INTRAMEDULLARY TUBERCULOMA REMOVED AT THE LEVEL OF THE FIFTH THORACIC SEGMENT OF THE SPINAL CORD

WILLIAM C. KRAUSS
1909 Journal of the American Medical Association  
ing method a too decidedly alkaline (deep blue) stain results, so that the red cells have a purple or blue tinge instead of the normal pink. Old stains, which have been little used, may take on this tendency. This is doubtless due to a slowly soluble alkaline impurity in the dye or dissolved out of the glass in the bottles. It is easily cor¬ rected (see below). With more use the transferred eosin, being acid, will eventually correct it, too. 4. Methyl Alcohol.-This is the factor most often at
more » ... tor most often at fault. I have always used alcohol recently imported for institutional use and, therefore, fresh. If fresh it is neutral in reaction. Old alcohol may become acid be¬ cause of the presence of moisture, which, with room temperature and exposure to light, permits slow oxida¬ tion of the methyl alcohol to formic aldehyd and finally formic acid. Alcohol obtained through jobbers and supply houses in this country may show this metamor¬ phosis. Peebles and Harlow,4 however, after calling attention specifically to this defect, have shown how to correct it. In brief, should the stained smear "fail to show any blue," add a drop of strong alkali (20 per cent, potassium hydroxid) to the bottle of méthylène blue solution; should it be stained "too blue," with the red cells purple, add a drop of glacial acetic acid to the méthylène blue. I find this works admirably. The eosin solution never requires correction-just the méthylène blue. Thus the intensity of either stain in a smear, being strictly a question of chemical reaction in the méthylène blue solution, is absolutely under control. As is well known, different bloods vary in the degree of alkalinity they possess. . With a given stain properly corrected the normal blood shows only a pale blue nuclear stain, whereas a stain from a case of pneumonia takes an intense dark blue nuclear stain. The red cells are stained red, the depth of red and its distribution depending on the amount and distribution of the hemo¬ globin. Should the latter show a purple tinge, the blue stain is too alkaline and should be corrected. The granules in the leucocytes are invariably stained (neutrophilic, eosinophilic, basophilic) regardless of slight differences in the chemical reaction of the stain. In order to have perfect stains of all blood conditions it may be well to have two méthylène blue solutions, the one made purposely more alkaline than the other. Try a smear in each. My observation is that any sample which will stain a normal blood so as to show pink-red erythroeytes, and pale blue nuclei in the polymorphonuclears, suffices for all elements in all blood smears, as in most of the pathologic conditions the blue intensifica¬ tion is greater, and the contrasts more marked. SUMMARY 1. Satisfactory blood-smears may be made by follow¬ ing specific directions. 2. The Harlow stain for blood-smears is utilized in a one-minute method so that it "stains everything" with perfect satisfaction. 3. The method is simple, convenient, and dependable. 4. The physician prepares his own stains to start with. 5. The stain solutions are always ready and keep indefinitely. 6. The stain and method of staining are recom¬ mended for dried smears of all kinds. 7. Peebles and Harlow's observations on corrections of faulty eosin-methylene blue stains render control practically absolute. P a t i e n t . \ p = m -\ A . G., aged 36, American, a wood-working machine hand, entered Buffalo General Hospital, Dec. 26, 1907, com-plaining of general weakness and pain in the left side of chest. History.\p=m-\His father died of old age at 82; mother is living and well at 65. He has five brothers and three sisters living and well. One brother died of typhoid fever at 44. There was no family history of tuberculosis, cancer or rheumatism. Patient had three children living and well; wife had had no miscarriages. Patient had had measles, mumps and whooping cough in childhood and had typhoid fever in 1892; was sick in bed about four weeks. Had influenza in spring of 1907 and a slight attack of pleurisy in summer of 1907. Since that time had been unable to do anything, because of general weakness and pain in various parts of body. Had been hard of hearing in right ear since having had influenza, health being good up to that time. Six or seven years ago patient had an operation for what was probably an hydroeele of left testicle. Last spring the right one began to be similarly affected. About one month before he was seen the left one again seemed to be enlarging. He denied all venereal h'story. His normal weight was from 135 to 140 pounds. One month before he was seen he weighed 117 pounds. Most of his weight had been lost since early in the summer of 1907. Smoked and chewed tobacco and drank moderately. Present Illness.-Since about Dec. 1, 1907, patient had beep growing markedly weaker. He had pain in left chest, especially when lying down and on deep inspiration. During past summer patient had frequent night sweats, and since Dec. 1, 1907. he had had profuse night sweats every night. Had no special cough. Bowels were constipated; during the two weeks before he was seen nothing but an enema proved successful. Examination.-This showed a fairly well developed but poorly nourished man. Pupils reacted normally. Tongue coated with grayish fur. Chest showed poor expansion throughout: less on right in supra-and infraclavicular regions. The heart was normal in size and position. Patellar reflexes were exag¬ gerated, ankle clonus and Babinski sign present. December 27, 1907: On right side in suprascapular re¬ gion, the breathing was bronchial in quality; in the infrascapular, it was exaggerated. Epididymis on each side was very hard and large. Glands in groin were somewhat en¬ larged, also along Scarpa's triangle. Suggestion of ankle clonus; knee-jerk quick. Some crepitus in left knee-joint on flexion ; less in right knee. December 29, 1907: Blood examination showed: hemoglobin, 85 per cent.; red corpuscles, 5,080.000: white corpuscles, 7,200; differential polymorphonuclears, 75 per cent.; large lymphocytes, 5.5 per cent.; small lymphocytes, 14.5 per cent.; eosinophiles, 3 per cent.; basophilics, 2 per cent. January 3. 1908: Fluorosconic examination showed two dis¬ tinct areas of shadow in the left chest. Bight chest was cleir. Left ehest was slightly darker over upper lobe than on the right side same point. Patient returned to his home unim¬ proved after a period of two weeks. The bowel movements became involuntary. A few days later he lost control of the bladder, and the urine passed involuntarily. The legs became suddenly weaker, and the pain in the lower part of the body and right leg increased in severity. He was seen by Dr. E. B.
doi:10.1001/jama.1909.92550230039003 fatcat:nrnwvixxkzb5tn53gimcnnubnu