most direct and swiftest route for amœbœ, bacteria or of them with the Romanowsky stain. It happens either infective emboli to enter the liver substance. that the granules do not take the stain at all or, more It will be noticed in the two cases cited that each had frequently, that they are not specifically stained. In had abscess in the right lobe previously, and at opera¬ fact, it is characteristic of young granular cells (mye- tion I found that in both cases there was reduction in locytes) with a Romanowsky slain that the granules take size of the right lobe with adhesions to the diaphragm a purplish color (i. e., basophilic), whether they are in and neighboring' structures and that there appeared to reality neutrophilic, oosinophilie or basophilic myelocytes. be wide-spread fibrous infiltration throughout the right It is only necessary to stain such a blood with the triacid lobe, indicating that the abscesses had been quite large stain to verify this statement. The differentiation at and destructive to the liver substance. This fibrous once becomes evident, the myelocytes (and polymorpho- shrinking of (be right lobe would operate to reduce the nuclears as well) appear more numerous, and the "un¬ volume of the portal circulation to that portion of the classified cells" are less conspicuous. .Furthermore, in a of lobe liver. Also compensatory hypertrophy the left specimen stained with a liomanowsky stain ii is at times would make its portal circulation swifter and more extremely difficult, if not impossible, to distinguish entrance direct for the of infective material. between some of the large mononuclear cells containing the other it that oc¬ on On hand, would appear abscesses azure granules on the one hand and myelocytes the curring subsequent to those in-the right lobe would have other. With the triacid stain this of course, selected problem, again the damaged right lobe as a point of least does not exist. While it is usually possible for one expe¬ resistance. rienced in blood work to interpret, with a certain degree The interesting points in these cases are: of accuracy, a specimen stained by the Romanowsky terms of triacid stain other words. :,i 1. lioth men had liver abscess in right lobe previously. method in tbe (in as to the of 2. Both were in excellent health in spite of their being the make a fairly satisfactory guess classification hosts of Aniirliic d.i/senli-riw. pathologic cells), still it holds good that for the average 3. Rapid onset of the disease. worker who does not specialize in hematology, and for I. Mild symptomatology, which was less defined than the the medical student this is an almost impossible task. descriptions indicate. Nor is there way of avoiding ibis pitfall liver abscess any apparent 5. Absence of many of the "classical" signs of so as the present classification of leukocytes is used, as in text-books. long given except a return to the Use of the triacid stain. li. Difficulties in early diagnosis which would have been by absence of and encountered in of history dysentery previous I'l X ATI ON OF FILM abscess. 7. Rapid convalescence and return to normal health in spite One of the. chief difficulties in applying the triacid of amcbisni. slain, indeed, the chief difficulty, is the fixation of the blood lilni, which nuisl he done by heat. Two methods of heat fixation are employed, (1) the quick VALUE OF TRIACID STAIN commonly THE EHRLICH'S method, by the use of the copper bur. and (2) ihe slow is the IN BLOOD WORK method, by means of a hot-air oven. The hitler one used in laboratories, where it is necessary ROGER S. MORRIS, M.D. teaching to fix a hundred or more blood films for class work; tbe Associate in Medicine in Charge of the Clinical Laboratory, Johns a aboiit 110 ('. for one Hopkins University lilms are heated at temperature of to or more hours. In order to determine the BALTIMORE two opti¬ mum fixation four or live lilms are placed in tbe oven, of Within recent years the development numerous one being removed at the end of an hour or an hour and the minutes' modifications of Romanowsky stain, by which blood a (punier, and then one at an interval of fifteen smears may be fixed and stained in a few minutes, has thereafter. The specimens are stained and examined limited the use of Ehrlich's triacid stain in many lab- and the proper fixation time noted. The remaining oratories. The former, it is true, are far preferable in are then lixed the length of time, spécimens required the the study of pathologic changes in the as and be stained at once or al any lime within erythrocytes, may the cell nuclei, nuclear particles, polychromatophilia, baso- next few months. This method is, of course, oui of philic and Cabot's ring bodies, as well as cer- for the practitioner, as it consumes altogether granules, question is all is tain are demonstrated to better advantage than too much time, when a single specimen that parasites, is far with any other single stain. With Ehrlich's triacid, ring For him the copper bar method prefer¬ required. is so thai its bodies and basophilic granules are not revealed, and able. The bar, resting on a tripod, placed is soon is shown very In study- is in a Bunsen llame; a constant temperature polychromatophilia imperfectly. tip and the however, the Romanowsky stains are Wafer is now dropped on the bar the ing leukocytes, acquired. Tim not to be with Ehrlich's triacid, and it seems noted at which the drop remains spheroidal. compared point side is unfortunate that they are so widely used at the present blood film, with the specimen up. placed just time in differential leukocyte counting. inside the "spheroidal point" ( i. e., toward the flame) and allowed to remain from live to one hundred and CLASSIFICATION OF LEUKOCYTES twenty seconds, ordinarily about thirty to forty-live a to lix several for The classification of the leukocytes seconds. It takes only moment films generally accepted of lime. All he stained at. once, and is that based on the staining reac- various periods may suggested by Ehrlich, selected for In a lixed tions of these cells to his triacid staining mixture. By the best specimen study. properly the I les bave a hull' color; o\eriixnlion means of it the normal and, what is more important, the specimen cry limey into definite causes them to he stained while in an undei'lixed pathologic leukocytes are clearly separated yellow, lilm are red. The final criterion which a or classes, and this is particularly well illustrated they by spéci¬ groups he a clear-i ill differenti¬ in the staining of the myelocytes. In the majority of men should judged is. however, instances it is impossible to obtain a satisfactory stain ation of the leukoeytic granules. ' Downloaded From: http://jama.jamanetwork.com/ by a Florida International University Medical Library User on 06/14/2015 STAINING TEOHNTC AN IMPROVED RONGEUR FOR MASTOID The staining technic is very simple. The specimen OPERATIONS IS covered with the slain for from five to ten minutes is washed, blotted and W. SOHIER BRYANT, A.M., M.D. (oveistaining impossible), dry, NEW YORK mounted. With a little experience a satisfactory prepar¬ ation should usually be obtained in fifteen in i mile- at This large powerful rongeur saves a great deal of the most, often in half this time. When the method time in the mastoid operation, since it will morsel hard lias been mastered the time-consuming qualities of bone very rapidly. The tip of the mastoid process and the triacid slain are not much greater than are those of the outer table of the mastoid are quickly bitten off. the Romanowsky stains—certainly not enough to war¬ When it is necessary to remove a part of the calvarium rant the apparent disuse into which Ihe stain has fallen. entire, this instrument will morsel it with great rapidity PREPARATION Of THE STAIN When it is necessary to prepare one's own staining mixture, another drawback to the triacid stain of Ehr¬ lich may he encountered. (Fortunately very satisfactory preparations of the slain are on the market, notably Griibler's.) The formula given in text-hooks frequently fails utterly and it becomes necessary often to waste numerous hatches of stain before a suitable mixture is obtained. As is well known, Ihe staining ingredients of and with very little jar. The leverage of the instru- Ehrlich's triacid are a basic slain, methyl green, and two ment permits the exertion of a tremendous force. The acid stains, orange 0. and acid fuchsin. The three basic rongeur is strong enough to take out the bone rapidly radicles of the methyl green are neutralized by the acid with a minimum of muscular exertion. stains, hence the name triacid, which Ehrlich selected. 41 East Thirty-third Street. Determining the proper quantity of euch stain in the mixture is the usual source of trouble in its preparation. While experiencing I his difficulty, a slight modification of the original formula was found, which has proved THE UVULA AND ITS SINS very helpful. The formula as modified is: e.e. ADRIAN F. BURKARD, M.D. Kill u ni ted iKineouK Bolullon of orange G.18.0 OMAHA Saturated ikiiu'oiis solution of acid I'lichsln. 7.(1 1 lis! ¡lied walel'..'.18.0 Absolu le alcohol .Iñ.o The uvula is so inconspicuous and innocent looking Sa I Hinted aqueous solution of methyl green.17.