William S. Ehrich
1915 Journal of the American Medical Association  
ing, it matters not whether he lies on his back, his side or his face, or whether he sits or stands ; if urine is voided it will be collected and retained. When the diaper is loosened the urinal remains right side up. While it was not originally intended to obtain twenty-fourhour specimens, by occasionally emptying the flask, quantitative amounts have been secured. The principal need in infants is a means of procuring a specimen of sufficient quantity for chemical and microscopic examination,
more » ... ee from contamination and without discomfort to the patient or trouble to the nurse. This simple device meets these requirements. It has been in use in the Children's Memorial Hospital for several months. The following is a description of a very simple but exceedingly useful little device to protect the hand in the none Shield for prostatic examinations. too pleasant examination and massage of the prostate gland. A piece of ordinary dentist's rubber dam is cut in a circle which will have a diameter of 5 inches. Through the center of this, a hole three\x=req-\ eighths inch in diameter is made. After an ordinary finger cot is slipped on, the finger is pushed through the center hole, which, of course, fits snugly, leaving a margin of at least three-sixteenths inch overhang. This makes a joint which is waterproof, holds the cot firmly, preventing wrinkles, and absolutely protects the knuckles from any dirt on the external parts. The shield is easily and quickly made, easily cleaned, and costs practically nothing. From the fact that many men who have visited our institute knew nothing of this method, and that "table diagnosis" is in disrepute by many surgeons, it seemed worth while to publish this technic, which I have been using for the past three years. I was led to adopt it by finding that by the usual method of freezing the unfixed tissue, and staining by polychrome methylene blue, sections were sometimes unsatisfactory, and that a diagnosis given in one case was found to be incorrect when further sections were made on fixed tissues. It seems to me that a great fallacy in making diagnoses at the table is the necessity of returning the report within three minutes. The surgeon expects to take his time with his operative procedure, while he expects the pathologist to be limited to a minimum time, and also to take the responsibility of the extent of the operation and the chances of the future of the patient. After my first mistake I refused to use the three-minute method, and frankly told the surgeons that I did not believe I could make a reliable diagnosis under eight minutes. I am happy to be able to say that, in the three years' experience with the following method, the table diagnoses have been confirmed in every case by further examination by the usual laboratory methods. The method is as follows : Just before the surgeon is about to remove the tissue, a large test tube, about 2.5 cm. in diameter, containing about 40 cc. of liquor formaldehydi, is brought to the boiling point and set aside. The removed tissue is laid on a dissecting board and cut with a sharp knife into sections about 5 mm. thick; these are carefully examined for suspicious areas, the selected piece is cut in a square 1.5 cm., put in the liquor formaldehydi, which is heated and allowed to boil for about thirty seconds, the tissue is now put in cold water" for a few seconds, and then sectioned on the freezing microtome in the usual way. The sections are stained for half a rtiinute in Harris acid hematoxylin and transferred in a weak solution of ammonia to bring back the blue color, then are run up through 50, 85 and 95 per cent, alcohols, then into 100 per cent, alcohol saturated with alcoholic eosin, then into carboxylol, put on the slide, blotted with filter paper and mounted in balsam. The section obtained by this method is usually as good as any frozen section obtained by the usual laboratory method.
doi:10.1001/jama.1915.25710490002013a fatcat:oujndbsd2rbq3krz7u6xptnsny