TABLE 3. Showing Kind of Specimens Examined Per Month and Results. Classification. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. 50 12 74 14 78 3 Gonococci. 35 22 34 17 39 24 Brains. 5 17 10 17 9 15 10 21 Sputum.. Diphtheria. Widal.. 57 320 81 397 95 472 99 371 118 315 140 293 118 249 129 237 144 288 74 298 76 246 59 254 4,930 77 263 64 204 90 262 25 134 23 74 21 94 23 85 17 62 11 80 14 24 48 26 40 12 7 23 16 19 33 12 4 7 12 3 8 3 1 14 10 3 5 11 103 4 ප 7 11 4 1 6 1 10 1 5 6 3 52002 129 1 242 115 130 2,702 9 322 5 2 2 3 3 4 6 1 3 3 202 7,137 14 52 204 1,758 216 2,591 240 1,522 175 860 189 878 212 746 198 709 239 942 257 1,044 515 4,266 330 1,363 251 1,011 20,716 Table 5 shows the total number of specimens examined each month during 1915. The average per month during the whole year is 1,725. In June and July the work was the lightest and it was heaviest in October. There is not a great deal of difference in the number of sputum specimens examined from month to month. Widal specimens are most numerous during July, August and September. Diphtheria specimens are most numerous during the months of October, November and December. Four thousand nine hundred and thirty specimens of sputum were examined for tubercle bacilli and 1,190 or 24 per cent of these specimens contained tubercle bacilli. It is remarkable how uniform are the number of sputum specimens examined from year to year. In 1914 there were 4,947 sputum specimens examined and of these 1,255 were found to contain tubercle bacilli. The following method is used in examining sputum specimens: Antiformin is added to the sputum in the proportion of three parts sputum to one part antiformin. This mixture is then shaken on a Rickard sputum shaker for five minutes after which it is poured into 50 c.c. centrifuge tubes, 30 c.c. of water added and then centrifugated at 3,000 revolutions per minute for ten minutes. The supernatant fluid is poured off by turning the tube upside down very quickly. The residue in the tube is then smeared on a large glass slide which has been previously smeared with Meyer's albumin. This slide is then stained with carbolfuchsin and decolorized with a 20 per cent solution of hydrochloric acid in 95 per cent Ethyl alcohol and then counterstained twice with Loeffler's Alkaline Methylene blue. There has been some criticism of the method of examining sputum: viz. that we fail to find tubercle bacilli in positive specimens. There are acid-fast bacilli in air and food stuffs that closely resemble tubercle bacilli and which ordinary Gabbet's blue will not decolorize but acid alcohol will. Antiformin will not destroy tubercle bacilli under any circumstances but it does seem to destroy some of the other acid-fast organisms. It is possible that the ordinary method of sputum examination may give too many positives. The following is the method used for making up antiformin: (a) Dissolve 15 Grams of sodium carbonate in 25 c.c. of water. (b) Add 10 Grams of chloride of lime to 25 c.c. of water. (c) Dissolve 15 Grams of sodium hydroxide in 50 c.c. of water. (d) Add equal parts of supernatant fluid (a and b) to "c." Only the best chemicals should be used. We have found that if 30 Grams instead of 15 Grams of sodium hydroxide are used the finished product can be diluted one half and the results will be just as good as if the full strength solution had been used. The stock solution should be put into brown bottles and stored in the ice box. We have been able to make antiformin with a drug cost of only about 10 cents per pint. The market price for the proprietary is 50 cents. Recently we have adopted a routine method for examining our sputum smears. The individual smears are made on the slide and are 1 centimeter wide and 5 centimeters long. The microscopic stage is moved 2 milimeters each time the microscope travels from one end of the smear to the other. This means that each smear is examined from one end to the other ten times. This method will under ordinary circumstances give 30 per cent positives and 70 per cent negatives. Of the negatives not less than 10 per cent will contain particles retaining the carbol fuchsin stain. One per cent of these substances will resemble tubercle bacilli to some extent so that one who is not accustomed to seeing tubercle bacilli might call them positive. This simply proves the contention of experienced consultants that acid-fast bacilli in the sputum without clinical symptoms does not always mean tuberculosis. In these uncertain cases another specimen is requested for examination. Many physicians want to know all of the varieties of bacteria in the sputum. Bacteriologists have contended that these findings were of little value because most of the sputum organisms were mouth |