diagnosis of cancer might be 
 formed by exclusion, but a cancerous ulceration does not follow 
 unless the cancer cells appear en masse, because the disintegration 
 of the cancerous structure may be effected by a fatty degenera- 
 tion ,of isolated cells. 
 
MICROSCOPICAL DIAGNOSIS. 51 
 
 Thirdly : The surface of so-called cancerous ulceration is in- 
 variably -covered with a striatum of cells undergoing fatty 
 degeneration, and when in that condition they are so much like 
 ordinary epithelium of the stomach, that it seems quite impos- 
 sible to discriminate between the two. And yet those cells we 
 have chiefly to expect in the raised material. 
 
 In fine, it should be remarked, though not strictly belonging 
 to our subject, that neither emesis per se, nor the emesis of a 
 brown-black material is in any way pathognomonic of cancer of 
 the stomach, nor would its absence exclude that disease. For 
 both presence and absence of vomitus are dependent on the diet 
 and extent of the cancerous degeneration, the quality of the 
 thrown off material, and on the general condition of the gastric 
 coats. 
 
 (4.) Vomit of Fermenting Substances, 
 
 and the presence of Cryptococcus cerevisice, have no direct patholo- 
 gical importance. It may, however, be inferred, that there is 
 some obstruction on the Pylorus, delaying the evacuation of 
 the stomach into the duodenum, thus giving time to the gene- 
 ration of the ferment-alg. In chronic catarrh of the stomach 
 (Lehmann's Physiol. Chemistry), mucus seems to be susceptible 
 to fermentation and conversion into butyric, acetic, and lactic 
 acids. 
 
 Cryptococcus cerevisise generates spontaneously in some 
 liquids and bread, and numerous spores enter therefore the 
 stomach with food. Unless the stomach is in a morbid condi- 
 tion, and contains material highly susceptible to fermentation, 
 the spores pass out again without trace or molestation. Is the 
 stomach, however, deranged, the alg multiplies by budding 
 and dividing, and it both favors and causes gastric fermenta- 
 tion. 
 
 The ferment-alg consists of single oval spores, - 003-0-007 
 Mm. diameter, with nuclei refracting light strongly (Fig. 36). 
 The spores present ordinarily the form as illustrated above and 
 left in the diagram. Their nucleus is very like a fat granule, 
 
52 MICROSCOPICAL DIAGNOSIS. 
 
 sometimes, however, the nucleus is rather large and dark, but 
 j>© © (^©o rarely absent. The highest state of develop- 
 ed© % ment attainable by Cryptococcus cerevisise in 
 ® lMlk)®^J the stomach is, that a few cells join each other 
 c^ © J*^>& Q and put forward some buds, likewise repre- 
 ^G> sented in the illustration. The diagram indi- 
 Fig. 36. ca t es a ] so t ^ e history of those cells, one grow- 
 ing from the other, as can be observed in fermenting malt liquids 
 and bread. 
 
 Once initiated in the stomach, the ferment -alg becomes a very 
 obstinate customer, resisting almost all reagents that can possi- 
 bly be borne by that organ. The only remedy against it, and 
 well known by the populace, is whiskey, which chemically dis- 
 turbs the formation of Alcohol. 
 
 In those fermenting and ejected substances yet another vege- 
 table occurs ; namely : Sarcina ventriculi (Goodsir), Merispodia 
 ventriculi (Ch. Eobin). 
 
 This parasite, belonging most likely to the family of algae, 
 was discovered and first spoken of by John Goodsir ; it has since 
 been frequently observed and examined. Since the author, in 
 1850, published all that was then known with reference to Sarcina 
 ventriculi, we have not advanced one single step in our know- 
 ledge of this parasite, so that Simon has already mooted the ques- 
 tion, whether the Sarcina was not often a mere transitory form of 
 Cryptococcus cerevisiae. 
 
 The vegetable is of a firm consistence and transparent ; it is 
 
 found in cubic, prismatic, and irregular masses : of O05 or 0*02 
 
 C.Mm., and is commonly composed of from 8 to 16-64 and even 
 
 a @ c more (Edin. Med. and Surg. Journal, 1842, 
 
 sJa II) H) P- 438) cubically shaped cells with rounded 
 
 a t s- angles and cruciated, each of O008 Cub. 
 
 Wm bsaJea £§§ §g3 Mm. in size. They are held together by a 
 
 jg sort of hyaline substance ; sometimes, how- 
 83 ^ ^#>t§ ever ' n0 intercellular material can be dis- 
 
 ss© °°° J& cerned. Most of those cells contain but one 
 
 o f* nucleus, being 0*003 Mm. in diameter, of 
 
 Fig. 37. rusty-brown color, which under the micro- 
 
 scope gi ves the whole a yellowish hue. 
 
MICROSCOPICAL DIAGNOSIS. 53 
 
 Sarcina occurs in all the diversified forms as represented in 
 Fig. 37, b-f, and rarely smaller, and more frequently larger. 
 The diagram has been copied from G. Simon's essay, " Ueber 
 die Entwicklung der Sarcina aus dem Hefenpilz." 
 
 Fig. 37, a, shows the common Cryptococcus cerevisiae, with 
 one, two, or even with four nuclei. In the rudimentary cells, 
 the division of the nuclei has been but imperfectly accomplished ; 
 in 37, &, the nucleus appears subdivided in four and eight ; it has 
 lost its round form and become cubical. Each nucleus in swell- 
 ing suffers at the same time constrictions, whereby the cubic cell 
 assumes a sort of dumb-bell shape- 
 Fig. 37, c. The nucleus again parts in eight new nuclei (c7), 
 which undergo the same process (b and/). The first cell gives 
 therefore rise to four or eight, the second stage of development 
 thirty-two to forty-six, and the third to 256-512 nuclei. 
 
 The same membrane, growing by this process thinner, at last 
 bursts (g) and the daughter cells are thereby separated. It is 
 easily perceived that this is a process of Sporotrych-develop- 
 ment (Kiitzing). 
 
 Sarcina (merismopsedia) is by far more frequent than is gene- 
 rally believed ; but it has but once been observed (by Wedl) with- 
 out the animal body. It is observed in men and mammalia, and 
 chiefly in the intestinal tract. Yirchow once met with it in a 
 fresh stomach, and once in a vomica or in a pulmonary cavern, 
 Keller in urine, and other observers in faeces. According to our 
 experience in four cases we have found Sarcina in faeces, after 
 having observed it previously in vomitus. In a fifth case the 
 faeces were not examined. 
 
 (5.) Fat in Vomit. 
 
 As has been already stated, fat is a common constituent of 
 vomited material. It is of course more copious after rich meals. 
 Cases are, however, recorded, as for instance that of Dr. Konig, in 
 whicli the patient abstained from all fatty articles of food and yet 
 vomited large quantities of oleaginous substances. The patient 
 referred to by Dr. Konig suffered from (cancerous ?) ulceration of 
 the stomach. His food was but milk. Early in 1851 he regurgi- 
 
54 MICROSCOPICAL DIAGNOSIS. 
 
 tated copious quantities of chocolate-colored material, the surface 
 of which presented a glossy appearance like dish-water or weak 
 beef-tea. Later, the vomited material was entirely covered with 
 a layer of yellow fat, which on cooling hardened like tallow. 
 This symptom was frequently accompanied by a rancid taste 
 and a burning sensation along the throat. No chemical or 
 microscopical examination was made. 
 
 The like cases are exceedingly interesting as to the effects of 
 gastric juice, and we have adverted to them in order to excite 
 attention and further inquiry. 
 
 (6.) Accidental Substances in Vomit. 
 
 The most miscellaneous substances have been found in vomit, 
 such as the larvae of insects and intestinal worms, having passed 
 either through the mouth or from the intestinal tract to the 
 stomach, hair-concrements, etc. We cannot, however, enter 
 upon a description of the like substances, being too diversified 
 and too foreign to our subject. 
 
 This, however, should not deter from their most careful 
 examination, as some most valuable discoveries may result there- 
 from. Fasces, in connexion with obstructions of the intestinal 
 canal, will casually give rise to these appearances in vomit, but 
 they are readily recognised. 
 
 D. DISCHARGES PER ANTJM, F^CES. 
 
 The fasces ordinarily consist of : 
 
 (a.) Decaying epithelium from all parts of the intestinal tract. 
 
 (b.) The indigestible residues of food. 
 
 (c.) Excretions of all those glands belonging or annexed to the 
 alimentary canal ; they are either liquid and intimately mixed 
 with the other constituents, or they supply the coloring matter 
 of the fasces, and are either amorphous or in a crystalline form. 
 
 It is therefore obvious that countless microscopical elements 
 should be found in fasces. There is scarcely a better microscopical 
 exercise than their examination, but their miscellaneous compo- 
 sition is equally prone to mistake and error. The only practical 
 
MICROSCOPICAL DIAGNOSIS. 55 
 
 purpose for which, faeces have hitherto been examined, was to 
 ascertain the presence of entozoa in the alimentary canal. There 
 are, however, still other investigations proposed and carried on of 
 sufficiently great importance to demand our close attention. 
 
 In certain forms of chronic diarrhoea, for instance, when there 
 is suspicion of ulceration of the mucous membrane, we have to 
 direct our investigation upon 
 
 (1.) Pus in Fazces. 
 
 In large quantities of faeces it is obviously difficult to find 
 and to discern pus. Numerous mucous corpuscles are produced 
 upon the mucous membrane of the alimentary canal ; and in still 
 larger number, if any irritation is going on. This circumstance 
 renders the diagnosis of pus corpuscles exceedingly precarious 
 and unreliable, and even more so than in vomit. The pus 
 corpuscles should be sought for in the viscid mucus which often 
 covers faeces, or in such parts, which differ from the rest of the 
 faeces by their respective appearance. It is, moreover, obvious, 
 that repeated examinations should be instituted before inferences 
 can be drawn. As in other secretions, the number alone is the 
 basis of our diagnosis of pus corpuscles. 
 
 We have twice succeeded in proving pus mixed with the 
 faeces. In one case it was derived from tuberculous ulcerations 
 of the small intestine, in the other from coloproctitis. At different 
 times, however, we have failed in perceiving pus corpuscles, when 
 the post-mortem examination disclosed such lesions that pus 
 could not have been absent. An established method for examin- 
 ing upon pus does not exist. 
 
 (2.) Blood in Fceces. 
 
 In so-called Melaena, red cholera discharges, and in Dysentery, 
 the blood can be easily discerned by the naked eye, and in most 
 cases the microscope is hardly required ; for the red blood-cor- 
 puscles are very numerous. Despite the great changes they 
 undergo through the contact with fecal matter, they retain their 
 characteristics in a certain measure, so as to be easily recognised. 
 
 There are, however, circumstances, in which it is desirable 
 
56 MICROSCOPICAL DIAGNOSIS. 
 
 that their presence or absence should be positively ascertained. 
 Thus it is known that the use of Calomel gives to the stools a 
 green color, although the cause of this peculiar action of Calomel 
 has not yet been disclosed ; still, this much we know, that blood 
 has no part in it. Some say that a sulphuret of quicksilver is 
 formed, which endows the faeces with the green color. Dr. 
 Alfred Vogel is, however, of the opinion, that the Cholepyrrhine 
 in contact with Calomel oxydizes into biliverdine, which is said 
 to be the identical coloring matter of Calomel-stools, whilst the 
 formation of Quicksilver-sulphide could only be supposed if 
 Calomel was administered in large doses. 
 
 Other green alvine evacuations may derive their color from the 
 superabundance of bile (Polycholy) provided the secretion of bile 
 does not go beyond the formation of biliverdine (Lehmann, vol. ii. 
 page 118). "Whereas in Typhus, D} r sentery, and some other intes- 
 tinal lesions, the green color of the stools is evidently connected 
 with the presence of small quantities of blood, and its micro- 
 scopical recognition lends us an important insight into the con- 
 dition of mucous membrane. 
 
 In other cases black or red fasces excite the apprehension of 
 the patient. The fasces turn black from the use of iron, conse- 
 quent upon its combination with sulphur. Indigo colors the 
 stools green ; Rhubarb, Gummisguttas, and Crocus give them a 
 high yellow color. Some articles of food exercise also a certain 
 influence upon the color of faeces ; as, for instance, the black- 
 berry, etc. These accidental influences upon the coloration of 
 faeces may be easily ascertained, so far as the agency of blood 
 corpuscles is excluded. 
 
 (3.) Gelatinous, Mucous, and Rice Bodies 
 
 Occur sometimes in alvine evacuations. Both are secreted by the 
 follicles of the large intestine, and they characterize themselves by 
 the presence of small, round or oval, pale and granulated cells, 
 besides numerous isolated granules, imbedded in the amorphous 
 mucus. The microscopical discrimination of these elements from 
 ingesta may have some interest and value in the treatment of 
 infants. 
 
MICROSCOPICAL DIAGNOSIS. 57 
 
 4. Pseudo-membranes, Exudations, Scabs from Typhus and Tuber- 
 culous Ulcerations of Follicles, and Fragments of the various 
 Structures of Intestines. 
 
 The products of inflammation and intussusceptions are gene- 
 rally discernible by the naked eye ; but even if this should be 
 the case, the microscopical examination should not be neglected, 
 for experience teaches us that the eye is not always to be relied 
 upon in such things. Moreover, confusion is possible. 
 
 The fragments of typhus-scabs characterize themselves by 
 densely grouped molecules, derived from decaying cells and 
 nuclei, besides crystals of phosphate of ammonia-magnesia ; the 
 discharges in Dysentery by blood and pus-corpuscles either iso- 
 lated or connected in membranes by a coagulable material. 
 
 (5.) Changes which Certain Articles of Food Sustain by the Digestive 
 Process. 
 
 The public is readily disposed to take everything that passes 
 the anus for intestinal worm, which presents an unusual appear- 
 ance ; and we have received many objects, for examination, 
 which had been sent with this view. In two cases we found 
 fragments of linen imbedded in mucus and faeces. Mere wash- 
 ing revealed their nature. A pretty thick linen-thread, cut in 
 inch-long pieces, had been swallowed by a child, and passed off 
 in three or four days. The frightened parent was, however, 
 comforted by our showing the fibrillre of the thread. 
 
 In another case cellular tissue was the cause of alarm, which 
 was, of course, at once recognised by the microscope. Again 
 the same element, derived from meat balls, was presented to us. 
 In another instance a number of small, white, equally wide 
 pieces were handed us, which by appearance looked as much like 
 tapeworm as could be imagined. The magnifying glass, how- 
 ever, sufficed to destroy the supposition, and the microscope dis- 
 closed the true nature of lichen islandicus. In one case, Prof. 
 Buhl observed mucus to have undergone such changes as almost 
 to simulate tapeworm. But these exemplifications will suffice. 
 
58 MICROSCOPICAL DIAGNOSIS. 
 
 To such delusions we can hardly count the case of Prof. Huss, 
 who observed for a period the discharge of fibres, which proved 
 to be adipose tissue, very like that of lipomas. We doubt 
 whether these elements had been introduced from without, and, 
 indeed, if they were, we should be unable to account for their 
 true nature. Perhaps they originated in a lipoma of the intes- 
 tinal canal, disintegrating and passing off in fragments. 
 
 6. Entozoa. 
 
 The entozoa hitherto found in the alimentary apparatus of 
 men, consist, as far as we know, of the following : 
 
 1. Nematodes : Trichocephalus dispar, Oxyuris vermicularis, 
 Ascaris lumbricoides and alata (?) and Ancylostomum duodenale. 
 
 2. Trematodes : Distomum heterophyes. Pentastomum con- 
 strictum. 
 
 3. Cestodes : Taenia solium, nana and mediocanalata, finally 
 Botryocephalus latus. 
 
 Of these, Trichocephalus dispar, Oxyuris vermicularis, Ascaris 
 lumbricoides, Taenia solium, and Botryocephalus latus occur in 
 Sweden. 
 
 Trichocephalus dispar has been but rarely observed. The 
 case related by Valleix, in which the ccecum was found to be 
 filled with this species, offers no particular diagnostic interest. 
 
 Oxyuris is frequently noticeable in alvine discharges ; at times 
 it escapes spontaneously from the rectum, and is then found on 
 the bedsheets. Ascaris lumbricoides, Taenia solium, and Botryo- 
 cephalus latus usually pass, either entire or in part, with the 
 alvine discharges, and in such cases there is no difficulty about 
 the diagnosis. But in cases where symptoms only exist, which 
 indicate the presence of Entozoa, without their discharge, the 
 microscope only can solve the doubt. 
 
 The Entozoa appear to be constantly generating and discharg- 
 ing ova and even those which are pregnant are covered with 
 them. Thus the ova in the faeces are positive evidence of the 
 presence of Entozoa. The attendant should therefore administer 
 a drastic purgative, and submit the excrements to microscopical 
 examination. The ova are usually found in the mucus, which 
 
MICROSCOPICAL IJIAGNOSIS. 
 
 59 
 
 should be examined by a power of 150 in order to obtain a suf- 
 ficiently large optical field. Having discovered an object resem- 
 bling an ovum a higher power (300 and upwards) is re- 
 quired to examine its structure and thereby to determine 
 its species. The annexed diagrams were drawn on 
 a scale of 320. Fig. 38 represents the ovum of Tri- 
 cocephalus dispar, 0*040 by 0*020 Mm. in size. It is fig. 38. 
 characterized by a distinct cylindrical termination at each end, 
 while its transparent membranes and the dark granular contents 
 are like those in the ova of other species of Entozoa. 
 
 Fig. 39. The ovum of Oxyuris, larger than the former, about 
 0*056 by 0*030 Mm., of oval form without cylindrical termination. 
 
 Fig. 40. Ova of Ascaris lumbricoides from an ovary, 0*056 
 by 0*050 Mm.; coats very thick, vitreous, and covered with 
 spines. Other ova are without them, as shown in Figs. 41, 42, 
 the latter of which predominate in the fasces. They all have 
 thick shells. 
 
 Fig. 39. 
 
 Fig. 40. 
 
 Fig. 41. 
 
 Fig. 43. 
 
 Fig. 44. 
 
 Fig. 43. Ova of Botryocephalus latus, 0*050 by 0*040 Mm. 
 The membranes extremely thin and fine ; for the rest like ascaris 
 ova. 
 
 Fig. 44. Ovum of Taenia cueumerina. We have taken and 
 drawn this ovum from an individual which had passed from a 
 child. 
 
 Fig. 45. Ova of Taenia solium, almost circular, of 0*033 
 Mm. in diameter. The membrane, upon the application of a low 
 power and false focus, shows parallel lines which cross each other 
 at right angles; with considerably increased power 
 we notice that the exterior coat consists of hexagonal 
 parallel plates with dark spots in the centre. In most 
 of them we found embryonic hooks. The presence and Fig. 45. 
 the general structure of the ovum are sufficient for the practical 
 purposes of diagnosis. 
 
60 MICKOSCOPJCAL DIAGNOSIS. 
 
 Figs. 46, 47. Ovum of Taenia solium, according to "Wedl. 
 
 Fig. 46. 
 
 Fig. 47. 
 
 Fig. 48. 
 
 Fig. 48. Ovum of Taenia lata from an ovary, by Dr. Lorenz 
 Tutschek. 
 
 The majority of the diagrams are taken from specimens in the 
 excellent collection of Dr. Hoks, to whose liberality we are 
 greatly indebted. 
 
 The vitellus of these ova is various in form, which, however, 
 depends on the stages of their respective development, and, 
 therefore, presents no particular characteristics. The Author 
 assumes that the development of the vitellus is the same in the 
 ova of the different Entozoa species. 
 
 The microscopical recognition of the ova of Entozoa is of no 
 special difficulty. On the one hand they have acutely shaped 
 and very firm coats ; they are elastically resistant and therefore 
 compressible, so as to be almost indestructible ; nor are they 
 affected by iodine or diluted acids. 
 
 (7.) Infusoria of the Intestinal Canal. 
 
 Prof. Malmsten of Stockholm found in two cases of chronic 
 diarrhoea a peculiar species of infusoria which he has called 
 Paramaecium coli, and described in the Hygiea, 1857, page 491, 
 and in Yirchow's Archiv, 1857, Numbers 2, 3, page 302. In 
 both cases they occurred in great numbers and existed indepen- 
 dent of any ulceration of the mucous membrane, and were for 
 months observed in the passages. In the other case they were 
 even found after death throughout the large intestine, but none 
 in the small. The Infusorium is of oval form, 0100 Mm. in 
 length, its exterior membrane is covered with ciliae and interiorly 
 provided with a nucleus. In addition to these we notice con- 
 tractile vesicles of fragments of food, apparently, and fat gra- 
 
MICROSCOPICAL DIAGNOSIS. 61 
 
 nules. Malmsten is of opinion that this species of Infusoria and 
 their immense number (20 to 25 in a fragment of mucus) are 
 well calculated by their restless activity to cause increased peri- 
 staltic motion and intestinal secretion, and consequently diar- 
 rhoea. That they have not been noticed more frequently before, 
 is probably no evidence of their rare occurrence, but owing to 
 their rapid decay after they leave the rectum. 
 
 It is therefore a material condition in respect to microscopical 
 examination that the faeces should be submitted to it without 
 delay ; unless — and this is preferable — mucus from the rectum 
 be taken. 
 
 (8.) Fat in Fceces. 
 
 Fat is met with in all faeces. It shows itself microscopically 
 as granules, drops, cholesterine and margarine crystals. In cases 
 in which the liver or pancreas perform their functions insuf- 
 ficiently, the quantity of fatty accumulation in the fasces is so great 
 that it may be readily discerned with the naked eye. It may 
 then be found in drops or larger masses, assuming when cooled 
 the consistence of butter or tallow. 
 
 (9.) Accidental Components of Faeces. 
 
 The accidental components of faeces may be of various kinds ; 
 most usually they are, however, undigested substances, although 
 larvae of insects are often met with by the observer. 
 
 Often they may have accidentally joined with the faeces, but 
 not rarely they pass with the food into the alimentary canal. 
 To our knowledge no insect has yet been discovered as indige- 
 nous to the intestinal canal ; a close examination of the larvae 
 would, however, be advisable. Among other accidental compo- 
 nents we may name the concretions of the intestinal canal. 
 They are partly formed therein — Holm's anatomical museum 
 possessing a fine specimen of them — and partly they originate 
 in the glands, adjacent to the intestinal canal. Those most fre- 
 quently met with come from the gall-bladder, but on account of 
 their size they are not of microscopical importance. 
 
62 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 E. THE UROGENITAL ORGANS. 
 
 The secretions of these organs in both sexes are discharged 
 through the same excretory ducts ; they are consequently more 
 or less intimately mixed. For the purpose of greater distinct- 
 ness, we shall consider them in different groups. 
 
 (1.) Organized Substances derived from the Urinary Bladder and 
 the Kidneys. 
 
 Assuming an accurate histological knowledge of these organs 
 on the part of the reader, we may, nevertheless, be permitted to 
 call special attention to certain points highly important for the 
 correctness and completeness of microscopical diagnosis. 
 
 The curved uriniferous tubules of the cortical substance 
 
 possess an approxi- 
 mate diameter of 0*010 
 Mm., and are lined 
 with either oval- pave- 
 ment- (Fig. 49, a a) 
 or circular- and poly- 
 gonal- epithelium, the 
 cells of which measure 
 Fl »- 49 - from 0-003 to 0-006 
 
 Mm. in diameter. At the basis of Ferrein's pyramids the uri- 
 niferous tubules are lessened in size (0*004 Mm.), in which, of 
 course, the epithelium participates (0*001 to 0*002 Mm.) ; but in 
 the pyramids they rapidly increase in diameter, so as to measure 
 in the middle 0*020 Mm., and close to the papillae as much as 
 0*030 Mm. The epithelium continues, however, to be flat and 
 small. 
 
 From the measure of the curved uriniferous tubules that of 
 the epithelial lining should be deducted, so that their actual 
 lumen does not exceed 0*005 to 0*003 Mm. 
 
 The renal pelvis, calices, and ureters present three layers of 
 epithelial cells. The most external consists of pavement-formed 
 polygonal (Fig. 49, b) or circular (Fig. 49 d) ; the middle one of 
 cylindrical (Fig. 49, c), being sometimes endowed with stellated 
 
MICROSCOPICAL DIAGNOSIS. 63 
 
 points, the innermost of oval or globular epithelium (Fig. 49, e), 
 all of them with one, rarely with two, eccentric nuclei, and 
 large granules of nearly half the size of the latter. 
 
 The epithelium of the bladder shows pretty much the same 
 arrangement as the renal pelvis, with the difference, however, 
 that the granules do not acquire the same size. 
 
 The short female urethra is lined with the same epithelium as 
 the urinary bladder, while in the male urethra it is chiefly cylin- 
 drical, with a subjacent layer of round and oval cells. 
 
 Uterus, nymphae, and the large labia are endowed with ciliated 
 epithelium, approaching the form of epidermal cells the more it 
 advances towards the rima pudendi. 
 
 Of all the forms of epithelium the urine may exhibit speci- 
 mens, but with the exception of menstruation and lochial dis- 
 charges they are not its normal constituents. Wherever they 
 are found they indicate morbid conditions, or at least an unusual 
 irritation of the organs from which the epithelium is derived. 
 
 For whatever microscopical elements the urine is to be exa- 
 mined, it should be done soon after its passage, and again 
 twenty-four hours later. To postpone the examination to a 
 still later period is not practicable, as an ammoniacal urine would 
 dissolve or destroy the organic constituents which are produced 
 in renal catarrh. Meanwhile, the urine should be kept in a cool 
 place, of 10° to 15° C, in an inverted cone-shaped vessel (cham- 
 pagne glass, funnel, or the like), so that the epithelium as it 
 settles may be more easily collected. A drop of this is then put 
 on the objective glass, and is first examined with a power of 150, 
 which is afterwards increased. It is scarcely necessary to go 
 beyond 450, — 350 being mostly sufficient. 
 
 Besides the forms of dust, just spoken of, various others are 
 met with in urine, and we therefore annex diagrams of several 
 of these foreign particles, which, unless properly recognised, 
 may induce error. Fig. 50, sheep's wool from felt ; Figs. 51, 
 
 52, cat's hair (51, the fine ends; 52, the thicker part); Fig. 
 
 53, bed feather ; Fig. 54, pine wood splinter from a floor. 
 
 The affections of the urinary organs, which cause separation 
 of epithelium, and thus furnish objects for microscopical obser- 
 vation, are 
 
64 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 Pig. 50. 
 
 Fig. 51. Fig. 52. Fig. 53. 
 
 Fig. 54. 
 
 (a.) Urethral and Vesical Catarrh. 
 
 In both of these disorders we find separation of the epi- 
 thelium from their beginning and later formation of pus corpus- 
 cles. The epithelium often occurs in considerable quantity ; the 
 large pavement epithelium, as well as the subjacent, cylindrical 
 and oval, from the bladder, and the cylindrical from the (male) 
 urethra. Mixed with it, we find numerous exudation- and 
 mucus- corpuscles, and an enormous quantity of large and small 
 granules. In an advanced stage, when the catarrh has so widely 
 spread as to affect, for instance, the entire bladder or the whole 
 urethra, or any distinctly circumscribed portions of either of 
 them, the epithelium rarely occurs of normal form ; but in its 
 place we find newly formed oval, neoplastic epithelial cells 
 (mucous-corpuscles) which are imbedded in the tough, viscid 
 mucus, peculiar to chronic urethritis or cystitis. 
 
 In this stage, particularly, we come across pus (although at 
 times it may be found much earlier), and sometimes in such 
 abundance that it soon decomposes and thickens the urine, and 
 even now and then produces an alkaline fermentation prior to 
 its discharge. In catarrh of this character, blood is sometimes 
 exosmosed, and the urine with or without such admixture of 
 blood is slightly albuminous. 
 
 (b.) Catarrh of the Uriniferous Tubules and u Bright 1 s Disease. 11 
 
 "We have placed the acute as well as the chronic catarrh of 
 the uriniferous tubules in the same category with Bright's dis- 
 
MICROSCOPICAL DIAGNOSIS. 65 
 
 ease, not that like some other authors who have preceded us, we 
 assume as certain that the latter affection is but the consequence 
 of the former, nor that we think they are identical, but because 
 the microscopic elements which we recognise, when found in 
 urine, as pathognomonic of these affections of the kidneys, may 
 be more easily compared in their characteristics, and better com- 
 prehended when placed alongside of each other. 
 
 We believe with Johnson, and for good pathologico-anato- 
 mical reasons, that the definition of Bright's disease requires 
 narrower limitation, and we have, therefore, followed his precept 
 in the enumeration of the microscopical elements appertaining 
 to different renal diseases. 
 
 In acute, more rarely in chronic Catarrh, in cases of Nephritis 
 and Cancer, extravasation of blood occurs in the uriniferous 
 tubules. It is obvious in what way the extravasated blood 
 can fill the uriniferous tubules, how it coagulates, and how it 
 forms thrombi and obstructions there. In a case of Hsematuria 
 we found the clot represented by Fig. 55, besides others com- 
 posed of blood and fibrin ; Johnson also mentions similar 
 observations. The patient, who was under treatment at 
 the Seraphinian Hospital, recovered, and we cannot, there- 
 fore, more closely determine the diagnosis by Autopsy, 
 though it will probably have to be designated acute 
 desquamative Nephritis. (Johnson.) 
 
 Aside from the bloody coagulation, this case presented 
 numerous epithelial coagula (Fig. 56), and epithelial cells FlG - 55 - 
 from the uriniferous tubules, and a goodly portion 
 of albumen. These are the microscopical elements 
 which characterize acute catarrh of the uriniferous 
 tubules (for so we shall have to entitle the disorder), 
 and they agree, mutatis mutandis, with what has 
 been said of the components of sputum in acute 
 Bronchitis. 
 
 Many writers (FrericJis among others) consider 
 these the characteristics of the acute form of Bright's 
 disease. 
 
 When Bright's disease assumes a chronic character, the urine 
 shows, besides a constant lower specific gravity and albumen, 
 5 
 
66 MICROSCOPICAL DIAGNOSIS. 
 
 the presence of tubular casts,* which present themselves in 
 various forms, totally different from those we have just de- 
 scribed. 
 
 Figs. 57, 58, are formations which frequently occur. They 
 somewhat resemble in point of width the curved uriniferous 
 tubules after their epithelial lining. has been cast off. They are 
 partly dark and granular, as in Fig. 57, partly 
 clear and wrinkled, as in Fig. 58. In the 
 former case Johnson calls them granulated 
 epithelial cylinders, and considers them to be 
 a coagulation of fibrine from the uriniferous 
 tubules, which, in coming away, have carried 
 with them the last remnants of the epithelial 
 lining. In the other case he calls them large 
 Fig. 58. waX y cylinders, and looks upon them as 
 coagulation of fibrine from the tubules previously deprived of their 
 epithelium. In both cases they belong to his " chronic desqua- 
 mative Nephritis," and correspond with what may otherwise be 
 called chronic Catarrh. In the cases described, the albumen, 
 according to Johnson, is wanting in the urine. The only remain- 
 ing microscopical element found in it is an abundance of amor- 
 phous granules being perhaps decayed epithelium from the renal 
 passages. We have never seen these coagulations under such 
 circumstances, but very often in Bright's disease, and from a case 
 of it we have drawn the diagrams. 
 
 Johnson also mentions a smaller species of waxy cylinders, 
 which we have copied from him under Fig. 59, and of which he 
 says that they come from the uriniferous tubules which have 
 as yet retained their epithelium. For our part we have never 
 seen any of them. 
 
 * The Swedish original, in speaking of these formations, uses the term Afgjutningar, 
 literally : that which is cast off. J. Vogel (Analysis of the Urine by Dr. C. Neubauer 
 and Dr. J. Vogel, 2nd edition, 1856, page 214-216) distinguishes, after Lehmann, 
 between three principal classes : 1. Epithelial tubes composed of epithelium from 
 the Belliuian tubules ; 2. Granulated renal cylinders, solid, of finely granulated 
 structure, comprising severally single epithelial cells, frequently blood- and pus- 
 corpuscles, and various forms of crystals ; and 3 . hyaline renal cylinders (Johnson's 
 waxy cylinders), also solid, but extremely pale and not readily discernible unless 
 colored by iodine. (Tutschek.) 
 
MICROSCOPICAL DIAGNOSIS. 
 
 07 
 
 Fig. 60 represents a form of tubular cylinders, which seems 
 always to occur, in greater or 
 less completeness, in Bright's m 
 disease. It resembles that ob- 
 served in ordinary Catarrh, 
 but varies from it, that it con- 
 tains fat granules and fat drops, 
 and that the epithelium, which 
 adheres to it, contains fat. 
 
 We even find such epithe- p ia 59 . 
 Hum, though rarely, in a disconnected state in the urine. In 
 other cases we have observed similar, but less granulated, thinner 
 and clearer cylinders. Owing to their thinness and transparency 
 they are often overlooked ; but they are of great importance as, 
 in our own experience, they seem to indicate an early state of 
 the disease. (Fig. 61.) 
 
 In all the last-named forms of tubular cylinder fat is found. 
 It is therefore not to be wondered at, if in fatty kidneys we also 
 meet With 
 
 Fig. 60 
 
 (c.) Fat in Urine, Galacturia, 
 
 which we sometimes find mentioned, although chemically and 
 microscopically examined cases are rarely recorded. Such have 
 been observed, however, by Christison, Bayer, Lehmann, and 
 Isaacs. Bence Jones gives (in Med.-Chir. Transactions, 1850, 
 xxxiii.) a masterly description of a case of Galacturia. Smaller 
 quantities of fat in the urine in some diseases (Icterus, pulmonary 
 cancer, etc.) have been observed, which result in rapid attenuation ; 
 or after the administration of oleaginous remedies and. s. f. The 
 causes of this phenomenon are, however, as yet not even remotely 
 ascertained. Small fat-drops are not uncommon in the urine of 
 women, but they undoubtedly are derived from the sebaceous 
 follicles of the great labia. Sometimes the fat may have been 
 introduced with the catheter, or in a similar manner, and cases 
 are related in which patients had added milk to the urine to 
 misguide. In former years a fatty membrane was described, as 
 covering the surface of the urine ; and Nauche once attached 
 much importance to the so-called kyestine in the urine of preg- 
 
68 MICROSCOPICAL DIAGNOSIS. 
 
 nant women. But it seems as if foreign particles, dust, alg- 
 fibrillae, and crystals of phosphates are the constituents of either, 
 but no fat. "Whenever there is fat in urine, the microscope will 
 promptly disclose its presence ; but before it is accepted as a 
 morbid constituent of urine, all practicable precaution should be 
 used, so as to preclude the possibility of mistake. And, at any 
 rate, the physician should be present and see the passage of the 
 urine himself which he intends to use as test. 
 
 As a peculiar affection of the kidneys, different from those 
 already discussed, Johnson describes an inflammation in which 
 the products, without detachment of epithelium, are rapidly con- 
 verted into pus. He terms that disease 
 
 (d.) Nephritis suppurativa, 
 
 corresponding with acute Nephritis of other authors. The urine 
 contains, in such instances, free pus in abundance and purulent 
 tuberculous fragments. 
 
 We have observed such a case, complicated with Icterus, in 
 the practice of Prof. Malmsten. The number of pus-corpuscles 
 was not particularly large, but there were many frag- 
 mentary coagula, both being yellow from the coloring 
 matter of bile (Fig. 62 is copied from this case). 
 
 In diseases of the kidneys the microscope is the most 
 important diagnostic auxiliar}-, and by no other means 
 can we so accurately determine the nature, seat, and 
 extent of renal affections. In fact the microscope 
 often alone reveals the actual condition of the organs. 
 In all the renal diseases before discussed, we had to deal with 
 either the ordinary elements of the organs or the ordinary 
 inflammatory products both in the progressive and regressive 
 stage. There are, however, two forms of renal degeneration, for 
 which, likewise, the microscope is of great importance, namely, 
 
 (e.) Cancer and Tuberculosis. 
 
 The former manifests itself by frequent admixture of blood 
 with the urine, which of itself is, however, no characteristic of 
 
MICROSCOPICAL DIAGNOSIS. 69 
 
 malignant disease. But in both the possibility exists of small 
 fragments of the cancerous or tuberculous structure being found 
 in urine, more especially when the respective diseases have 
 advanced to the Malpighian pyramids or the renal pelvis. 
 
 In the absence of specific characteristics, both of cancerous and 
 tuberculous matter, the microscope alone cannot be relied upon 
 for diagnosis ; though its aid will prove of value even in these 
 instances. Observations on this point are rather scanty, and even 
 at that they are not reliable, and we have no experience of our 
 own. Possibly all that appertains to cancer of the stomach is 
 equally applicable to the same disease of the kidneys.* 
 
 (2.) Accidental Organic Elements in the Urine. 
 
 This class comprises Entozoa, Entophytes, and especially 
 
 (a.) Echinococcus hominis. 
 
 A case in which this parasite has been found in the urine 
 Frerichs has reported, f 
 
 * Dr. Lampl (Prager Vierteljahrschrift, xiii., 1856) has published seven cases of 
 cancer of the urinary bladder with the results of his careful and detailed microsco- 
 pical examinations. Prof. Wagner, in referring to them (s. Schmidt's Jahrbiicher, 
 vol. 92, page 40), justly doubts the reliability of conclusions based upon the micro- 
 scopical elements of urine, in as far as the diagnosis of cancer is concerned. In fact 
 he admits the same axiom laid down by our author when discussing the micro- 
 scopical diagnosis of gastric cancer, namely, that only the fragments of the carcino- 
 matous mucous membrane give any certainty to diagnosis. 
 
 Something similar may have occurred in cases of epithelioma and polypus of the 
 urinary bladder, related by Dr. von Dueben (since the publication of this essay), in 
 which he succeeded in diagnosing those affections by the microscope. Accord- 
 ing to Julius Vogel (1. c. page 213) the cancerous mass usually forms clusters or 
 aggregations of cells (parent and daughter cells) with their cell-walls caudated, and 
 spindle-formed elongated cells. 
 
 Tubercular mass, presenting itself to the naked eye as pus, consists, as the same 
 author states, of irregular pus-corpuscles, besides an indefinite detritus, fragments 
 of cells, incompletely developed nuclei and granule, and indefinite finely granulated 
 substance, occasionally comprising fragments of cholestearine-crystals. 
 
 f Medico-Chirurgical Review, 1842. Kingdon's case belongs likewise to this cate- 
 gory, in which ascaris lumbricoides passed with the urine, being in more than one 
 point of great interest. A boy seven years of age had swallowed a darning needle ; 
 it stuck in the vermiform process, causing inflammation and subsequent adhesion 
 
70 MICROSCOPICAL DIAGNOSIS. 
 
 The Echinococcus characterizes itself by its gelatinous vesicle, 
 swimming about in the urine, and its hook may be even then 
 recognised when it has suffered some changes. The like cases 
 have been observed by Creplin (Mueller's Archiv, 1840, page 
 149), by Fiane (Compt-Rend. Societe Biolog. ii. page 8), and by 
 Barker (Med. Times and Gazette, 1855, page 63). In the last 
 case, examined by John Quekett, 150 vesicles passed with the 
 urine. The patient in question, had chiefly relied on pork and 
 sheep's brain as articles of food. 
 
 (b.) Strongylus gigas. 
 
 This Entozoon, though but seldom found on the human body, 
 has now and then been observed, and should therefore be men- 
 tioned here. 
 
 (c.) Spiroptera hominis 
 
 has twice been found in urine, namely, once by Barnett of Lon- 
 don, and at another time by Brighton of New York. The exa- 
 mination in either case was imperfect however. 
 
 (d.) Infusoria. 
 
 Besides the species of Trichomonas vaginalis, Fig. 63,* first 
 observed by Donne in the vaginal secretion, there are many 
 infusoria generating in the vagina, under the favorable influence 
 of warmth and moisture, which mix with the urine. It does 
 
 with the urinary bladder. Having perforated both and entered the latter it became 
 thus the nucleus for a calculus. Through this passage several ascarides entered the 
 bladder and were discharged with the urine. 
 
 * Trich. vag. has an oval, pear-shaped, slightly ciliated body, of - 008 Mm. 
 diameter, with double filiform appendages (tails) ; its movements are very rapid. 
 Scanzoni and Kolliker have observed this infusorium species in great numbers, and 
 in the different forms of Blennorrhcea, but never in the secretion of the womb. 
 When the mucous membrane of the vagina is in a state of perfect health, Trich. 
 vag. is not met with. It follows, therefore, that this animalcule depends on morbid 
 secretion, which needs not necessarily to be of specific character. 
 
MICROSCOPICAL DIAGNOSIS. 71 
 
 not seem, however, that they possess any pathological im- 
 portance, and therefore do not call for any par- 
 ticular notice from us.* 
 
 In urine in which, after exposure to atmospheric 
 air, alkaline fermentation has set in, we have seen 
 infusoria in great number and variety. They are 
 partly round, a species of monades (crepusculum ?) 
 partly vibriones. It is well to notice all such 
 details, although they are probably of no sig- 
 nificance in regard to diagnosis of disease. Fl(J 63 
 
 (e.) Cryptococcus 
 
 cerevmce. 
 
 This alg — which we have in the preceding pages both described 
 and represented — or rather a smaller species of it, as some authors 
 assert, is frequently noticed in urine. 
 
 In cases of Diabetes, under our notice, which terminated fatally, 
 no opportunity was afforded us to trace the ferment-alg into the 
 urinary bladder, nor have we noticed it in urine immediately 
 after its passage. But a few hours later the ferment-alg had 
 become a constant microscopical element of saccharine urine. 
 
 From this statement the inference should not be drawn, that 
 Cryptococcus is not generated in diabetical urine before its dis- 
 charge from the bladder, as a few spores and filaments in recent 
 urine may easily escape notice. But this much is certain, that 
 very soon they multiply at a rapid and surprising ratio. Indeed, 
 our numerous examinations of urine led us to suppose, that 
 Cryptococcus cerevisia? generated only in saccharine urine, and 
 where it is found, it should at once induce an analysis upon 
 grape sugar. 
 
 There are occasionally some other species of alga? in urine, 
 generating upon either the uterine or vaginal mucous membrane, 
 which we, however, omit to discuss, as they are of no patho- 
 logical interest. 
 
 * The presence of infusoria (Vibrio rugula) is of pathognomic, that is, diagnostic 
 importance, when found in the recently passed urine of advanced Bright's disease. 
 
72 MICROSCOPICAL DIAGNOSIS. 
 
 ( f.) Sarcina {Merismopcedia) ventriculi 
 
 in the urine has been found three times bj Heller, twice by 
 Johnson, twice by Beale, and once by Mackay. 
 
 The facts, that Eud. Yirchow has discovered Sarcina in a pul- 
 monary cavern, and Jenner, in a lateral ventricle of the brain (?), 
 seem to intimate that this Phytozoon is of common occurrence 
 even in healthy individuals, and thus no particular importance 
 can be attached to its presence in the urine. 
 
 How sarcina should have found its way into those localities 
 is, without the resumption of generatio equivoca, as yet incom- 
 prehensible, and it must be reserved for future investigation to 
 throw light upon this subject. 
 
 As Wedl has found sarcina in water, it may be surmised that 
 its occurrence in urine is of mere extraneous significance, and 
 it may not be far from the truth, that the urine-chamber con- 
 tained it prior to the reception of urine. 
 
 At any rate all observers agree, that the alg is of no patho- 
 logical moment, wheresoever it may have been found. 
 
 (g.) Hair. 
 
 The urine may contain hair from various portions of the body, 
 which, as accidental components, are of no interest to us ; unless 
 they are hair-like formations, in great number, and partly in- 
 crusted, from the urinary bladder itself. This uncommon and 
 highly remarkable phenomenon has as yet not been sufficiently 
 explained, and we have to refer those of our readers, who may 
 feel disposed to investigate this subject more thoroughly, to the 
 excellent monograph of Rayer, " Sur le trichiasis des voies uri- 
 naires et sur la pili-miction." — Mem. de la Societe de Biologie, 
 vol. ii. 16. 
 
 (3.) The Male Genitals. 
 
 Of entirely different, and vastly greater significance than the 
 real infusoria, which for a time were classed with the latter, and 
 have even retained their name, but which may now properly be 
 included in the order of ciliated epithelium, are the : 
 
MICROSCOPICAL DIAGNOSIS. 73 
 
 Spermatozoa. 
 
 It may be readily comprehended that spermatic animalcules 
 are sometimes found in the urine of a healthy and vigorous 
 male, and they certainly are found in it after coition and pollu- 
 tion. If no opportunity is at hand to obtain material for 
 examination from a subject, we should avail ourselves of such 
 as have just been mentioned to make ourselves acquainted with 
 spermatozoa. 
 
 Their diagnosis is of particular interest in what is called Sper- 
 matorrhoea. By descriptions of the consequences of masturbation, 
 and the number of quack publications which have been put into 
 circulation on " secret diseases," many persons are led to believe 
 that they suffer from loss of semen, and despair consequently of 
 their propagating power. In other cases symptoms set in, which 
 lead the physician to suspect Spermatorrhoea, and in which a cor- 
 rect diagnosis can only be arrived at by the discovery of Sperma- 
 tozoa in the urine. Such persons, and particularly those belong- 
 ing to the former category, sometimes experience sensual emissions 
 of small drops of mucus, be it in the form of a pollution or 
 during the act of evacuation from the bowels. The material 
 obtained from, and immediately after such discharges, is best 
 suited for the purposes of examination. It is recognised as either 
 mucus and epithelial cells (from the prostate gland, Cowper's 
 mucous follicles) or as Spermatozoa.* 
 
 In other cases in which no such marked discharges occur, 
 semen may imperceptibly pass out with the urine, and then be 
 collected and treated as we have indicated above. 
 
 By taking a drop from the bottom of the vessel and placing 
 it upon the objective slide, Spermatozoa may be easily recog- 
 nised by applying a power of 250 ; at the same time it should 
 not be neglected to examine them with the highest power which 
 the instrument may permit. 
 
 * In cases of Spermatorrhoea, and especially in those where discharges of semen 
 simultaneously take place with alvine evacuations, I have frequently succeeded in 
 obtaining material by pressing the prostate gland per anum— sometimes a tea- 
 spoonful in quantity. In these instances the liquid was both milky and thin. — B. 
 
74 
 
 MICROSCOPICAL DIAGNOSIS. 
 
 Fig. 64. 
 
 The diagrams (Fig. 64) represent them as they appear in the 
 urine by a power of 250, and again 
 of 650. They consist of a cell* and 
 its cilium (tail). The cell approxi- 
 mates the length of 0*009 Mm., by 
 0-003 Mm. in width, and 0*002 Mm. 
 thick. The shaded parts of the cell 
 are true to nature, but we will not 
 venture to determine whether or not 
 they depend on the unevenness of 
 the surface. The nearly straight cilia 
 of the cells are about 0'04 to 0'05 Mm. long. The entire object 
 has a peculiar bluish, fatty lustre, so peculiar indeed as to 
 instantly attract the eye, even though the cell should not lie 
 completely within the focus. Fig. e represents a spermatozoon, 
 lying on its side. The specimen, fig. d, is drawn as it sometimes 
 appears in the urine, with its cell at an angle to the cilia, giving 
 it the appearance as if the cilia were jointed to the cell. 
 
 Although the cilium in the majority of cases is nearly straight, 
 we now and then find curved specimens ; we represent such a 
 one by fig. e, which also shows an appendage to the cilium 
 immediately below the cell, which not rarely assumes different 
 shapes (remnants of parent-cells). The diagnosis of spermato- 
 zoa is important not only in Spermatorrhoea, but in medical 
 jurisprudence even; examinations to establish their presence 
 are necessary, sometimes in cases of rape, or suspicion caused by 
 spots, etc., and we will mention, although it does not strictly 
 belong here, that we readily discerned Spermatozoa ten days after 
 pollution, by moistening the linen. 
 
 (4.) The Female Genitals 
 Furnish, both in health and disease, various secretions, the 
 
 * The spermatozoa, according to Kolliker, are completely homogeneous soft cor- 
 puscles (not cells) on which we distinguish the body or head, and the filament or 
 caudal seminal-cells and cysts. He calls those cells and cysts which show them- 
 selves particularly in the testicles and in the superior part of the epididymis during 
 puberty, which inclose, according to their size, a varying number of from 1 to 10, 
 and even up to 20 bright nuclei (with nucleoli) in which a spermatozoon is gene- 
 rated. 
 
MICROSCOPICAL DIAGNOSIS. 75 
 
 examination of which, however, has thus far not produced 
 any diagnostically important results, mainly, it would seem, 
 owing to the difficulty of obtaining material.* We have 
 examined only a few cases of fluor albus, and these but very 
 imperfectly, for which reason we must confine ourselves in the 
 following remarks to the statements of other writers. 
 
 (a.) Menstrual Discharges 
 
 Are said to be composed of blood without fibrine, and therefore 
 not coagulable, besides epithelial fragments from the uterine 
 cavity. As it seems to be generally conceded that every 
 menstrual discharge ensues upon the detachment of ova, it fol- 
 lows that they must pass out with the menstrual flux, although 
 if found, it is by mere accident. It is, moreover, asserted that 
 menstruation causes the formation of decidua, and that dysme- 
 norrhcea is sometimes accounted for by the presence of the lat- 
 ter or of another pseudo-membranous formation ; and some 
 observers allege even to have seen them come away with the 
 catamenia. If this is the case, particles of it can of course be 
 recognised. 
 
 (b.) Lochia. 
 
 Those of the earlier period, the red lochias, are chiefly com- 
 posed of blood which is discharged from the interior of the 
 womb. When the lochias become serous, both the blood and 
 the detached fragments of the mucous membrane of the uterus 
 disappear from them and are replaced by mucous and pus 
 corpuscles. 
 
 The white (milky) lochia? contain pus in abundance and 
 epithelium in the process of regeneration. 
 
 (c.) Fluor Albus, Leucorrhoea. 
 This appellation, which is derived from a former period, com- 
 
 * See examinations of mucus from the vagina and cervix uteri in healthy or 
 non-pregnant, as well as in diseased and pregnant women. By Kolliker and Scan- 
 zoni. (Scanzoni, Beitriige, etc., vol. ii. 1855.) 
 
76 MICROSCOPICAL DIAGNOSIS. 
 
 prises the muciform discharges from the female genitals. A closer 
 examination into the nature of this symptom has shown that it 
 may be caused by affections of the most heterogeneous character, 
 such as congestion, inflammation, suppuration, and tumors. It is 
 obvious, therefore, that the combined examination with the hand, 
 eye, and microscope, must necessarily prove a different constitu- 
 tion of the morbid secretions. 
 
 In the absence of careful and reliable investigations of this 
 nature we can only hint at the great variety of secretions which 
 fall into the province of microscopical diagnosis, and leave a 
 closer description of them for future consideration. In the dif- 
 ferent formations of the epithelium of the various parts, we find 
 ample suggestions in regard to the sources of morbid secretions. 
 
 Although pus accompanies granular vaginitis, we are justified 
 to infer ulcerations when finding it in abundance. Structural 
 elements, when found in the secretion, determine the seat and the 
 extent of the affection. 
 
 (5.) Inorganic and Crystalline Constituents of Urine, Urinary 
 /Sediments. 
 
 Under the term of urinary sediments we comprise all the 
 constituents of the urine that sink to the bottom of the vessel by 
 virtue of their greater specific gravity. Some of the microscopical 
 elements already considered, likewise belong to this section. 
 We therefore consider it practical to enter more particularly upon 
 the discussion of the urinary sediments, irrespective of their 
 organic or inorganic origin, and shall thereby complete our essay 
 in a point purposely reserved for this title. An accurate de- 
 scription of all characteristics of urinary sediments will enable 
 the reader to recognise the most prominent ones by the naked 
 eye with an approximative degree of certainty. 
 
 In comparing the urinary sediments of different persons, it 
 will be found that they present themselves in three forms. 
 
 1. Light and flocky, commonly translucent and in large 
 quantity. 
 
 2. Dense and opaque, likewise voluminous. 
 
MICROSCOPICAL DIAGNOSIS. 77 
 
 3. Granulated, crystalline, in small quantity, adherent to the 
 walls and bottom of the vessel. 
 
 The first category consists of mucus, epithelium, semen, infu- 
 soria, algae, tubular thrombs, cylinders, foreign bodies as: fat, 
 cotton, feathers, and dust. 
 
 The second embraces pus, phosphates, urates, starch, and also 
 different foreign bodies. 
 
 The third comprises uric acid, carbonate and oxalate of lime, 
 cystine, small portions of triple phosphates, blood, and foreign 
 bodies, such as sand, bread-crumbs, etc. 
 
 Having already described the organic constituents of the urine 
 dependent on certain pathological conditions of the uro-genital 
 organs, as well as most foreign bodies accidentally coming in 
 contact with the urine, we may at once turn our attention to the 
 inorganic and crystalline substances of the urine, which form and 
 precipitate themselves in consequence of the fermentative process 
 ensuing. 
 
 Lehmann says, in reference to the fermentation of normal urine: 
 
 " In perfectly clean vessels, normal urine does not readily 
 decompose. Left undisturbed it usually forms a light nubecula, 
 like suspended mucus ; if exposed for some time to the ordinary 
 temperature, its normal sour reaction increases — sour fermentation 
 — forming yellowish-red rhomboidal crystals (uric acid). Sub- 
 sequently, sometimes not until after several weeks, but sooner 
 in higher temperature, and when containing much fluid or mucus, 
 the urine covers itself with a membrane of glossy, iridescent, or 
 fatty appearance, consisting of dust, algae, vibriones, urate of 
 soda, and phosphates, of which some fragments precipitate; 
 dirty, white yellowish flakes mix with the mucous sediment; 
 the urine becomes pale and its reaction alkaline — alkaline fer- 
 mentation. At this epoch an offensive odor developes itself 
 simultaneously with white granules (urate of ammonia), and 
 colorless, light, strongly refracting prismatic crystals (phosphates 
 of ammonia and magnesia). 
 
 The fermentation of abnormal urine within or without the 
 affected uropoietic organs, and irrespective of its morbid consti- 
 tuents, differs from it in time only, that is, it developes and 
 terminates more rapidly. A premature sour fermentation in the 
 
78 MICROSCOPICAL DIAGNOSIS. 
 
 renal pelvis or urinary bladder, gives rise to gravel. The latter, 
 or a primary cystic catarrh, prematurely superinduces alkaline 
 fermentation within the bladder, whereby the mucus acts as a 
 ferment (Scherer). And this fermentation accounts for the alka- 
 line reaction of recent urine and the formation of urinary calculi. 
 We cannot, however, enter upon the chemical bearing of this 
 otherwise interesting subject, which has certainly derived great 
 elucidation from chemistry, but we have to proceed at once to the 
 
 SEDIMENTS OF SOUR URINARY FERMENTATION. 
 
 (a.) Urate of Soda. 
 
 This urinary salt, of which it has been said, that the mere 
 cooling of the urine was sufficient to precipitate it, has since 
 been recognised as the product of sour fermentation con- 
 nected with the chemical decomposition of urinary pigments. 
 It is one of the first, if not the first of the sediments, and 
 is never wanting in normal urine, though its quantity may 
 be but small. Urate of soda shows itself as a 
 light, white cloud, suspended in the midst of 
 the fluid, descending gradually to the bottom 
 of the vessel. Under the microscope this sedi- 
 ment exhibits, by a power of 250, forms like 
 those represented in Fig. 65. They are irregu- 
 lar clusters of fine granules, sometimes joined 
 in a network like finely branched moss. 
 
 We do not know as yet whether this urinary salt has any 
 other significance than that of indicating the fermentable ten- 
 dency of the urine, although it occurs usually in large quantities 
 in cases of impeded oxydation of the blood. 
 
 (b.) Uric Acid. 
 
 Aside from those cases where the sour fermentation already 
 takes place within the bladder, uric acid does not easily 
 separate from recent urine and certainly not before sour fer- 
 mentation sets in. In certain pathological conditions this may 
 
MICROSCOPICAL DIAGNOSIS. 
 
 79 
 
 ensue very soon and even in a few hours.* Uric acid is never 
 found in an amorphous but always in a 
 crystallized state. Its crystals are of 
 a pale yellow or red color. Their sim- 
 plest forms are represented by Fig. 66 ; 
 a, a, semi-transparent rhomboidal plates ; 
 Z>, traces of the formation of small plates ; 
 c, the small plates fastened upon a larger 
 crystal. 
 
 Another form resembles that of the 
 grindstone. The crystals of these various 
 forms are partly free, partly joined in 
 clusters as shown by e. This sediment possesses so character- 
 istic a color (brick-dust color) that its recognition is not depen- 
 dent on the microscope. 
 
 Fig. 66. 
 
 (c.) Oxalate of lime 
 
 is observed in the sediments of normal urine in the earliest 
 stages of its sour fermentation, and is most probably its 
 product. Its crystals, though small and scanty, are constant 
 ingredients of urine. Oar investigations render it proba- 
 ble, that no crystals are as frequent in the urine as those of 
 oxalate of lime, though on account of their minuteness they may 
 often be overlooked. 
 
 In certain morbid affections the crystals of oxalate of lime are 
 very numerous, and so large as to induce the proposition of a 
 specific Oxaluria. Whether this new form of blood-disease is 
 accepted or not, the diagnosis of the crystals is an acceptable 
 guide for the treatment. Crystals of this salt are moreover coin- 
 cident with Spermatorrhoea, and in such cases we have the best 
 opportunities for examining them. 
 
 They are discernible with a power of 250, but they should 
 also be examined by a higher magnifying power. Fig. 67, 
 
 * In newly born infants we find, on the second or the third, and on subsequent 
 day,?, gold-colored or red-brown stains on the diapers not unlike blood. This is the 
 normal excretion of uric acid and urate-infarcts. 
 
80 MICROSCOPICAL DIAGNOSIS. 
 
 a a, represents the crystals of oxalate of lime, observed with 
 a low, and b, with a high power. They look 
 very like a letter envelope of square form, 
 are rectangular or oblique, and octahedral. 
 
 English authors also speak of dumb-bell 
 crystals, but we have never yet seen oxalate 
 of lime in that form. We nevertheless have 
 Fig. 67. added illustrations of them, Fig. 67, c, after 
 
 Eobin and Verdeil, d, after Golding Bird, and e, when dried upon 
 
 glass, after Bowman. 
 
 (d.) Cystine. 
 
 This substance, discovered by Wollaston, contains in its 
 chemical composition a considerable portion of sugar (25 
 p. c. Lehmann). He observed it first in a calculus, then, 
 although not often, it has also been observed in urinary sedi- 
 ments, particularly in England. In Sweden, to our knowledge, 
 Cystine has never been found, nor have we observed it in its 
 original state, that is in sedimentary form, but only as a calculus, 
 or crystallized from its solution in ammonia. 
 
 As a sediment it is said to possess the form represented by 
 Fig. 68, a, which Golding Bird surmises to be 
 composed of numerous plates lying upon one 
 another. From a solution in Ammonia, the 
 cystine deposits in colorless, transparent hexa- 
 hedral discs (not prisms) partly solitary, as 
 Fig. 68. in b, partly overlapping each other, as in c, 
 
 which form diversified figures, for instance the rosettes of Bird. 
 In order to distinguish the similar crystals of triple-phosphates 
 and chloride of sodium from cystine, it should be borne in mind, 
 that the first dissolve in acetic acid, the second in water, and cys- 
 tine in neither. 
 
 SEDIMENTS OF ALKALINE FERMENTATION. 
 
 (e.) Phosphates 
 
 form a considerable ingredient in urine and especially in 
 
 o'O 
 
MICROSCOPICAL DIAGNOSIS. 81 
 
 connexion with, ammonia, soda, lime, and magnesia. The 
 ordinary and most prominent combinations are the "earthy 
 phosphates," or the phosphates of lime and magnesia, the 
 so-called triple-phosphates. This salt occurs only in alkaline 
 urine, and it is immaterial whether the alkaline fermentation has 
 taken place within or without the urinary bladder. In the for- 
 mer case it is observable immediately after the passage of the 
 urine, in the latter not until some time has elapsed. Sometimes 
 it is combined with other ingredients, as in the membrane which 
 covers the fermenting urine, or mixed up with flakes of urate of 
 soda and mucus, and the sediments of phosphates of lime and 
 urate of ammonia, the latter by complete fermentation of the 
 urine. These compounds might «* <$mx£^> 
 
 easily be mistaken for mucus or pus, 
 but for the microscope, which readi- 
 ly reveals the components. 
 
 The ordinary forms of the triple 
 phosphates are given in Fig. 69. 
 Their crystalline prototype is the 
 prism; they show, however, innu- 
 merable modifications with reference 
 to the formation of their ends. In Pig. 69. 
 
 stale urine they are still more irregular and larger, b, b. In c, 
 we see stellated combinations of plate-formed crystals, the radia- 
 tion of which clearly exhibits articulations, as in c?, and at /,/, 
 stars composed of single and double wings. 
 
 All these forms present themselves under the microscope in 
 still greater variety and modification in urine from affected organs. 
 Their chemical composition is not satisfactorily understood. 
 With the most frequent form of triple phosphate crystals we find 
 numerous amorphous granules of phosphate of lime. 
 
 (f.) Urate of Ammonia 
 
 is observed only in urine undergoing alkaline fermentation. 
 We then find it, either in the form of small granules, Fig. 
 70, a, or staff-shaped, free, or connected, partly as fine crys- 
 
 6 
 
82 MICROSCOPICAL DIAGNOSIS. 
 
 tals differently grouped ; the more frequent forms are annexed 
 
 in the diagram. When the urine has 
 
 ^vi, J$ jjjjiL become strongly alkaline, we notice in 
 
 " ^4 a ^ the sediment the peculiar crystals of 
 
 ""*£ 1W- St*vw% a ball with numerous transparent points 
 
 •^ jk' A-lv ^fe, of urate of soda, as represented by Fig. 
 
 i& «&« ft- r* *^* 70 ' 6 ' 6 ' ( Keller -)* The ^ are observed 
 
 ^& ^T - F - n c ] usterS) as we n as i n solitary crys- 
 
 FlG - 70 - tals. 
 
 The granules of the urates of ammonia and soda cannot be 
 microscopically discriminated from each other ; but irrespective 
 of the chemical reagents, they occur in the urine under very 
 different circumstances. 
 
 (g.) Carbonate of Lime 
 
 is frequently an ingredient of sediments, caused by alkaline fer- 
 mentation, in which it becomes mixed with triple-phosphates, 
 urate of ammonia, and phosphate of lime. Like the latter 
 it occurs as amorphous powder, and neither can therefore be 
 discerned from each other. In a case of Urethritis and Cystitis 
 in a child, we have observed, twenty -four hours after the pas- 
 sage of the urine, and while but of weak alkaline reaction, large 
 masses of carbonate of lime. Its form, in that instance, was that 
 of small heaps and stars, partly isolated, part- 
 ly in agglomeration, and consisting of fine 
 (2 J\^\ /ga^ needle-crystals, connected with each other. 
 
 ^k ^*Q£/ Not rarely does it appear in the shape of 
 V . ILQIL ^ ^ dumb-bells, with a great variety of form 
 (Fig. 71). This sediment is rarely consider- 
 able, and we do not recollect one' solitary 
 instance, where it had been found already deposited within the 
 bladder. 
 
 * To the naked eye these crystals appear white ; under the microscope, dark and 
 scarcely pellucid. 
 
 THE END. 
 
 $QQQ88