A CASE OF TETANY TREATED BY CALCIUM SALTS

HARVEY B. STONE
1909 Journal of the American Medical Association  
stain and other similar stains wherein a neutral dye (azure-blue) is produced, but this is of no value to the physician and is apt to be confused by the less experienced with the granules in the cytoplasm. It is easy to test the purity of the methyl alcohol in regard to water contents. It should be at least 99 per cent. pure. Such a sample shaken up with about a gram of powdered anhydric copper sulphate in a test-tube and allowed to stand for four hours should show no blue color to the solution
more » ... lor to the solution and only a bare trace of green in the copper sulphate sediment in the bottom of the testtube at the end of that time. A more accurate test is in -hake equal parts of the alcohol and benzol together when any turbidity of the resulting solution proclaims the presence of water. In case of failure with either of the stains it is usually best to test the alcohol first, as 1 have more often found this at fault than the dyes themselves. One peculiarity that may be noted is that it' an absolute methyl alcohol can not be obtained, but one which is at least 95 per cent., the alcohol-soluble eosin (Grübler) will often make a very satisfactory stain where the water-soluble eosin fails. it will be noted from the method given above that a little of the eosin is conveyed by the cover-slip each time into the methylene-blue solution. This is no detriment, and is, in fact, I believe, one of the reasons why the latter solution improves "with age." I have had no success, however, with direct admixture of the two dyes either in equal proportions or various proportions. It is to be noted that this is the scheme of the Jenner stain except that the addition of distilled water is made and a new dye substance (neutral dye) is really formed. In my experience the presence of water in either of the staining solutions accounts for the uncertainty of the stains at various times, their tendency to deteriorate, and for the failure to bring out the nuclei, especially of the large mononuclcar forms, and to stain the granules in the myelocytes. Stains made up at various times will vary somewhat in the intensity of their reactions, but the propensities of any given sample are quickly learned, and as the dye is used over and over again the original 100 c.c. solution will last many months if not years. On account of the supersaturation all that is necessary when the dye gets down near the bottom of the bottle is to render more of it soluble by the addition (if methyl alcohol. I have some stain at hand which is over four years old and will stain thoroughly in ten seconds. It will not overstain if left several hours. SUMMARY 1. The stain for blood smears here advocated for busy physicians is a modified Jenner-Bomanowski (polychrome eosin-methylene-blue), commonly called Skelton's stain. 2. This stain consists of only three ingredients (methyl alcohol, eosin and méthylène blue) and is made up by the physician himself in ten minutes' time. 3. The following directions embody the secret of success with the Skelton stain: 1. Keep the two dye solutions separate. 2. Stain away from the air. 3. ITse pure methyl alcohol and keep the stains uncontaminated with water. -I. Advantages of the stain and method are: 1. Rapidity-one to three minutes for the entire process. 2. Simplicity-no special technic, no guess work, no "eye on the watch." 3. Impossibility of overstaining. I. Polychrome staining acidophilic, basophilic and neutrophilic properties brilliantly contrasted as well as pathologie discolorations. 5. Red cells stained in direct proportion to amount of hemoglobin carried a Tallqvist scale on a microscopic principle. 6. Staining of the blood plates. 7. The ideal parasite and bacterial stain for blood smears. 8. Improvement with age; the stain never deteriorates. 9. Inexpensiveness-the same stain is used repeatedly one to two dollars will buy enough of the ingredients for a lifetime practice. 5. Indication for blood smears: fever or pallor. 6. The physician is urged to make a blood smear (preferably cover-slip) at least in every case where indicated, whether other blood determinations are made or not; for (1) some idea of the number of erythrocytes and the percentage of hemoglobin (in ordinary anemias) can be readily attained; (2) the color index and the leucocyte count can be estimated well within clinical limits; (3) the differential leucocyte count, poikilocytosis, parasites, etc., in other words, the true pathologic picture can be obtained in no other manner; and (4) a permanent record of all these findings is gained wdiich has been easily obtained, and an indication and stimulation for more blood work where necessary. In a recent issue of The Journal1 attention was editorially called to the relation between calcium metabolism and tetany, and reference was made to a paper by MacCallum and Voegtlein2 on the subject. In a preliminary report by these authors, appearing last year,3 I was first made aware of the importance of calcium in tetany, and was prepared to apply clinically the experimental principles evolved by these writers should the occasion arise. Such an opportunity has presented itself, and the purpose of this article is to put on record clinical observations which may be of interest and importance. I have no intention of venturing on an elaborate discussion of the whole question of tetany in a paper primarily simply a case report; but a brief preliminary summary of the work referred to above is necessary, in order to make evident the bearing of the findings in
doi:10.1001/jama.1909.25420400028002a fatcat:ozb3lnp2dbhqtokciukjljm6cq