^ 1 ■ 1 ^§- LIBRARY OF CONGRESS". UNITED STATES (: .-IMEEICA. rKL PRIMER CLINICAL MICROSCOPE, BOSTON OPTICAL WOEKS. BY EPHRAIM CUTTER, M. D., Member of the Philosophical Society of GtReat Britain, Americak Institute of Micrologt, etc. •J/ Copyright, 1879, by 9mmmmmmmmmm. .^ ^ C^i/Kl^^ -^HT^'^^ BOSTON: PUBLISHED BY CHARLES STODDER, 131 Devonshire Street. 1879. iPrice Fifty Cents.2 a'- 6'f7 V THE PRIMER CLINICAL MICROSCOPE. (Made at the Boston Optical Works.) By EPHRAIM CUTTER, M. D., Boston, Mass. [Copyright Reserved.] Prelude. — Believing tliat micrograpliic {fitKpo^, small ; Ypdipew^ to write) writers have aimed too high ; that the use of this clinical microscope is as easy as a sewing machine ; that in a short time instruction in person would suffice with- out any book ; but that as this personal instruction is impos- sible in most instances, pupils should become as children, and learn from the simple printed form of instruction. We ignore no good instrument, but confine the teachings to this clinical microscope because of its simplicity and suf- ficiency for physicians whose duties include travel to the bed- side. What is a Microscope ? {/Jtifcp6(;, small ; gkotz^Ii^^ to view. A tool or instrument for viewing small things. What is a Simple Microscope f A single lens or set of lenses (bi-convex or plano-convex). What is a Compound Microscope P One that has two or more sets of lenses, of which one combination comes next to the eye, and is called an " eye-piece, ^^ and another set that comes next the object, and is called an ^^ohjective." CLINICAL MICKOSCOPE PRIMER. What is this Clinical Microscope P A compound microscope designed for physicians' use at the bedside of the patient. Of what parts does it consist ? The following: 1. A Jth ob- jective. 2. 1-inch eye-piece. 8. Tube. 4. Cap to eye-piece. 5. Stand. 6. Stage. 7. Clips. 8. Stage screw. 9. Coarse adjustment. 10. Tine ad- justment. 11. Cap of tube. Accessories, but essential : 12. Slide. 13. Cover. jWhat is a Ith-inch Objec- tive f The set of lenses next the object that magniiies as much at ten inches distance from its face as a bi- convex lens of ith inch focal distance, to wdt, 50 diameters. Objec- tives are distinguished by na- tionalities, makers,^ systems and classes. Thus we speak of American, English, French and German objectives; also of Tolles, Spencer, Wales, Gundlach, Powell and Leland, Smith ana Beck, Hartnach, Zeiss, &c., objectives. Also, w^e speak of two-system, three-system, four-system objectives, according as the compound lenses are two, three, four, &c. What classes Objectives f Varies w^ith different makers ; with Mr. Eobert B. Tolles (1) angular aperture. (2) Com- plexity of structure. (3) Definition and resolving power. , What is Angular Aperture ? The angular breadth of the pencil of light entering the objective to form the image. A great V controversy has been waged on this subject, and it is net settled yet. For us, it is only necessary to say that when .all the pencil of light, so to speak, enters the objective and CLINICAL MICROSCOPE PRIMER. 3 measures 180 degrees, the "180 degrees" would be called the angular aperture; so when the angular breadth of the pencil measures 90 degrees, the angular aperture of the ob- jective would be called " 90 degrees." A first-class objec- tive should have over 160 degrees of angular aperture, and an adjustment for cover thickness — that is, arranged so that covers of varying thickness may be used, and the objective corrected for each thickness by moving the milled ring on the objective. A graduated circle renders it possible to make a registry of the different covers used, so that by the number the proper adjustment may at once be found; also, its resolving, penetrating and defining power must be in the highest degree of perfection. (Note. — This varies for difier- ent objects. A first-class objective may work splendidly on one class of objects, and quite poorly on another set of ob- jects. A first-class ocean steamer cannot be a first-class river boat.) What is an Immersion Objective f Where the face of the objective is wet with water, glycerine, oil of cloves, &c. What is a Dry Objective f It is one where nothing but air comes between the cover glass and the objective. What is Balsam Angle ? The angle of light coming through an object mounted in Canada balsam. First-class objectives are usually wet and immersion. What is the Working Distance ? This means the distance of the objective in focus from the object cover ; sometimes it is the 2^^^ th of an inch. What is a Second- Cla.^s Objective P One with cover adjust- ment, and less than 160 degrees of angular aperture, though it is possible to have a first-class objective of less angle. A third-class objective has less than 100 degrees of angu- lar aperture, three sj^stems of lenses, and no cover adjust- ment. This class of objectives is now made with clearness, flat field, resolving power and definition amply sufiicient for clinical work. Such an one is furnished with this clinical microscope. On monetary considerations, it is now unwise to refrain from buying a microscope when this instrument can be bought for $25. ^ This Primer is not written for the benefit of those to whom 4 CLINICAL MICROSCOPE PRIMER. money for a microscope is of no account. On the contrary, it is intended for those who must make the most of the means they have at command. Hoiv sJiouId you Rate this Objective ? American, Tolles, 3- system, 3d-class, dry, not adjustable ; working distance about ^^^th inch. What is a One-Inch Eye-Piece ? It is the one found in this microscope, made of two plano-convex lenses — one next the eye, called the eye-glass, and the other is called the field- glass. When the plane surfaces are next the eye, it is called a Huygen's eye-piece. When the convex faces are towards each other, it is called a Ramsden eye-piece. The terms ''1-inch," "2-inch," }-inch," "J-inch," apply loosely to the length of the combination. A 2-inch eye-piece magnifies five diameters ; a 1-inch magnifies 10 diameters. So that the amplification of the clinical microscope, 50 by 10 equals 500 diameters, when the standard length of ten inches is adopted. The clinical is seven inches in length, hence its power is 350 diameters. If so ordered, the clinical can be supplied with a draw-tube; i, e., a tube to slip out and into the barrel, or it can be made ten inches long at the start. Remarks. — Having an objective and an eye-piece, one has the necessary elements of a compound microscope. Were it possible to hold in the hands the objective, the eye-piece, and the object properl}^, observations could be made in mi- croscopy. But a tube is necessary to hold the eye-piece at one end and the objective at the other, and to cut oiF cross- lights, as in a spy-glass. This tube is found in all varieties of the compound microscope. In this clinical microscope, it is 5 J inches long, and IJ- inches in diameter. The eye- piece fits into one end, and the objective screws into the other end. Thirty-six threads to the inch is the standard " society screw " for objectives adopted by the London Mi- croscopical Society and most American societies; so that any objective may be used on any stand with this standard thread. In case of French and German objectives, adapters are made to fit them to the English pattern. What is (4) Cap to Eye-Piece ? A simple brass cap to cover the eye-glass of the eye-piece for protection. CLINICAL MICROSCOPE PRIMER. 5 What is (5) the Stand ? A contrivance to hold or stand the tube on. In the present case, it consists of a thin tube surrounding the barrel of the microscope just described. It tits accurately, and should touch the collar on the eye-piece end of the barrel. At the other end it projects beyond the objective. Here is cut a female screw. Into this iits the stage screw, which is a ring slightly bevelled on the inside. Into this bevel fits a ring that projects from the under side of the stage. What is the Stage ? A small platform with a central open- mg. In this case it is circular. Its use is to hold the object. Its diameter is 2j^th inches ; Jth inch of the periphery is -^^iXi inch thick. The inner table is y^gth inch thick — ^this allows of a space for the object. What are the Clips? Two watch springs, free at one end and fastened at the other, with a bar having two pegs that go through holes in the stage, for the purpose of holding the slide. (Fig. 2.) These complete the clinical stand. Object- ives 4-inch to ^^oth-inch Tolles have been used with this stand successfully. What is the Coarse Adjustment? It is the focussing appa- ratus that moves in great (comparative) distances. In this clinical microscope it is secured by simply drawing out and in the barrel of the microscope inside of the tube of the stand. What is the Fine Adjustment? It is the focussing obtained by turning the stage on the screw-ring in the end of the stand tube. What are the Caps? They are two brass covers — one to protect the eye-piece, and the other the objective, when out of use. The cap of the eye-piece fits on as a tube. The other cap has a beveled projection exactly like that of the stage. It replaces the stage for portability in the pocket. ffow is the Stage Removed? - By simply pulling off. Some- times it sticks. It is then best to turn the stage screw, and bring the stage sharp against the end of the tube. The le- verage of the screw will start it off. The cap is then inserted in its place. Sometimes it does not adhere, as owing to a fault of construction, the projection is not as long as that of the stage. This is the worst feature of the whole instrument. C CLINICAL MICROSCOPE PRIMER. / In this case, I usually put the stage in (not too tight) and turn the screw out. Then the stage is pulled off, and the cap easily fits, and may be turned close to the tube. When the cap sticks, it is removed like the stage, by sharply turn- ing against the tube. Remarks. — A classmate lately purchased one of these in- struments. I failed to communicate how it should be used. He removed the stage screw and cap, when he wished to use the instrument. He held the object in front of the objective, and said he obtained views. This is mentioned only as a warning to others, and as a work of supererogation. The clinical microscope, with caps on and stage off, is best kept in a chamois bag. It can then be carried in a side pocket, and the stage in the vest pocket ; or it may be car- ried in a satchel with stage on or off. As the clinical microscope is intended for bed-side use, it has been the aim of the writer to reduce its features to the least possible number. But something more than the instru- ment is needed, as a microscope without illumination is like an engine without steam. What is the Light? It is the illumination by which objects are viewed under the microscope. How many hinds of Light are used? !N^atural and artificial. What is meant hy Natural Light as suitable for the Clinical Microscope? The following: (1) Ordinary diffused daylight in an apartment with one window (preferably). A room with more than one window may be used ; but trouble comes from cross lights and too much light. (2) Sunlight reflected from a white object, as a house, a handkerchief, a garment, paper, &c. These make the best white cloud illumination I have used. (3) White cloud light. What is Artificial Light ? (1) A common coal oil or ker- osine flame, such as is used all over the country. This flame, used direct, gives the best light for Tolles' ^^ih inch objective (2) A wax or paraffine candle. (3) Gas light— the poorest of all illuminations. Remarks. — The Perkins & House (of Cleveland, Ohio) lamp is the best I ever used with the clinical microscope. CLINICAL MICROSCOPE PRIMER. 7 Mr. Tolles commends the patent mechanical lamp with a naked flame. What is Direct Light? A light unmodified bj reflection or refraction. How is the Clinical Microscope used with the Direct Light or Reflected Sunlight? By pointing it towards the source of light. What are some of the reasons of its favor f (1) It was in common use 200 years ago. (2) It is efiective ; and (3) Less troublesome than reflected light. (4) It saves time. (5) It allows of the use of the clinical microscope when the ob- server is placed on a lounge, in bed, in railroad cars in mo- tion, on ship board — indeed, anywhere that a lamp will burn, and the motions are not too violent. The microscope and the eye move together. The eye-piece, objective and object move together. (6) It does away with the reflecting mirror, and thi.s reduces expense and motions of adjustment. Of the. Object — What is it f Anything that can be seen with the microscope. We confine our remarks to the clini- cal microscope for ])revity. There are two classes of objects: (1) Transparent, and (2) Opaque. Only class 1 can be used with the clinical microscope. In the case of opaque objects, sections are made so th..t the light can penetrate through the substance, or a minute portion of an object may be obtained in any other desirable way. What are the Essentials of an Object? (1) To be thin enough, (2) spare enough, or (3) separated enough so as to let the light permeate or penetrate. Objects of observation with the clinical microscope are easy to mount. What is Mounting? -A preparation of an object for micro- scopic observation, either temporary or permanent, as for a collection of objects in a cabinet The latter is a department by itself. It consists in preserving the specimen by media, that exclude the action of the air, and, as far as possible, inter- stitial changes of the object. What is Staining? A coloring of the object or portion of the object by reagents, for diagnosis and differentiation. This art has made wonderful progress of late. (See the systemic works.") ^ CLINICAL MICROSCOPE PRIMER. What besides the Clinical Microscope and the Illumination are necessary for an Observation f (1) A slide. (2) A cover. (3) Pipette. (4) A piece of old cotton or linen, and (5) The object. What is a Slide? According to the London Microscopical Society's standard, it is a piece of clear glass 3 x 1 x {-j\) inches, with rounded edges ; but the dimensions vary. Fig. 2. Wliat is a Cover? Usually a square or circular piece of thin glass, less than one inch in diameter, and of a thickness varying from /oth to ^^th inch. Thickness of covers for this microscope iJoth inch. How are Slides cleaned? Ordinarily, by washing with water? and wiping dry with an old cotton or linen handkerchief. Covers require much care, for fear of breaking. After soaking, I have found that by moistening with water a small surface of a handkerchief, taking the cover gently in the moistened fold, then rubbing to and fro with the thumb and forefinger, the object is best accomplished. Dr. E,. TJ. Piper, of Chicago, has invented a very simple CLINICAL MICKOSCOPE PRIMER. 9 device, for this purpose. He takes a piece of glass plate 2x3x -"jjtli inches, and secures on it two thinner plates of glass hy balsam or cement, in such a manner that a space like the letter Y is formed ; the length of the largest plate is the length of the Y. It is easy to see how a cover may be cleaned and any amount of pressure brought to bear on it without breakage, as it is engaged in the Y and held. To free slides from covers cemented by blood dried on, simply soak over night in cold water. A better plan is to clean the slide immediately after use. Remarks. — ^For transportation and years of wear, a zinc plate box, just sufficient to receive 8 to 10 slides, I have found satisfactory. A moist cloth or paper laid in the box will keep specimens from drying. Covers mav be carried in between the slides. An India rubber band will keep the box closed. What is a Pipette? A little tube of glass (usually) 6 to 10 inches in length, and one-eighth inch inside diameter. (Fig. 3 — Pipettes.) A 'Eo. 5 catheter serves well, and does not easily break. The pipette is used to collect deposits from urine, &c. Office Stand of the Cliiiical Microscope. — An upright post of wood ten inches long by two inches square may be set in a base, and bored transversely or obliquely, so that the opening is just large enough to receive the tube of the stand, not the micro- scope. It may be lined with velvet. For use, the barrel with the eye-piece and objective should be removed; the tube then placed in the foramen in the post; the barrel is replaced, and the illumination set against the objective. Fifty cents would cover the cost. Figure 4 10 CLINICAL MICROSCOPE PRIMER. is another device for the same purpose form for viewing opaque objects. Figure 5 is another Fig. 6. Fig. 4.— Waddington Stand. Having thus given a brief account of the clinical micro- scope, it is proposed next to give examples of its use, 30 plain that it is hoped the average intelligence can repeat them. Example l.^^Hair. — This is a coarse object for the clinical microscope ; still its marked characters are so striking, that the novice would do well to practise with it. Its size and color make it visible long before it comes into focus. An easj^^mode of mounting a specimen of hair, for examination, is ai follows: Put a small drop of clear water on the Centre CLINICAL MICROSCOPE PKIMER. 11 of the slide ; then take a small pencil of hair (removed from the beard or head) between the left thumb and forefinger. Cut the free end off, square, with scissors. Then holding the hair over the drop of Tvat^r, cut a section J-inch in length, trans- versely. Enough pieces of hair will fall into the drop to make an object for practice, when they are covered with a covering glass, and the excess of water removed by a bibu- lant, such as a blotter or cotton cloth touched to the edge of the superfluous drop. When this is done, the slide can be put in any position, and the cover will not move, as the capilla- rity will hold it close and fixed. The removal of the excess of liquid from the object is a necessary procedure in the use of this clinical microscope, for obvious reasons. The next step is to place the slide, cover towards the ob- jective, under the clips of the stage. A hair can then be readily brought over the centre of the objective, by observa- tion with the naked eye. The facility with which objects can be found by this manipulation and holding is a recom- mendation of the clinical microscope. It saves time which otherwise might be lost. Of course, the next thing is to turn the microscope towards the illumination — be it dififuse daylight, a w^hite cloud, re- flected sunlight, lamp or gas light. The observer gazes through the microscope as he would through a telescope — holding the barrel with the right hand and the stage with the left hand. (It is well to have the clipped part of the stage uppermost. The left forefinger may be above and the thumb below.) It is probable that a faint outline of the hair will be perceiv- ed. Holding the stage still (as above), turn the barrel with the right hand. If the object becomes more distinct, keep on turning till it becomes clearly in focus If, however, the ob- ject becomes more dim, turn in the opposite direction until the image is clearly seen. This turning backwards and for- wards is termed the '' fine adjustment." Look for the cor- tical portion of the hair, its imbrications like shingles, its medullary portion. ]N'ote the coloring matter, and get a general idea of the physical features as one on* picket scruti- nizes a "new comer in war times. Move the slide about on 12 CLINICAL MICROSCOPE PRIMER. the stage, and bring successive hairs into the field of vision. Focus off and on if each hair is not perfectly clear and dis- tinct. Pluck out a hair by the root, cut it off over water as above directed, and then the physical features of the bulb can be studied. Study comparatively the hairs of different parts of the body, of different races, ages and sexes, of animals and insects. Also study the hairs and connected glands of plants. These may be obtained by sections of leaves and stems, or by wetting leaves in water and then gently scraping off the cuticle with a lancet or delicate knife-blade. A portion of the pulp is placed on the slide, gently teased out with needles or pins, and covered with a cover. Water is added or re- moved as may be necessary to make the cover stick; and then proceed as with the first case. Many hours and days could be profitably occupied in the study of hairs. II. — Urinology. — Things needed: microscope, urine (put in a clear wineglass or bottle or tumbler), pipette or catheter, slide, cover, light, bibulant. Suppose we have a case of oxaluria. Having previously decanted the clear urine and poured that portion containing the deposit into the urine glass, tumbler or bottle, note the situation of the deposit. Then holding the pipette between the right thumb and middle finger, close the upper end tightly with the forefinger. Bring the free end of the pipette near to the deposit in the urine, and then remove the fore- finger. The hydrostatic pressure forces the deposit into the tube ; next re-apply the forefinger. Withdraw the tube, and deposit on the middle of the slide owe drop containing the sediment. Apply the cover to the drop. If the amount of liquid is rightly gauged, the capillary attraction will cause the cover to adhere, so that the slide can be turned in any direction, and the cover will not slip. If the cover does slip, absorb the excess of fluid by touching the edge of the cover with a blotter or dry cloth. The specimen is then ready for examination. Proceed, as in the case of the hairs, after bringing the. deposit over the centre of the object, as near as possible. Bemarks. — Be sure the barrel of the microscope is pushed CLINICAL MICROSCOPE PRIMER. 13 hc^ie against the tube of the stand. In the case of a delicate object hke this, it is a good plan to turn the stage quite near to the objective; and then in focussing, it is only necessary to turn the stage off. On having mastered the hair demonstration, the novice had better take oiF the specimen, when in focus, and prepare the urinary deposit, with the same slide and coyer. Having accomplished this, the object comes into focus almost at once. There is, then, an advantage in the use of the same slide and cover for many examinations. If oxalate of lime is present, beautiful and characteristic octahedral crystals will pjainly appear. Once seen, they will not afterwards need identification. Note. — It sometimes happens with such transparent objects as oxalate of lime, that the focussing is difficult. If so, move the slide so that the edge of the cover comes in the centre of the field. Focus it clear, and then move the deposit to the centre of the objective's face, and it will be readily focussed. Also, there is usually too much light with the clinical microscope. If so, the observer may retreat away from it, or darken the room by day time, so as to cut off cross lights. Triple Phosphates (ammonia and magnesia). — These appear in large white and transparent crystals — common and harm- less. Bright's disease — Urine coagulated by heat and nitric acid, large cylindrical bodies (casts), fattily degenerated epi- thelium, granular detritus, etc. Ague plants. — These float in flocks halfway down the col- umn of liquid. Under the microscope, they appear as circu- lar bodies with double periphery enclosing a clear interspace, with a central granular of green or red contents. (Species of Palmellae, described by Salisbury, see American Journal Med. Sciences^ 1866 ; Revue Seientifique, 'Nov. 1869.) (For other pathological bodies, see the systemic works.) Remarks. — The following foreign substances, to be classed as dirt, are found in urine: Cotton, silk, linen and other fibres of textile fabrics, feathers, silica, woody fibres, bast, pitted cells, etc, yeast plants, and often fungi, etc. Bacteria and Vihriones. — Keep urine for a few days until it stinks. Put a drop under the cover, removing the excess 14 CLINICAL MICROSCOPE PRIMER. with a bibulant. Examined under the microscope, number- less minute swarming threads or rods, combined with dots, all in protoplasmic motion, will be clearly seen. If it is de- sired to amplify them more, attach to the stand a tube of 10 inches length, of pasteboard or of brass, whose diameter is sufficient to receive the eye-piece at one end, and at the other end to fit the barrel or tube of the microscope. Thus a greater distance of the eye-piece from the object is obtained, and consequently an enlargement of the object, on the prin- ciple of shadows lengthening as their course is removed from the source of light. Note. — Bacteria are often confoufided with the spores of entophytal [evroa within; (porov^ life or being) alg?e and fungi. This department needs study more than any other, as there is so much difference of opinion amongst authori- ties. It is probably true that bacteria are mixed with the spores of the vegetation — for example, of a yeast in the case of the fetid putrefactive fermentative vegetation. In place of exhaling carbonic acid gas, they give off sulpho-hydric acid gas and other gases, possibly phospho-hydric ; so that bacteria do not form all the bodies found in fetid urine. They are mingled with the spores of other vegetations in the same way £ls in a phanerogamous forest all the trees are not of the same species. Urinological evidence must always be taken in connection with the rational and physical signs accompanying. At present, the urine receives more attention than any other ex- cretion or tissue. There are others equally and more impor- tant. To give anything like a complete idea of urinoscopy is out of the question. (See Beale's Microscope in Medicine ; also, Richardson k Wyeth on the Microscope.) The following list of substances to be found in urine is taken from Beale, in addition to those already named: 1. Starches of difierent grains. 2. Fragments of tea leaves, spiral tissue and paren- chyma. 3. Oil from catheter, milk or butter. 4. Mustard, cheese, potato skin, fruits. (These the student should study and know away from urine.) 5. Uric acid. 6. Cystine. 7. Carbonate of lime. 8. Sarcin^ (found at Fresh Pond and CLINICAL MIcnOSCOPE PRIxMER. 15 a lagoon at Oak Bluffs, Mass.). 9. Spermatozoa. 10. Casts of the seminal tubes. 11. Dumb-bell crystals of the oxalate of lime. 12. Casts of uriniferous tubes — -epithelial, waxy, fatty, granular. 13. Chyle. 14. Urates. 15. Phosphate of lime. 16. Cancer cells, exudation corpuscles. 17. Small organic globules (Golcling-Bird). 18. Granular matter, &c. III. Mouth. This is a handy site for microscopic investiga- tion. Take a clean slide and cover; gently scrape the upper surface of the tongue with the cover itself or with a knife blade, collecting only a small drop of not more than \ inch longest diameter ; place the cover with the drop on the slide, or deposit a drop from the blade on the slide, covering as before. If properly managed, the cover will adhere to the slide, and it can be put in any position. Place this prepared slide on the stage and focus as described be- fore. The following objects should be seen if the observa- tion is made before or sometime after a meal, which scours off the tongue rapidly. 1. Epithelial Cells. — These are flat, wrinkled, irregularly squared bodies, with a nucleus or spot within. Sometimes there are two. ^ They line the mouth, cover the tongue, and are found on all the mucous surfaces of the body (see systemic works). 2. Globes filled with granules actively moving with protoplasmic motions; also containing nuclei.^ These are mucous corpuscles with -the famous Brunonian movements. They are a good test for an objective. To bring out well the dancing movements of the minute points is also a good test of the observer's powers. It would be Avell to lengthen out the tu])e as just described. 3. Filaments of an Alga. — Some call it a fungus vegetation that grows harmlessly with its host. .. The filaments are very delicate and subtile. It is known as the leptothrix buccalis. 4. Masses of Spores which may or may not belong to the lep- tothrix. 6. Some of the papillce of the tongue. 6. Vegeta- tions about the teeth from decaying particles of retained food. 7. Foreign substances, etc. Mouth in Disease. — Aphthoe are examined by scraping off some portion of the white pellicle and depositing on a slide. It is then covered. If there is not enough moisture to hold on the cover, a small drop of water placed on the periphery 16 CLINICAL MICROSCOPE PRIMER. will penetrate "anderneath tlie cover and hold it by attrac- tion. If the specimen does not show filaments, spores and sporangia (spore cases), it may be from the fact that it is not teased apart enough. A layer of too great thickness can be thinned by tearing into small shreds by pins or needles. So, also, can the membrane in croup, or diphtheria, etc., be studied. Sputa embrace not only the discharges from the mouth, but also from the pharynx, larynx, trachea and bronchial tubes. The productions of so large a territory with thous- ands of glandular structures, furnish a collection motley in disease. We name some : 1. Clear, structureless mucus, in which the form elements float. 2. Epithelial cells — pave- ment, cylindrical and ciliated. 3. Mucous cells, protoplas- mic, and usually undergoing the amoeboid (amoeba means changing) movements. They appear in all sorts of weird, bizarre shapes, found best in acute bronchitis and catarrh. 4. Blood in pneumonitis and hsemoptysis. 6. Curling spiral pulmonary tissue (phthisis). 6. Fungi — vegetative mycelial [fiuKo^^ mushroom) filaments, spores, sporangia. 7. Foreign substances inhaled in the air. 8. Calculi of the lung (Salis- bury). 9. Asthmatos ciliaris in contagious colds. (See Va. Med. Monthly, I^ov., 1878, and April, 1879.) Nasal excretion contains mucous cells, concretions of more or less solidity, pus, blood, ciliated and non-ciliated epithe- lium, dirt, asthmatos ciliaris, vegetative filaments, pollen (hay-asthma), etc. The tears are remarkably free from any form elements ; but in the contagious colds, the asthmatos ciliaris is found in the thick, ocular excretion by Salisbury. Epithelium, pus and blood are found in ophthalmi^e. Cata- ract is a good object on which to study fa:ty degeneration. I have found the fibres a darkly- outlined, rough substance, granular, very much different from the clear hyaline fibres seen in health. Ears. — Place the cerumen on a slide, with or without w^ater or glycerine. In the amorphous substance, crystals of cho- lesterine, fungi, pus and blood are found. A drop of miln^ placed on the slide and treated as described above, show^s a field full of globules of fat, all molecularly dancing and CLINICAL MICROSCOPE PRIMER, 17 tumbling about in ceaseless motions. These are physical, not protoplasmic, movements. If the specimen be taken in the first flow of milk, the colostrum corpuscles will be seen as large, aggregated, compound globules. 3Iilk should present no foreign bodies. Swill milk pre- sents such (Piper). Vegetations are readily developed in milk by keeping. It is an instructive study to examine milk often until it is soured. A few comparative examinations of milk of known purity will serve as a standard by which to judge the morphology of diseased or suspected milk. A mi- croscopical should always go with a chemical analysis of milk. We a;re much indebted to the labors of Dr. Piper, of Chicago, for light in this direction. Vaginal discharges furnish a field for the microscope. A drop is deposited as described. Cancer may be thus at times determined. The detection of parasites, the establishment of virility of tbe husband in sterile marriages, the detection of syphilitic and gonorrhoeal vegetations, the presence of spermatozoa in a case of rape, would be of value. Fceces. — This is an extensive but not well -cultivated field. Macroscopic should precede the microscopic examination. A small piece of wood (toothpick) serves to deposit a minute portion on the slide ; the cover holds usually without aid. Among the things to be seen are the eggs of intestinal worms — fermentative vegetations — epithelial cells in various stages of development (cholera). The best dissections of the spiral tissues of plants are obtained from the fseces by stir- ring up with water. Dr. Salisbury has cultivated this repul- sive field, and is the best expert in this department that the writer knows of The Skin is a fruitful field of study. It may be wet with water and then rubbed with a knife blade, for example, and the collected drop may be mounted on the slide ; or the scum of a bath-tub, after a bath without soap, may be 'studied. The following may be looked for : 1. Epithehum without nucleus. 2. Itch insects. 3. Fungi of skin diseases. 4. Foreign substances from the clothing, sweat and atmosphere, cryptogamic spores and filaments, cotton, silk, linen, woolen 2 18 CLINICAL MICROSCOPE PRIMER. and woody fibres, hairs, salts from sweat, starcli grains, cys- tine, fat and fat acids from the sebaceous glands, sand, smoke products, coal dust, harvest bugs, ticks and other insects, vegetations of boils and carbuncles, bloody sweat, come- dones, etc. The study of histology belongs rather to the anatomist and the dissecting room. Still the clinician may study the characters of tumors, outgrowths, the contents of cysts, ab- scesses, etc., which are relieved by aspiration. It is easy to see the form elements of ovarian and fibro-cystic tumors. A drop, treated as before directed, will furnish a field. Though time has not verified Drysdale's ovarian corpuscle and Gluge's compound cells as diagnostic, still their characters are well worth studying. For making thin sections of tissues, they may be set in wax, paraifine or tallow, and cut with a well- sharpened razor — Seller's cutter recommended. The clinician should know the morphology of the air of respiration found in crowded rooms, ill-ventilated apartments, shops, hospitals, of districts infected with disease (contagious or not), of court rooms, of ague districts, of ships, prisons, of school rooms, of sewers, etc. Methods. — 1, Simple exposure of slides smeared with gly- cerine in the apartments named. 2. Arrange a funnel on a vane, so that the wind ^vill always blow through the nose on to the slide placed against it 3. Aspiration by air sucked or blown over or agaiin t the prepared slide. 4. Fill a glass bottle or other vessel with a mixture of salt and ice. *i^ An ex- amination of the drops of water that collect on the outside will furnish some of the forms of matter that float in the at- mosphere. 5. Blow^ air through cotton fibre, which remark- ably arrests foreign aerial bodies; examine the cotton directly, or wash it with water that is known to be free from forms of life or mineral matter, or with which the observer is familiar. It should never be forgotten that air is food, and should be pure. -»> Vegetable Food. — /S'/iarcA.— Scrape a small portion of the pulp of a comm.on potato. Place it on a slide; add a minute drop of water; cover, and treat as before described. The CLINICAL MICROSCOPE PRIMER. 19 beautiful grains of starcli will clearly appear. Once seen, their form cannot be forgotten by the careful observer. Wheat — Place a drop of water on a slide ; stir in a minute portion of flour ; rub with the flat surface of a common case knife into a uniform mixture ; then examine with the mi- croscope. The forms of the starch grains will be seen to vary much from those found in the potato. The same processes applied to rye, oat, corn (maize), barley, sago, tapioca, etc., will give a clear idea of starch and amyloid bodies. In case the cellulose coverings of wheat are ex- amined as found in real Graham flour, dark cells, set like bricks m mortar, are the so-called " gluten cells," on which so much stress is rightly laid as being true nerve food. The changes that occur in cooking is strikingly shown in beans. One has only to make a section of the bean before cooking and compare it with a portion of the same after baking, for example, to satisfy himself on this point. This list might be extended indefinitely ; but it is believed that enough has been indicated to show how much work can be done with this simple clinical microscope by the practical man. With a brief allusion to the examination of the blood we close. The clinical examination of blood is a matter of great importance. The profession is indebted to Dr. J. H. Salisbury for opening up a new physical means of diagnosis by the in- spection of the blood under the microscope. The field is so new that some find it easier to ignore it rather than to study it in detail. I am not prepared to say that everything that Dr. Salisbury has pointed out (some 67 states, conditions and products) are just as he describes ; but I can say that in every- thing he has attempted to point out to me, personally, in the course of 12 years, he has succeeded in doiug. I think I am doing no wrong to ask the profession to attend to what I have to say and to show, especially as I state nothing but what I believe to be the truth, and have demonstrated, to my own satisfaction if not to others. ( Vide "Blood Exami- nations," by Dr. SaUsbury; published by Moorhead, Bond & Co., l^ew York, 1868. Also, a paper on the Morphology of Diseased Blood. Southern Olinic, March, 1879.) Preliminaries. — It is necessary to have the patient, the mi- 20 CLINICAL MICROSCOPE PRIMER. croscope, the light, the means of withdrawal of the blood (a lancet — spring lancet — the scarificatorof the writer, a needle, which is not the best thing) all together. There is no such thino; as taking^ the blood home to examine. The chan:i:es CD !^ CD are so rapid that most of the important ones disappear in ten minutes time. Still, after these are gone, many valuable points remain to be looked for. Kind of Blood. — The capillary — not the venous nor arte- rial. Site of Withdrawal. — On the radial edge of the forearm be- tween the wrist and elbow. The skin should be clean and free from hair. If dirty, wash with soap suds or ammonia water. Note. — It is well that the beginners should study the skin surface, dirt and epithelium, before looking at the blood. Take the patient's forearm in the hand and make the skin tense in the interval between the thumb and forefinger. A quick puncture is then made about one-eighth of an inch deep. The tension of the grip will squeeze out a' drop of blood. The size of the drop should bear a direct relation to the size of the cover. If of the right size, the blood will diffuse itself uniformly between the cover and slide. The cover will not slip. If there is too little blood, the corpus- cles will become crenated — that is, wrinkled from a sort of protoplasmic action induced by too much dryness in the space about the blood. If there is too much, the superfluity will float the cover about ; there will be too much thickness of the film, and it will crowd the red corpuscles so much as to render them indistinguishable. The excess must be removed by a bibulant. Very much depends on handling the drop of blood rightly. When the drop evenly diff'uses itself, it is presumed that the film is about uniform in thickness, so that one can judge somewhat as to the comparative number of corpuscles in each specimen. The process of transferring the blood should not take but a few seconds of time ; a frac- tion should be sufiicient. Of course, the slide and cover should be previously clean- ed, and also the microscope should be free from dirt and in focus, as after a previous use. If the blood specimen is CLINICAL MICROSCOPE PRIMER. 21 quickly placed on the stage, it will be in focus at once, and the rapid movements, changes, and morphological elements will be visible. The novice had better scrutinize carefully everything he sees — not caring whether he knows the name ol the object or not. The following is the Salisbury plan : For our purpose, we will divide the field into three divi- sions. (1.) The colored corpuscles. (2.) The colorless cor- puscles. (3.) Serum. "Note the following about the red corpuscles: (i.) In normal proportion. (2.) In excess. (3.) In diminished quantity. (4.) ]N"ormal consistence. (5.) Too soft, plastic, and sticky; adhering together and being drawn out in thread-like prolongations. (6.) l!^ummulated, like rolls of coin. (7.) ^ot nummulated. (8.) Evenly and loosely scat- tered over the field. (9.) Slightly grouped. (10.) In irreg- ular, compact masses. (11.) In ridges. (12.) Holding firmly the coloring matter, yet soft and plastic. (13.) High-colored, smooth and even in outline, hard and rigid. (14.) Allowing the coloring matter to escape freely, obscuring their outlines. (15.) Mammilated. As to colorless corpuscles, note if they are (1) In normal pro- portion. (2) In too small quantity. (3) In excess. (4) 'Nor- n:al in quantity, sticky and plastic, endangering the formation of thrombi and emboli. (5) Eagged and broken down. (6) In excess ragged and broken. (7) In excess, smooth and even. (8) Containing vacuoles. (9) Containing vegeta- tions that distend them to an enormous size. As to serur)i, note (1) Too little. (2) Too much. (3) for- mal. Also, the following foreign matters : 1. Minute grains and ragged masses of black, blue, brown or yellow pigment. 2. Fat. 3. Amyloid matter. 4. Broken-down parent cells. 5. Thrombi of fibrin, filled or not with granular or crystal- line matters. 6. Thrombi of algse spores. 7. Thrombi of algse filaments. 8. Algse filaments and spores without ag- gregation. 9. Fungi spores. 10. Fungi filaments. 11. Ox- alate of lime. 12. Crystine. 13. Phosphates. 14. Stelline. 15.^ Stellurine. 16. Granules and crystals of a miscella- neous character. 17. Conchoidine. 18. Pigmentine. 19. 99 CLINICAL MICROSCOPE PRIMER. Euciiie. 20. Creatine. 21. Uric acid and urates. 22. In- osite. 23. Zymotosis regularis spores. 24. Zymotosis regu- laris mycelial filaments. 25. Entophyticus hfematicus spores. 26. Spores of mycelial filaments. 27. Penicillum quadrili- dum spores and mycelial filaments. 28. Penicillum botrytis infestans. To cite a specific example, take syphilis (see American Journal Medical Sciences^ April, 1867) : If the novice takes a well-marked case in the later stages, and collects the blood as designated, he will find that the white, corpuscles are en- larged and distended with the entophytal growths ; also, some cylindrical, smooth, uniform, clubbed at the ends, my- celial filaments of crypta syphilitica, which are copper-col- ored when slightly turned off from the focus ; also, if the light is good, small spots will appear in profusion, which must be distinguished from globules of fat, that are copper- colored, and have the protoplasmic movements of ordinary spores, to wit. : they dance about in the serum spaces ; and besides, their lateral movements, which might be taken for physical motions, they locomote often, moving by each other in opposite directions. Also, they may be seen to dissipate under the eye and be lost to the vision. Moreover, they are seen inside the white corpuscles to be of a red color. I have found the copper-colored spores and enlarged white corpus- cles in all cases that I have examined. The filaments are not so readily found. Whatever else may be said of this diagnosis, I can say for myself that I have found it invalua- ble in my own practical experience. I have been able thus to treat cases that otherwise w^ould have baified me. I don't think that the value of this physical exploration can be too highly estimated. The Pre-Emholic State. — (See Chicago MedicalJournal, Feb., 1879.) If the blood of a rheumatic is examined often, there are found, according to Dr. Salisbury [American Journal Med- ical Sciences^ October, 1867, page 350), microscopic thrombi (Figure 5, page 376, ut supra). The nucleus of these is a collection of white corpuscles, a collection of crystals, &c. They form skeins like a sailor's fancy coil of rope, or masses irregularly rounded and pointed, like a boy's A kite. JSTow CLINICAL MICROSCOPE PRIMER. 23 these thrombi, of a microscopic character, are found in the blood long before there are any signs of embolism. They are quite large and easily distinguished. The attention of the novice is directed to this as an important point in all re- spects. Rheumathm., — (See American Journal Medical Sciences^ October, 1867.) Ague. — (See American Journal Medical iSciences, October^ 1866.) To collect the ague plants in the natural habitat, I have found an easy task. During the month of August, visit an ague locality; examine the surface of earth that has been spaded up within a month ; note the fine white dust, as if the earth had been sprinkled with fine salt. Take a minute por- tion of this dust; place it in a slide; add a drop of water; rub up with a knife-blade, cover, absorb the excess with a bibulant, and then place under the microscope. The field will be found swarming with millions of spores. These are small, minute dots, that dance w^ith ceaseless motions to and fro, .here and there, yet never jostling each other. If this motion is compared with that found in milk, the difference will be seen betw^een the molecular motions and the proto- plasmic. Scattered here and there, will be seen round bodies like a coin, twdce the size of a red blood corpuscle, with an outer wall next a clear space, then another wall and next the protoplasmic contents. These are fully described in the American Journal Medical Sciences {loco citato). If the ob- server wall scrape a very minute portion of the soft, spongy, sometimes greenish, surface of the banks of some streams in the ague districts, he will secure some fine specimens of the plants Dr. Salisbury has so w^ell described. Be not discour- aged if you don't get them at first. Allow me to relate a bit of my own experience. Soon after Dr. Salisbury's paper appeared, I wrote to him to send me some earth. He did so. I labored on it for some tirhe, but without getting a single specimen. I inferred that I was w^rong — not the author. So I went 700 miles and carried a box of the earth, to have the discoverer show me, in person, just how he collected the plants. He took my box and, in a few seconds, displayed the forms under the microscope just 24 Clinical miceoscopb primi:h. as be had described. My trouble was that I took too large a quantity of material. In thus confessing my own incompetency, and its speedy disappearance under the eye of the master, the writer would like to suggest to those who should follow the procedures that I have laid down in this primer, and should not succeed, that the trouble must not be laid to the writer too strongly, as the printed page is but a poor substitute for the kinder- garten mode of instruction. As long as the writer cannot be favored with the personal presence of the pupils, he has done the best he could. In closing, allow me to say that Dr. Salisbury, after de- monstrating the presence of the plants in the soil, showed to me afterwards the plants in the blood of a patient (the blood was drawn in my presence), in the urine, and in the sputa. Having much exceeded the limits of my primer, I must close by saying that the presentation has been, of necessity, very laconic and brief. Perhaps it may answer as a fit step for some mind in the profession who is in earnest in his bat- tles with disease, I hope that the microscope may not be relegated to the younger members of our profession alone. It is an instrument for old age. Ehrenburg worked with his microscope up to a few days of his death. The focussing accommodates the defects of vision. Moreover, it is a com- fort and a solace to an aged physician to quietly explore the mysteries of the unseen world he has been dealing with ma- croseopically during a long and laborious life. May it be a good preparation for that endless life where we shall no longer see through a glass darkly ! Tremont Temple, 18T9. POSTSCRIPT. This primer is merely a prelude to the systematic Trorks. So is the Clinical Microscope. When this has been mastered the student may essay either the student's stand (see cut No. 1) or the magnificent B stand of Tolles (see cut No. 2). No. 1. No. 2. Tlie following works are recommended and for sale by CHAKILES STODDER: — Micrographic Dictionarj' $21 00 Carpenter on the Microscope 5 00 Hogg 3 00 Frey, Microscopical Technology 4 00 Newcomh, Popular Astronomy 4 00 Subscriptions received for the following Periodicals: — Journal Royal Microscopical Society, London, bimonthly 6 00 Quarterly Journal Microscopical Science * 5 00 Journal Queckct Microscopical Club (irregular) , per ntmiber 40 Science Grossip, London, monthly, contains articles on Microscopy 1 50 Cincinnati Medical News, monthly, has a Microscopical Department 2 00 American Monthly Microscopical Journal 1 00 TO THE FOLLOWING GENTLEMEN C^is Work b g^bicatttr : Dr. JAMES H. SALISBURY, Cleveland, Ohio. Dr. GEORGE B. HARRIMAN, 94 Tremont Street, Boston. Dr. LOUIS ELSBERG, Girt 6th Avenue, 2^ew York. Dr. W. R. WEISAGER, Manchester, Va. Dr. R. U. piper, Chicago, III. Dr. a. W. ^YHITLN-G, Canton, Ohio. Prof. PAULUS F. REINS CH, Erlangen, Prussia. Dr. E. M. STEESE, Brookline, 3Iass. Mr. G. D. smith, 394 Washington Street, Boston. MY ASSOCIATES IK THS AMEBIC AK mSTITUTE OF MICBOLOGY. WHICH HAS BEEN ORGANIZED TO FOUND A NEW SCHOOL OF THE MICROSCOPE. Lists of the "Works of these Authors to Ju-ly, 1878. PuMi^lied Wofk^ k^l ?kj)ei^^ J. H. SALISBURY, A. M., M. D. 1. Analysis of Fruits, Vegetables and Grains. N. Y. State Geological Reports. 1847-48-49. 2. Prize Essay. — Chemical Investigations of the Maize P. ant in its various stages of growth, with tlie temperature of the soil at various depths, and that of trees in diifereiit seasor^s of the year. 206 pages. State Agricultural Reports of N. Y. and Ohio. 1849. 3. Chemical Analysis of Five Varieties of the Cabbage. 1850. 4. Rheum rhaponticum. Chemical examination of the various parts of the Plant. 1850. 5. Chemical Examination of Rumex crispus. 1855. 6. Experiments and Observatiou on the luflueuce of Poisons and Medicinal Agents upon Plants. 1851. 7. Chemical Examination of the Fruit of five (5) varieties of Apples. 1850. 8. Chemical Investigations connected with the Tomato, the Fruit of the Egg Plant, and Pods of the Okra. 1851. 9. History, Culture and Composition of Apium graveolens and Cichorium intibus. 1851. 10. Some Facts and Remarks on the Indigestibility of Food. 1852. 11. Compositions of Grains, Vegetables and Fruits. Ohio State Agricultural Reports. 1861. 12. Microscopic Researches, resulting in the discovery of what appears to be the cause of the so-called "Blight" in Apple, Pear, and Quince Trees, and tlie decay in their fruit; and the discovery of the cause of the so-ca.\\ed *^ Blister ajid Curl" in the leaves of Peach Trees; with some observations on the development of the Peach Fungus. Illustrated with 6 plates. Ohio State Agricultural Reports. 1863. 13. Chronic Diarrhoea and its Complications, or the diseases arising in Armies from a too exclus- ive use of Amylaceous Food, with interesting matter relating to tha Diet and Treatn ent of these abnormal conditions, and a new Army Ration proposed with which this large class of diseases may be avoided. The Ohio Surgeon General's Report for 1864. 14. Something about Cryptogams, Fermentation and Disease. St. Louis Medical Reporter. February, 1869. 15. Probable Source of the Steatorzoon folliculorum. St. Louis Med. Reporter. January, 1869. 16. Investigations, Chemical and Microscopical, resulting in what appears to be the Discovery of a New Function of the Spleen and Mesenteric and Lymphatic Glands. Do., Aug., 1867. 29. pages. 17. Defective Alimentation a Primary Cause of Disease. Do. March and April 1 & 15, 1868. 70 pages and two plates of illustrations. 18. On the Cause of Intermittent and Remittent Fevers, with Investigations which tend to prove that these affections are caused by certain species of Palmellas. Am. Jour. Med. Sciencs, 1866. Also in Revue Scientifique. Nov., 1869. 19. Some Experiments on Poisoning with the Vegetable Alkaloids. Am. Journal Medical Sci- ences. Oct., 1862. 28 pages. 20. Discovery of Cholesterine and Seroline as secretions in health of the Salivary, Tear, Mammary, and Sudorific Glands; of the Testis and Ovary; of the Kidneys in Hepatic Derangements; of Mucous Membranes when congested and inflamed, and the fluids of Ascites and that of Spina Bifida. Do., April, 1863. 2 plates. 17 pages. 21. Remarks on Fungi, with an account of Experiments showing the influence of the Fungi of Wheat and Rye Straw on the Human System, and some observations which point to them as the probable source of Camp Measles, and perhaps of Measles generally. Do., July, 1862. 1 plate. 20 pages. 22. Inoculating the Human System with Straw Fungi to protect it against the contagion of Measles, with some additional observations relating to the influence of Fungoid growths in producing disease, and in the Fermentation and Putrefaction of Organic Bodies! Do., October, 1862. 8 pages. 23.'Parasitic Forms Developed in Parent Epithelial Cells of the Urinary and Genital Organs, and in the Secretions. "With 34 illustrations. Do., April, 1868. 24. Remarks on the Structure, Functions and Classification of the Parent Gland Cells, with Microscopic Investigations relative to the causes of the several varieties of Rheumatism, and directions for their treatment. 1 plate of illustrations. Do,, Oct., 1867. 19 pages. 25. Microscopic Researches relating to the Histology and Minute Anatomy of the Spleen and Lacteal and Lymphatic Glands, showing their ultimate structure and their organic ele- ments, of' their highly interesting and important functions, with some remarks on the cause of ropiness of Mucus and the tendency of all healthy and many diseased cells to be metamorphosed into filaments. 1 plate. 34 pages. Do., April, 1866. 26. Description of two new Algoid Vegetations, one of which appears to be the specific cause of Syphilis, and the other of Gonorrhoea. With 16 illustrations. Do., 1867. Also Zeitschrift fur Parasitenkunde. 1873. 27. Geological Report of the Mill Creek Canal Coal Field. With one map and 2 plates. Pub- lished in Cincinnati, 1859. 28. Analysis, Organic and Inorganic, of the Cucumber. Cultivator, 1849. 29. Experiments on the Capillary Attractions of the Soil, explaining some important and inter- esting principles and phenomenon in Agriculture and Geology. The American Polytechnic Journal. 1853. 30. A New Carbonic Acid Apparatus. Do. 1853. 31. Analysis of Dead Sea Water. 1854. 32. Two interesting Parasitic Diseases; one we take from sucking Kittens and the other from, sucking Puppies, — Trichosis Felinus and T. Caninus. Boston Medical and Surgical Jour- nal, June 4th, 1868. Gillus. Also, Zeitschrift fur Parasitenkunde, Hallier. Jena., 1875 33. Pus. and Infection, Boston Journal of Chemistry. January, 1878. 34. Microscopic Examinations of Blood and the Vegetations found in Variola, Vaccine and Typlioid Fever. 66 pages and 62 illustrations. Published by Moorbead, Bond & Co. : New York. 1868, 35. Vegetations found in the Blood of Patients suffering from Erysipelas. Halliers Zeitschrift fur Parasiteiiknnde. 1873. 8 illustrations. 36. Infusorial Catarrli and Astlinia. 18 illustrations. Do,, 1873. 37. Analysis, Organic and Inorganic, of the White Sugar Beet. The Albany Cultivator. Oct., 1851. 38. Analysis, Organic and Inorganic, of the Parsnip. N. Y. State Ag. Report. 1851. 39. Ancient Rock and Eartli writing and inscriptions of the Mound-builders, with a description of their fortifications, enclosures, mounds and other earth and rock works. 49 plates lu the hands of the American Antiquarian Society, and only partially published in their trans- actions and in the Ohio Centennial Report. 1863. 40. Influence of tlie position of the body upon the Heart's action. Am, Jour. Med. Scien. 1865. 41. Material Application of Chemistry to Agriculture. Albany Cultivator. 1851. 42. Analysis, Organic and Inorganic, of the several kinds of Grains and Vegetables. The Albany Cultivator. Aug., 1849. TTzxp-CLlolislied. "^TsT^orlsis SLncS. iE^a^pers. 1. Diphtheria, its Cause and Treatment. 3 plates of illustrations. 1862. 2. Asthnui, the various forms of, and their causes and treatment. 3 plates of illustrations. Ready for press since 1866, 3. Consumption, its causes and treatment. 4 plates. Ready for press in 1867. 4. Hog Cliolera, its Cause and Prevention. 1858. 5. Ultimate Structure and Functions of the Liver. 1865 3 plates. 6. Ultimate Structure and Functions of the Kidneys. 1864. 2 plates. 7. Geological Report of the Coal Fields of Virginia and Kentucky. 1857. With maps and many illustrations. 8. Histology of Phmts, Prize Essay. 65 illustrations. 1848. 9. Causes and Treatment of •'Bright's Disease." 1865. 10, Causes and Treatment of Diabetes, 1864. 11, Causes and Treatment of Goitre, Cretinism, Ovarian Tumors, and other Colloid Diseases. 1863. 12. Causes and Treatment of Progressive Locomotor Ataxy. 1867. 13. Cause and Treatment of Fatty Diseases of the Heart, Liver and Spleen. 1864. 14. Cause and Treatment of Paresis. 1865, 15, One of the most Common Causes of Paralysis, with Treatment. 1867. 16 Microscopic Examinations connected with Spermatozoa and Ova, with contents of pollen Grains and modes of development of Zoosporoid Cells, 1860, 17. Cryptogamic Spores in the Tissues of the Living Animal, Their development in food one source of disease, and a cause of fermentation, gangrene or death and decay in organized bodies, 7 plates and 102 illustrations, 18. iSIicroscopic Investigations connected with the Exudation and Expectoration of Angina mem~ branacae and Gangrenosa and Scarlatina Anginosa, resulting in the discovery of the true source of and the pathological process by which tlie exudations are produced; and the further discovery of a peculiar fungus belonging to the Genns Peronospora, developing in the sloughs and membranes, the spores of wliich are infectious and produce the dis- ease; also some general conclusions on the Etiology of Fevers, the peculiar functions of the Epithelial cell envelope, and the probable way in which the system receives a more or less permanent protecive immunity by one attack of certain contagious diseases against a second invasion of the same. 3 plates. 160 illustrations. 1862. 19. Description of several new species of Ascaridae found on and in tlie human body, and a brief account of several new Entozoa. 2 plates and 30 figures. 1865. 20. Investigations connnected with the Cause and Treatment of Paralysis of the Will, Paralysis of the Memory and Paralysis of the entire Intellectual and Moral Faculties, causing a peculiar luental states and Insanity. List of Writings Published by 1. Free Mercury in Vulcanite. Dental Cosmos. March, 1870. 2. The Discovery of Cells with Fibres in the Dentine at the Junction of the Enamel and Cemen- tum. American Journal of Dental Science. May, 1870 Illustrated. 3. The Effects of Animalcules on the Teetli. Do. Nov., 1870. Do. 4. Tlie Discovery of Nerve Fibres in the Soft Solids of the Dentine, Dental Cosmos. Jan., 1870, 5. Bone Fibrous. American Journal Dental Science. Illustrated. June, 1871. 6. Tlie Structure and Development of the Teeth, Dental Register. July, 1872, Illustrated. 7. The Period when the Teeth Begin to Form. Do. August, 1872, 8. 1^ the Dentine Tubular? Do. September, 1872. Illustrated. 9. Tlie Dentine Cellular and Fibrous. Do. 1872. Illustrated 10. What AVill Make Good Teetb? Do. Nov., 1872. 11. AVhat Makes Teeth Decay? Do. 1874. 12. Anaesthetics— Three Deaths from Chloroform and Ether. Do Deo., 1874. 13. The Microscope in Analysis. New Bedford Mercury. January, 1872. 14. Tlie Microscope. Dental Register. March, 1874. 15. Anaesthetics. Do, January, 1875. IG. The Use of 1-75 Objective in Micro-Chemical Examinations of Blood Stains. 17. Professional Success. 18. The Fifth Pair of Nerves. Partial List of Published Papers and Works — OF— Dr. EPHRAIM CUTTER, July, 187S. 1. Case of Thoracentesis. Boston Med. and Surg. Journal. 1857, 2. Dr. N. R. Smith's Anterior Si)lint. Mass. Med. Society. Com. 1858. 3. Report on the Zymoses of 1857 as they occurred in the Middlesex East District Medical So- ciety. Do.. 1858. 4. Report on th^; VHiatrum Viride, in connection with Truman Rickard, M. D., and "W. Ingalls, M, D. American Journal Med. Sciences. Jan., 1858. 5. Do., do., 1860. Second Report. 6. Experiments with Animal Vaccination. B. M. and S. J. 1860. 7. On Kerosolene as an Anaesthetic. Do. 1860. 8. On the Laryngoscope and Rhinoscope. Do. Vol. LXIX., No. 20, page 389. 9. Veratrum Viride. London Lancet, 1862, 10. Veratrum Viride. Dublin Quarterly Journal of Medical Sciences. 1862. 11. Veratrum Viride. London Medical Sciences and Gazette. 1862. 12. Emploi Tlierapentique du Veratrum Viride. Gazette hebdomadire de Med. et de Chemique* Paris, 1862. Also in Pamphlet form 13. Veratrum Viride, Rankins' Abstract. London, 1862. 13. Practical Uses of the Laryngoscope and Rhinoscope in Diagnosis. B. M. and S. Journal. Several papers. 1866-7. 15, Case of Aplionia cured by extirpation of a neoplasm on the vocal cords by laryngotomy. A. J. M. S, Oct,, 1866. Remains so. 1878. 16, Apparatus for Bedridden Patients. Do, Jan., 1867. 17, On the Apparatus for the Nebulization of Medicinal Substances, M. and S. Reporter. Phila. Vol. XV,, No, 3, page 60, Also Com, Connecticut Med. Society. 1866. 18, On the Contemporaneous Investigation of Therapeutical Substances. 1?.M, andS,J. 1863. 19, Case of Nephritic Calculus Complicating Labor, B. Jour, Chemistry. 1867. 20, On the Attacliment of Sponge to Metallic Bougies, Do, 1868. 21, Reports of the Midd. East District Med. Society. Several published. B. M, and S. J. 1857-G8 22, On the Normal ConditioU of the Eustachian Tube, Do, Feb., 1867 23, Veratrum Viride as a Tiierapeutical Agent. Pamphlet. Riverside Press, II. O. Houghton & Co. Cambridge. 1862. 24, Modes of Administration of Systemic Anaesthetics. B. M. & S. Jour. Vol. LXXVI. p. 117. 25, Contribution to the Treatment of Retroversion of the Uterus, Do, Nov, 26, 1868. 26, On the Feasibility of Public Baths in Woburn. Middlesex Co. Jour. April 4, 18G8. 27, How to Vaccinate with the Crust from Kine. B. Jour. Chemistry. Sept., 1868. 28- Carbolic Acid. Do. Oct., 1868. 29. Book Notice of Dr. Salisbury's Microscopic Examinations of the Blood. Do. Do. 30. Vaccine Virus from Kine. Do. Nov., 1868. 31. Cotfee as a Deodorizer. Do. 22. About the Laryngoscope. Do. Do. Feb., 1869. , 33. Benzoated Oxide of Zinc Ointment. Do. 34. A New Clinical ]\Iicroscope. Do. April, 1869. 35. Extra Laryngenl Operation for the Removal of Growths upon the Vocal Cords. B. M. and S. J. Feb. 18, 1869. 36 & 37. Observations on the Illuminations in Laryngoscopy. B.J. C. June and July, 1869. 38. Another Parasite in the Pig, Do. Aug., 1869. 39. A New Metallic Suture. Do. Do. 40. Urethral Calculus. B. M. and S J. Oct. 7, 1870. 41. Nasopharyngeal Polypus removed through the mouth by a modified ecrazeur. Illustrated. B. M. and S Journal. Nov. 24, 1870. 42. Contribution to the Treatment of Hemicrania and Frontal Headache. B. J. C. Do., 1870. 43. Vaginometry. Gynecological Journal of Boston. Nov., 1871. Page 174. 46, Contribution to the Treatment of the Versions and Flexions of the Unimpregnated Uterus. Do. 1871. Published in Pamphlet form 1872. 47. Do. Second Edition. Book form. J. Campbell & Son. 1876. 48. Tliyrotoiny Modified. Pamphlet. Do. 1872. 49. Pliosplionis in Sleeplessness. B. J. C. April, 1872. 50. Odious Odors not always Noxious. Woburn Advertiser. 1871. 51. Water Question, Do. Do. 52. Observation on Eustachian Tubes with a new Catheter. A.J. M. S. April, 1872. 53. Partial Report on tlie Production of Vaccine Virus in the United States, Trans. Am. Med. Asso. Do, in Pamphlet form. 54 & 55. The Physics of Cantation and Phonation. B. J. C. Jan. and Feb., 1873. 56. Case illustrating- the use of the Laryngoscope. B. M. and S. Jour. Nov, 27, 1873. 57. Tlie Piriform Fossae. Do. Do. 58. Com.totlie Water Commissioner of "Woburn in relation to the action of Lead upon Horn Pond Water. Middlesex Co. Journal. July 6, 1873, 59. Report of Section Materia Medica Meeting. Aui. Med. Asso. Philadelphia. 1872. 60. Do. Do, St. Louis. 1873. 61. Glycerined Sponge. Boston Jour. Chemistry. Do. 1873. 62. Indian Meal as a vehicle for heat. Do. Jan., 1874. 63. Treatment of Sore Nipples by perforated corl< shields. N. T. Med. Record. Ai)., 1874, p, 180. 64. Does the use of Flour promote the Decay of Teetli ? Dec, 1874. B. J C. 65. Letter to the Middlesex East; District Medical Society. B. M. and S. J. Dec, 1S74. 66. A new Hypodermic Syringe. B. J. C. 1873. 67. Does the use of Flour promote Affections of the Nervous System? Do. Feb., 1875. 68. Caso of Cancer of Pancreas diagnosed before death and treated with a modifieavings on the Pictorial Art in illustrating microscopic observations, with two original drawings. Chi- cago Medical Journal, March 1877. 18. Treatise on Paints, Oils, and Painting. Chicago. 1874. UNPUBLISHED. 19. Lecture on the use of the Microscope in Legal Investigations, before the College of Law. Chicago, 1879. 20. Lecture on the Life and Writings of "Wm. CuUen Bryant. 1879. 21. Work on the Natural History of Nahant. Forty original etchings, 1863 22. Paper on the Sucking Appar'Btus of the House-Fly. 1878. S3. Paper on Experiments with the Poison of the Rattle-Snake. 1878, 24. Paper on the Disease of the Kidneys in Swill-fed Cattle. 1878. 25. Microscopical Examinations of Vegetable Poisons. Twenty origins plates. 1879. 26. Lecture on Alcoholic Drinks, delivered at the Washingtonian Home, with forty original magic lantern slides, 1878. 27. The Microscope. Paper read before the Illinois State Microscopical Societj 28. Revelations of the Microscope. Lecture delivered before the Young Mens Christian Association. Chicago. 29. Lecture on the use of the Microscope, delivered before the Chicago Society Physicians and Surgeons. 30. Blood Stains. Lecture delivered before the College of Law. 187^). 31. Lecture on Blood, delivered before the West Chicago Medical Society. 187? PUBLISHED IN 1879. 32. Three Papers on Oleomargtarine. With Illustrations. 33. Two Papers on Impure Water. Its connection with Typhoid Fever, Cholera, Dysentery, etc. Boston Optical Works, R B. TOLLES, Proprietor. CHAHLBS STODDEH, SELLINU ASENT, l"Tlie E.ialto'1 131 DEVONSHIRE ST. ToLLES Clinical Microscope . . . . $25 ToLLES Students' Microscope Stands, from 28 to 75 ToLLES C Microscope Stands (Patented) . . 160 ToLLES B Microscope Stands . . . . 225 EYEPIECES AND OBJECTIVES, At Price List, as selected by the purchasers. One incli Objectives, from f 6 to $30 Four inch " " 12 to 35 Two inch " " 8 to 20 Half inch " " 12 to 35 Quarter inch and One-fifth inch Objectives, from . . . 12 to 70 One-eighth inch Objectives, from 20 to 80 One-tenth inch " " . . . . . . 30 to 85 One-twentieth inch " " 80 to 150 A :)ill accessory :^pparaius, Chemicals, and Mounling Materials m STOCK OR MADE TO ORDER. :F*rice Xjist se3:it for IS Oents in. DPosta-gfe Sta^i^-ps. LIBRARY OF CONGRESS O-007 682 073 9 •J^M