Full download ebook at ebookmass.

com

Urinalysis and Body Fluids 6th Edition

For dowload this book click link below

https://ebookmass.com/product/urinalysis-and-body-
fluids-6th-edition/

OR CLICK BUTTON

DOWLOAD EBOOK

Download more ebook from https://ebookmass.com

More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Diseases of the Human Body, 6th edition 6th Edition,

(Ebook PDF)

https://ebookmass.com/product/diseases-of-the-human-body-6th-
edition-6th-edition-ebook-pdf/

CT and MRI of the Whole Body, 2-Volume Set 6th Edition

https://ebookmass.com/product/ct-and-mri-of-the-whole-
body-2-volume-set-6th-edition/

The Human Body in Health and Illness E Book 6th

Edition, (Ebook PDF)

https://ebookmass.com/product/the-human-body-in-health-and-
illness-e-book-6th-edition-ebook-pdf/

Hydrodynamic Lubrication of Non-Newtonian Fluids Ping

Huang

https://ebookmass.com/product/hydrodynamic-lubrication-of-non-
newtonian-fluids-ping-huang/
Existence Theory for Generalized Newtonian Fluids 1st
Edition Breit

https://ebookmass.com/product/existence-theory-for-generalized-
newtonian-fluids-1st-edition-breit/

Petrophysical Characterization and Fluids Transport in

Unconventional Reservoirs Jianchao Cai

https://ebookmass.com/product/petrophysical-characterization-and-
fluids-transport-in-unconventional-reservoirs-jianchao-cai/

Body Schema and Body Image: New Directions Yochai

Ataria

https://ebookmass.com/product/body-schema-and-body-image-new-
directions-yochai-ataria/

The Body Productive Rethinking Capitalism, Work and the

Body Steffan Blayney

https://ebookmass.com/product/the-body-productive-rethinking-
capitalism-work-and-the-body-steffan-blayney/

Field Theoretic Simulations in Soft Matter and Quantum

Fluids Glenn H. Fredrickson

https://ebookmass.com/product/field-theoretic-simulations-in-
soft-matter-and-quantum-fluids-glenn-h-fredrickson/
3920_FM_i-xv 23/01/14 11:22 AM Page i

Urinalysis
and Body Fluids
SIXTH EDITION

Susan King Strasinger, DA, MLS(ASCP)

Faculty Associate
Clinical Laboratory Sciences Program
The University of West Florida
Pensacola, Florida

Marjorie Schaub Di Lorenzo, BS, MLS(ASCP)SH

Adjunct Instructor
Division of Laboratory Sciences
Clinical Laboratory Science Program
University of Nebraska Medical Center
Omaha, Nebraska
and
Phlebotomy Technician Program Coordinator
Health Professions
Nebraska Methodist College
Omaha, Nebraska
3920_FM_i-xv 23/01/14 11:22 AM Page ii

F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com

Copyright © 2014 by F. A. Davis Company

Copyright © 2014 by F. A. Davis Company. All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the
publisher.

Printed in the United States of America

Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1

Senior Acquisitions Editor: Christa Fratantoro

Manager of Content Development: George W. Lang
Developmental Editor: Molly Mullen Ward
Art and Design Manager: Carolyn O’Brien

As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s)
and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The
author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed
or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards
of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts)
for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently
ordered drugs.

Library of Congress Cataloging-in-Publication Data

Strasinger, Susan King, author.

Urinalysis and body fluids / Susan King Strasinger, Marjorie Schaub Di Lorenzo. — Sixth edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8036-3920-1 (pbk. : alk. paper)
I. Di Lorenzo, Marjorie Schaub, 1953- author. II. Title.
[DNLM: 1. Urinalysis—methods. 2. Body Fluids—chemistry. QY 185]
RB53
616.07’566—dc23
2013021830

Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users
registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222
Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been
arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-3920-1/14 0 + $.25.
3920_FM_i-xv 23/01/14 11:22 AM Page iii

To Harry—you will always be my Editor-in-Chief

—SKS

To my husband, Scott; my daughter, Lauren;

my sons, Michael and Christopher;
my daughters-in-law, Kathleen and Ashley;
and my grandsons, Cameron and Joseph.
—MSD
3920_FM_i-xv 23/01/14 11:22 AM Page iv
3920_FM_i-xv 23/01/14 11:22 AM Page v

Preface

As will be apparent to readers, the sixth edition of Urinalysis Each chapter opens with objectives and key terms and
and Body Fluids has been substantially revised and enhanced. concludes with multiple choice questions for student review.
However, the objective of the text—to provide concise, com- In response to readers’ suggestions, the number of color images
prehensive, and carefully structured instruction in the analysis and figures has been significantly increased. The text has been
of nonblood body fluids—remains the same. extensively supplemented with tables, summaries, and proce-
This sixth edition has been redesigned to meet the changes dure boxes. Case studies in the traditional format and clinical
occurring in both laboratory medicine and instructional situations relating to technical considerations included at the
methodology. end of the chapters offer students an opportunity to think crit-
To meet the expanding technical information required by ically about the material. A new feature, Historical Notes, pro-
students in laboratory medicine, all of the chapters have been vides a reference for topics or tests that are no longer routinely
updated. Chapter 1 covers overall laboratory safety, precautions performed. Another new feature, Technical Tips, emphasizes
relating to urine and body fluid analysis, and the importance of information important to performing procedures. An answer
quality assessment and management in the urinalysis laboratory. key for the study questions, case studies, and clinical situations
Preexamination, examination, and postexamination variables, is included at the end of the book. Key terms appear in bold-
procedure manuals, and current regulatory issues are stressed. face blue color within the chapters. General medical terms
Chapter 6 includes numerous additional images showing appear in boldface in the text and are also included in the
the various urine microscopic components. In Chapters 7 and Glossary. The abbreviations noted in boldface red color have
8 the most frequently encountered diseases of glomerular, been collected in a convenient Abbreviations list at the back
tubular, interstitial, vascular, and hereditary origin are related of the book. An electronic test bank, chapter-by-chapter Power-
to their associated laboratory tests. To accommodate advances Points, a searchable digital version of the textbook, resources
in laboratory testing of cerebrospinal, seminal, synovial, serous, for instructors, and interactive exercises and animations for
and amniotic fluids, all of the individual chapters have been students are provided on the DavisPlus Web site.
enhanced, and additional anatomy and physiology sections We thank our readers for their valuable suggestions, which
have been added for each of these fluids. An entirely new chapter have guided us in creating this exciting new edition and the
(Chapter 15) dedicated to vaginal secretions and covering electronic ancillary supports.
proper specimen collection and handling, diseases, and related Susan King Strasinger
diagnosis laboratory tests has been added.
Marjorie Schaub Di Lorenzo
Appendix A provides coverage of the ever-increasing
variety of automated instrumentation available to the urinalysis
laboratory. Appendix B discusses the analysis of bronchoalveolar
lavage specimens, an area of the clinical laboratory that has
been expanding in recent years.

v
3920_FM_i-xv 23/01/14 11:22 AM Page vi
3920_FM_i-xv 23/01/14 11:22 AM Page vii

Reviewers

Lorraine Doucette, MS, MLS(ASCP)CM

Associate Professor and Medical Laboratory Technician Program Coordinator
Anne Arundel Community College
Arnold, Maryland

Pamela B. Lonergan, MS, MT(ASCP)SC

Medical Technology Program Director
Department of Nursing and Allied Health
Norfolk State University
Norfolk, Virginia

Jessica Loontjer, MLS(ASCP)CM, LS(ASCP)CM

Clinical Instructor, Special Chemistry and Urinalysis/Body Fluids
Nebraska Methodist Hospital Laboratory
Omaha, Nebraska

Michelle Moy, MAd Ed, MT(ASCP)SC

Program Director
Clinical Laboratory Science Program
Loyola University
Chicago, Illinois

C. Thomas Somma, PhD

Associate Professor
School of Medical Diagnostics and Translational Sciences
College of Health Sciences
Old Dominion University
Norfolk, Virginia

vii
3920_FM_i-xv 23/01/14 11:22 AM Page viii
3920_FM_i-xv 23/01/14 11:22 AM Page ix

Acknowledgments

Many people deserve credit for the help and encouragement over the years: Donna L. Canterbury, BA, MT(ASCP)SH;
they have provided us in the preparation of this sixth edition. Joanne M. Davis, BS, MT(ASCP)SH; M. Paula Neumann,
Our continued appreciation is also extended to all of the MD; Gregory J. Swedo, MD; and Scott Di Lorenzo, DDS.
people who were instrumental in the preparation of previous We also thank Sherman Bonomelli, MS, for contributing
editions. original visual concepts that became the foundation for many
The valuable suggestions from previous readers and the of the line illustrations, and the students from the University
support from our colleagues at the University of West Florida, of West Florida, specifically Jennifer Cardenas, Shannel
Northern Virginia Community College, University of Nebraska Hill, Jelma Moore, and William Laguer, who worked under
Medical Center, and Methodist Hospital have been a great asset the guidance of Sherman Bonomelli to produce many of
to us in the production of this new edition. We thank each and the new images. Images for Chapter 14 were provided by
every one of you. Brenda Franks has provided us with many Carol Brennan, MT(ASCP), Diane Siedlik, MT(ASCP), Chris-
valuable documents for reference in this text. The authors thank tian Herdt, MT(ASCP), and Teresa Karre, MD, from Methodist
and acknowledge Pamela S. Hilke, MS, CT(ASCP), Education Hospital.
Coordinator and Instructor, and Sophie K. Thompson, MHS, We would like to express our gratitude for the help, patience,
CT, (ASCP) (IAC), Program Director and Associate Professor of guidance, and understanding of our editors at F. A. Davis: Christa
the Cytotechnology Program at the School of Medical Diagnos- Fratantoro, Senior Acquisitions Editor; George Lang, Manager of
tic and Translational Sciences, College of Health Sciences, Old Content Development, Health Professions/Medicine; and Molly
Dominion University, Norfolk, Virginia, for their contributions M. Ward, Development Editor. We thank all the members of the
of spectacular cytology images. F. A. Davis team who were instrumental in bringing this edition
We extend special thanks to the people who have pro- to fruition: Elizabeth Stepchin, Alisa Hathaway, Carolyn O’Brien,
vided us with so many beautiful photographs for the text and Sharon Lee.

ix
3920_FM_i-xv 23/01/14 11:22 AM Page x
3920_FM_i-xv 23/01/14 11:22 AM Page xi

Contents

PART ONE: Background Suprapubic Aspiration 34

Prostatitis Specimen 34
CHAPTER 1 Pediatric Specimens 34
Safety and Quality Assessment 3 Drug Specimen Collection 35
SAFETY 4 CHAPTER 3
Biologic Hazards 4 Renal Function 39
Personal Protective Equipment 7 Renal Physiology 40
Hand Hygiene 7 Renal Blood Flow 40
Biologic Waste Disposal 9 Glomerular Filtration 41
Sharp Hazards 9 Tubular Reabsorption 43
Tubular Secretion 45
Chemical Hazards 10
Chemical Spills and Exposure 10 Renal Function Tests 46
Chemical Handling 10 Glomerular Filtration Tests 47
Chemical Hygiene Plan 10 Cystatin C 49
Chemical Labeling 10 Tubular Reabsorption Tests 50
Material Safety Data Sheets 10 Tubular Secretion and Renal Blood Flow Tests 52
Radioactive Hazards 11
Electrical Hazards 11 PART TWO: Urinalysis
Fire/Explosive Hazards 12 CHAPTER 4
Physical Hazards 13 Physical Examination of Urine 59
QUALITY ASSESSMENT 13 Color 60
Urinalysis Procedure Manual 14 Normal Urine Color 60
Abnormal Urine Color 61
Preexamination Variables 14
Examination Variables 16 Clarity 62
Postexamination Variables 20 Normal Clarity 62
CHAPTER 2 Nonpathologic Turbidity 63
Pathologic Turbidity 63
Introduction to Urinalysis 27
Specific Gravity 63
History and Importance 28
Refractometer 64
Urine Formation 29 Osmolality 65
Urine Composition 29 Reagent Strip Specific Gravity 66
Urine Volume 29 Odor 66
Specimen Collection 30 CHAPTER 5
Containers 30 Chemical Examination of Urine 71
Labels 30 Reagent Strips 72
Requisitions 31
Reagent Strip Technique 72
Specimen Rejection 31 Handling and Storing Reagent Strips 73
Specimen Handling 31 Quality Control of Reagent Strips 73
Specimen Integrity 31 Confirmatory Testing 73
Specimen Preservation 31 pH 73
Types of Specimens 32 Clinical Significance 73
Random Specimen 32 Reagent Strip Reactions 75
First Morning Specimen 33 Protein 75
24-Hour (or Timed) Specimen 33 Clinical Significance 75
Catheterized Specimen 34 Prerenal Proteinuria 75
Midstream Clean-Catch Specimen 34

xi
3920_FM_i-xv 23/01/14 11:22 AM Page xii

xii Contents

Renal Proteinuria 76 Sediment Examination Techniques 102

Postrenal Proteinuria 76 Sediment Stains 103
Reagent Strip Reactions 77 Cytodiagnostic Urine Testing 105
Reaction Interference 77 Microscopy 105
Glucose 79 Types of Microscopy 107
Clinical Significance 79 Urine Sediment Constituents 110
Reagent Strip (Glucose Oxidase) Reaction 81 Red Blood Cells 110
Reaction Interference 81 White Blood Cells 112
Copper Reduction Test (Clinitest) 81 Epithelial Cells 113
Clinical Significance of Clinitest 82 Bacteria 118
Ketones 82 Yeast 119
Clinical Significance 82 Parasites 119
Reagent Strip Reactions 83 Spermatozoa 120
Reaction Interference 83 Mucus 120
Casts 121
Blood 83 Urinary Crystals 128
Clinical Significance 84 Urinary Sediment Artifacts 138
Hematuria 84 CHAPTER 7
Hemoglobinuria 84
Myoglobinuria 84 Renal Disease 147
Reagent Strip Reactions 84 Glomerular Disorders 148
Reaction Interference 85 Glomerulonephritis 148
Bilirubin 85 Nephrotic Syndrome 149
Bilirubin Production 85 Tubular Disorders 150
Clinical Significance 86 Acute Tubular Necrosis 150
Reagent Strip (Diazo) Reactions 87 Hereditary and Metabolic Tubular Disorders 153
Reaction Interference 87
Interstitial Disorders 154
Urobilinogen 87
Acute Pyelonephritis 155
Clinical Significance 88 Chronic Pyelonephritis 155
Reagent Strip Reactions and Interference 88 Acute Interstitial Nephritis 155
Reaction Interference 88
Renal Failure 155
Nitrite 88
Renal Lithiasis 157
Clinical Significance 88
Reagent Strip Reactions 89 CHAPTER 8
Reaction Interference 89 Urine Screening for Metabolic Disorders 163
Leukocyte Esterase 90 Overflow Versus Renal Disorders 164
Clinical Significance 90 Newborn Screening Tests 164
Reagent Strip Reaction 90
Reaction Interference 91 Amino Acid Disorders 165
Phenylalanine-Tyrosine Disorders 165
Specific Gravity 91
Branched-Chain Amino Acid Disorders 167
Reagent Strip Reaction 91 Tryptophan Disorders 168
Reaction Interference 92 Cystine Disorders 169
CHAPTER 6 Porphyrin Disorders 170
Microscopic Examination of Urine 99 Mucopolysaccharide Disorders 172
Macroscopic Screening 100 Purine Disorders 174
Specimen Preparation 100 Carbohydrate Disorders 174
Specimen Volume 100
Centrifugation 100
Sediment Preparation 101 PART THREE: Other Body Fluids
Volume of Sediment Examined 101
CHAPTER 9
Commercial Systems 101
Examining the Sediment 101 Cerebrospinal Fluid 181
Reporting the Microscopic Examination 101 Formation and Physiology 182
Correlating Results 102
Specimen Collection and Handling 182
3920_FM_i-xv 23/01/14 11:22 AM Page xiii

Contents xiii

Appearance 183 Cell Counts 220

Traumatic Collection (Tap) 184 Differential Count 220
Uneven Blood Distribution 184 Crystal Identification 221
Clot Formation 184 Types of Crystals 221
Xanthochromic Supernatant 185 Slide Preparation 222
Cell Count 185 Crystal Polarization 222
Methodology 185 Chemistry Tests 224
Total Cell Count 186 Microbiologic Tests 224
WBC Count 186
Quality Control of CSF and Other Body Fluid Cell Serologic Tests 224
Counts 186 CHAPTER 12
Differential Count on a CSF Specimen 186 Serous Fluid 229
Cytocentrifugation 186 Formation 230
CSF Cellular Constituents 187
Specimen Collection and Handling 230
Chemistry Tests 193
Transudates and Exudates 231
Cerebrospinal Protein 193
CSF Glucose 196 General Laboratory Procedures 231
CSF Lactate 195 Pleural Fluid 232
CSF Glutamine 195 Appearance 232
Microbiology Tests 195 Hematology Tests 232
Gram Stain 196 Chemistry Tests 235
Microbiologic and Serologic Tests 236
Serologic Testing 197
Pericardial Fluid 236
CHAPTER 10
Appearance 237
Semen 203 Laboratory Tests 237
Physiology 204 Peritoneal Fluid 237
Specimen Collection 205 Transudates Versus Exudates 237
Specimen Handling 205 Appearance 238
Laboratory Tests 238
Semen Analysis 205
Appearance 205 CHAPTER 13
Liquefaction 206 Amniotic Fluid 243
Volume 206 Physiology 244
Viscosity 206
pH 207 Function 244
Sperm Concentration and Sperm Count 207 Volume 244
Sperm Motility 208 Chemical Composition 244
Sperm Morphology 209 Differentiating Maternal Urine From Amniotic
Fluid 245
Additional Testing 210
Specimen Collection 245
Sperm Vitality 211
Seminal Fluid Fructose 211 Indications for Amniocentesis 245
Antisperm Antibodies 212 Collection 246
Microbial and Chemical Testing 212 Specimen Handling and Processing 246
Postvasectomy Semen Analysis 213 Color and Appearance 246
Sperm Function Tests 213
Semen Analysis Quality Control 213 Tests for Fetal Distress 246
CHAPTER 11 Hemolytic Disease of the Newborn 246
Neural Tube Defects 247
Synovial Fluid 217
Tests for Fetal Maturity 248
Physiology 218
Fetal Lung Maturity 248
Specimen Collection and Handling 218 Lecithin-Sphingomyelin Ratio 248
Color and Clarity 219 Phosphatidyl Glycerol 249
Foam Stability Index 249
Viscosity 219 Lamellar Bodies 249
3920_FM_i-xv 23/01/14 11:22 AM Page xiv

xiv Contents

CHAPTER 14 Diagnostic Tests 271

Fecal Analysis 255 pH 271
Physiology 256 Microscopic Procedures 272
Diarrhea and Steatorrhea 257 Vaginal Disorders 277
Diarrhea 257 Bacterial Vaginosis 277
Steatorrhea 258 Trichomoniasis 278
Candidiasis 278
Specimen Collection 258 Desquamative Inflammatory Vaginitis 279
Macroscopic Screening 258 Atrophic Vaginitis 279
Color 258 Additional Vaginal Secretion Procedures 279
Appearance 259 Fetal Fibronectin Test 279
Microscopic Examination of Feces 259 AmniSure Test 279
Fecal Leukocytes 259 APPENDIX A Urine and Body Fluid Analysis
Muscle Fibers 259 Automation 283
Qualitative Fecal Fats 260
APPENDIX B Bronchoalveolar Lavage 293
Chemical Testing of Feces 261
Answers to Study Questions and Case Studies and
Occult Blood 261 Clinical Situations 297
Quantitative Fecal Fat Testing 262
APT Test (Fetal Hemoglobin) 263 Abbreviations 305
Fecal Enzymes 264 Glossary 307
Carbohydrates 264 Index 315
CHAPTER 15
Vaginal Secretions 269
Specimen Collection and Handling 270
Color and Appearance 271
3920_FM_i-xv 23/01/14 11:22 AM Page xv
3920_Ch01_002-026 23/01/14 9:19 AM Page 2

PART ONE

Background
Chapter 1: Safety and Quality Assessment
Chapter 2: Introduction to Urinalysis
Chapter 3: Renal Function
3920_Ch01_002-026 23/01/14 9:19 AM Page 3

CHAPTER 1
Safety and Quality
Assessment
LEARNING OBJECTIVES
Upon completing this chapter, the reader will be able to:
1-1 List the six components of the chain of infection and 1-7 Discuss the components and purpose of chemical
the laboratory safety precautions that break the chain. hygiene plans and Material Safety Data Sheets.
1-2 State the purpose of the Standard Precautions policy 1-8 State and interpret the components of the National
and describe its guidelines. Fire Protection Association hazardous material
labeling system.
1-3 State the requirements mandated by the Occupational
Exposure to Blood-Borne Pathogens Compliance 1-9 Describe precautions that laboratory personnel should
Directive. take with regard to radioactive, electrical, and fire hazards.
1-4 Describe the types of personal protective equipment 1-10 Explain the RACE and PASS actions to be taken when
that laboratory personnel wear, including when, how, a fire is discovered.
and why each article is used.
1-11 Recognize standard hazard warning symbols.
1-5 Correctly perform hand hygiene procedures following
1-12 Define the preexamination, examination, and postex-
Centers for Disease Control and Prevention (CDC)
amination components of quality assessment.
guidelines.
1-13 Distinguish between the components of internal
1-6 Describe the acceptable methods for handling and
quality control, external quality control, electronic
disposing of biologic waste and sharp objects in the
quality control, and proficiency testing.
urinalysis laboratory.

KEY TERMS
Accreditation External quality assessment (EQA) Postexposure prophylaxis (PEP)
Accuracy External quality control Precision
Biohazardous Fomite Preexamination variable
Chain of infection Infection control Preventive maintenance (PM)
Chemical hygiene plan Internal quality control Proficiency testing
Clinical Laboratory Improvement Material Safety Data Sheet (MSDS) Quality assessment (QA)
Amendments (CLIA) Occupational Safety and Health Quality control (QC)
Clinical and Laboratory Standards Administration (OSHA) Radioisotope
Institute (CLSI) Personal protective equipment Reliability
Electronic quality control (PPE)
Standard Precautions
Examination variable Postexamination variable
Turnaround time (TAT)
3920_Ch01_002-026 23/01/14 9:19 AM Page 4

4 Part One | Background

S A F E T Y received in the clinical laboratory. Understanding how microor-

ganisms are transmitted (chain of infection) is essential to
preventing infection. All health-care facilities have developed
The clinical laboratory contains a variety of safety hazards, procedures to control and monitor infections occurring within
many of which are capable of producing serious injury or life- their facilities. This is referred to as infection control. The
threatening disease. To work safely in this environment, labo- chain of infection requires a continuous link between an in-
ratory personnel must learn what hazards exist, the basic safety fectious agent, a reservoir, a portal of exit, a means of trans-
precautions associated with them, and how to apply the basic mission, a portal of entry, and a susceptible host.4 Infectious
rules of common sense required for everyday safety for agents consist of bacteria, fungi, parasites, and viruses. The
patients, co-workers, and themselves. reservoir is the location of potentially harmful microorganisms,
As can be seen in Table 1–1, some hazards are unique to such as a contaminated clinical specimen or an infected
the health-care environment, and others are encountered rou- patient. It is the place where the infectious agent can live and
tinely throughout life. Safety procedure manuals must be read- possible multiply. Humans and animals make excellent reser-
ily available in the laboratory that describe the safety policies voirs. Equipment and other soiled inanimate objects, called
mandated by the Centers for Disease Control and Prevention fomites, will serve as reservoirs, particularly if they contain
(CDC) and the Occupational Safety and Health Adminis- blood, urine, or other body fluids. Some microorganisms form
tration (OSHA), and strict adherence to these guidelines by spores or become inactive when conditions are not ideal and
laboratory personnel is essential. The manual must be updated wait until a suitable reservoir is available. The infectious agent
and reviewed annually by the laboratory director. The Clinical must have a way to exit the reservoir to continue the chain
and Laboratory Standards Institute (CLSI) provides the of infection. This can be through the mucous membranes of
guidelines for writing these procedures and policies.1-3 the nose, mouth, and eyes, and in blood or other body fluids.
Once the infectious agent has left the reservoir, it must have
a way to reach a susceptible host. Means of transmission include:
Biologic Hazards
1. Direct contact: the unprotected host touches the patient,
The health-care setting provides abundant sources specimen, or a contaminated object (reservoir)
of potentially harmful microorganisms. These mi- 2. Airborne: inhalation of dried aerosol particles circulating
croorganisms are frequently present in the specimens on air currents or attached to dust particles
3. Droplet: the host inhales material from the reservoir (e.g.,
aerosol droplets from a patient or an uncapped centrifuge
Table 1–1 Types of Safety Hazards tube, or when specimens are aliquoted or spilled)
Type Source Possible Injury 4. Vehicle: ingestion of a contaminated substance (e.g., food,
water, specimen)
Biologic Infectious Bacterial, fungal,
5. Vector: from an animal or insect bite
agents viral, or parasitic
infections After the infectious agent has been transmitted to a new
Sharps Needles, lancets, Cuts, punctures, or reservoir, it must have a means to enter the reservoir. The por-
broken glass blood-borne tal of entry can be the same as the portal of exit, which includes
pathogen exposure the mucous membranes of the nose, mouth, and eyes, breaks
in the skin, and open wounds. The susceptible host can be an-
Chemical Preservatives and Exposure to toxic, other patient during invasive procedures, visitors, and health-
reagents carcinogenic, or care personnel when exposed to infectious specimens or
caustic agents needlestick injuries. Immunocompromised patients, newborns
Radioactive Equipment and Radiation exposure and infants, and the elderly are often more susceptible hosts.
radioisotopes Stress, fatigue, and lack of proper nutrition depress the im-
Electrical Ungrounded or Burns or shock mune system and contribute to the susceptibility of patients
wet equipment; and health-care providers. Once the chain of infection is com-
frayed cords plete, the infected host then becomes another source able to
Fire/ Open flames, Burns or transmit the microorganisms to others.1
explosive organic dismemberment In the clinical laboratory, the most direct contact with a
chemicals source of infection is through contact with patient specimens, al-
though contact with patients and infected objects also occurs.
Physical Wet floors, heavy Falls, sprains, or Preventing completion of the chain of infection is a primary ob-
boxes, patients strains jective of biologic safety. Figure 1–1 illustrates the universal sym-
From Strasinger, SK, and DiLorenzo, MA: The Phlebotomy Textbook, third
bol for biohazardous material and demonstrates how following
edition, FA Davis, Philadelphia, 2011, p 52, with permission. prescribed safety practices can break the chain of infection.
Figure 1–1 places particular emphasis on laboratory practices.
3920_Ch01_002-026 23/01/14 9:19 AM Page 5

Chapter 1 | Safety and Quality Assessment 5

Break the link Break the link

• Immunizations • Disinfection
• Patient isolation Infectious agent • Hand hygiene
• Nursery • Bacteria
precautions • Fungi
• Healthy lifestyle • Parasites
Susceptible • Viruses
host Reservoir
• Patients • Humans
• Elderly • Animals
• Newborns • Insects
• Immuno- • Fomites
compromised • Blood/body
• Health-care fluids
workers

Portal of exit
Portal of
entry • Nose
• Mouth
• Nose
• Mucous
• Mouth
membranes
• Mucous
• Specimen
membranes
collection
• Skin
• Unsterile
equipment

Means of transmission
• Droplet
• Airborne
Break the link • Contact Break the link
• Hand hygiene • Vector • Sealed biohazardous
• Standard precautions • Vehicle waste containers
• PPE • Sealed specimen
• Sterile equipment containers
• Hand hygiene
• Standard precautions
Break the link
• Hand hygiene
• Standard precautions
• PPE
• Patient isolation

Figure 1–1 Chain of infection and safety practices related to the biohazard symbol. (From Strasinger, SK, and DiLorenzo, MA: The Phlebotomy
Textbook, FA Davis, Philadelphia, 2011, with permission.)

Proper hand hygiene, correct disposal of contaminated of all needles and sharp objects in puncture-resistant contain-
materials, and wearing personal protective equipment (PPE) ers. The CDC excluded urine and body fluids not visibly
are of major importance in the laboratory. Concern over expo- contaminated by blood from UP, although many specimens can
sure to blood-borne pathogens, such as hepatitis B virus contain a considerable amount of blood before it becomes vis-
(HBV), hepatitis C virus (HCV), and human immunodefi- ible. The modification of UP for body substance isolation
ciency virus (HIV), resulted in the drafting of guidelines and (BSI) helped to alleviate this concern. BSI guidelines are not
regulations by the CDC and OSHA to prevent exposure. In limited to blood-borne pathogens; they consider all body
1987 the CDC instituted Universal Precautions (UP). Under fluids and moist body substances to be potentially infectious.
UP all patients are considered to be possible carriers of blood- According to BSI guidelines, personnel should wear gloves at
borne pathogens. The guideline recommends wearing gloves all times when encountering moist body substances. A major
when collecting or handling blood and body fluids contami- disadvantage of BSI guidelines is that they do not recommend
nated with blood and wearing face shields when there is danger handwashing after removing gloves unless visual contamina-
of blood splashing on mucous membranes and when disposing tion is present.
3920_Ch01_002-026 23/01/14 9:19 AM Page 6

6 Part One | Background

In 1996 the CDC and the Healthcare Infection Control and reprocessed appropriately. Ensure that single-use
Practices Advisory Committee (HICPAC) combined the major items are discarded properly.
features of UP and BSI guidelines and called the new guidelines 6. Environmental control: Ensure that the hospital has
Standard Precautions. Although Standard Precautions, as adequate procedures for the routine care, cleaning, and
described below, stress patient contact, the principles can also disinfection of environmental surfaces, beds, bedrails,
be applied to handling patient specimens in the laboratory.5 bedside equipment, and other frequently touched sur-
Standard Precautions are as follows: faces. Ensure that these procedures are being followed.
1. Hand hygiene: Hand hygiene includes both hand 7. Linen: Handle, transport, and process linen soiled with
washing and the use of alcohol-based antiseptic blood, body fluids, secretions, and excretions in a man-
cleansers. Sanitize hands after touching blood, body ner that prevents skin and mucous membrane exposures
fluids, secretions, excretions, and contaminated items, and clothing contamination and that avoids the transfer
whether or not gloves are worn. Sanitize hands immedi- of microorganisms to other patients and environments.
ately after gloves are removed, between patient contacts, 8. Occupational health and blood-borne pathogens:
and when otherwise indicated to avoid transferring Take care to prevent injuries when using needles,
microorganisms to other patients or environments. scalpels, and other sharp instruments or devices; when
Sanitizing hands may be necessary between tasks handling sharp instruments after procedures; when
and procedures on the same patient to prevent cross- cleaning used instruments; and when disposing of used
contamination of different body sites. needles. Never recap used needles or otherwise manip-
2. Gloves: Wear gloves (clean, nonsterile gloves are ade- ulate them using both hands or use any other technique
quate) when touching blood, body fluids, secretions, that involves directing the point of a needle toward any
excretions, and contaminated items. Put on gloves just part of the body; rather, use self-sheathing needles or a
before touching mucous membranes and nonintact mechanical device to conceal the needle. Do not remove
skin. Change gloves between tasks and procedures on used unsheathed needles from disposable syringes by
the same patient after contact with material that may hand, and do not bend, break, or otherwise manipulate
contain a high concentration of microorganisms. Re- used needles by hand. Place used disposable syringes
move gloves promptly after use, before touching non- and needles, scalpel blades, and other sharp items in
contaminated items and environmental surfaces, and appropriate puncture-resistant containers, which are lo-
between patients. Always sanitize your hands immedi- cated as close as practical to the area in which the items
ately after glove removal to avoid transferring microor- were used, and place reusable syringes and needles in a
ganisms to other patients or environments. puncture-resistant container for transport to the repro-
3. Mouth, nose, and eye protection: Wear a mask and cessing area. Use mouthpieces, resuscitation bags, or
eye protection or a face shield to protect mucous mem- other ventilation devices as an alternative to mouth-
branes of the eyes, nose, and mouth during procedures to-mouth resuscitation methods in areas where the need
and patient care activities that are likely to generate for resuscitation is predictable.
splashes or sprays of blood, body fluids, secretions, or 9. Patient placement: Place a patient in a private room
excretions. A specially fitted respirator (N95) must be who contaminates the environment or who does not (or
used during patient care activities related to suspected cannot be expected to) assist in maintaining appropriate
mycobacterium exposure. hygiene or environment control. If a private room is not
4. Gown: Wear a gown (a clean, nonsterile gown is ade- available, consult with infection control professionals
quate) to protect skin and to prevent soiling of clothing regarding patient placement or other alternatives.
during procedures and patient care activities that are 10. Respiratory hygiene/cough etiquette: Educate
likely to generate splashes or sprays of blood, body health-care personnel, patients, and visitors to contain
fluids, secretions, or excretions. Select a gown that is respiratory secretions to prevent droplet and fomite
appropriate for the activity and the amount of fluid transmission of respiratory pathogens. Offer masks to
likely to be encountered (e.g., fluid-resistant in the coughing patients, distance symptomatic patients from
laboratory). Remove a soiled gown as promptly as others, and practice good hand hygiene to prevent the
possible, and sanitize hands to avoid transferring transmission of respiratory pathogens.
microorganisms to other patients or environments. The Occupational Exposure to Blood-Borne Pathogens
5. Patient care equipment: Handle used patient care Standard is a law monitored and enforced by OSHA.6,7 These
equipment soiled with blood, body fluids, secretions, controls are required by OSHA to be provided by or mandated
and excretions in a manner that prevents skin and mu- by the employer for all employees. Specific requirements of
cous membrane exposure, clothing contamination, and this OSHA standard include the following:
transfer of microorganisms to other patients or environ- Engineering Controls
ments. Ensure that reusable equipment is not used for 1. Providing sharps disposal containers and needles with
the care of another patient until it has been cleaned safety devices.
Another random document with
no related content on Scribd:
 CHAPTER XII—MUSTERED OUT

Jack Heaton and I had just finished our goulash at Moquin’s on Sixth
Avenue (New York), and the waiter, under the stimulus of a piece of
money, graciously removed the table cloth as he had been asked to
do on twelve previous occasions.
I took a couple of quires of blank paper out of my brief case and
laid them in front of me; then I produced a pair of fountain pens,
one filled with black ink and the other with red ink, the latter for
writing on chapter headings and putting in such corrections as might
be necessary, and all of which showed without any deduction that I
was in for a writing spell.
“Well, Jack, we’ve got down to the last chapter and this sitting will
finish it,” I started off encouragingly.
“I’ve told you all my experiences and if there’s any more to be
said I guess you’ll have to say it, Mr. Collins,” remarked the bored
young soldier.
“No, my boy,” I said firmly, “there are still some outstanding
features about wireless I want to talk over with you, and besides I
have never turned in a script to my publishers that had less than
twelve chapters, that is, except a shortcut arithmetic and the shorter
a book of that kind is the better.”
“I don’t know of any outstanding features as you call them; it
seems to me I’ve told you everything that ever happened to me.
What else can I say?” protested the young man.
“Give me your version of how we met, tell how you looked in that
natty overseas uniform, how I looked, what is on your mind now and
all that sort of thing. Then we’ll discuss the wireless transmission of
power, wireless airships and submarines, talking to Mars and finally
about the diamond fields of South America for I’m as interested in
them as your friend Bill Adams,” I suggested.
Jack laughed.
 “Why, if I painted a word picture of you I’m afraid you and I’d part
company.”
“Hardly, my boy, hardly,” I reassured him. “I’ve gone through war,
or what war is; I’ve licked a couple of would-be Kaisers myself and
I’m going after a few more of them before I have done with life. I
am, forsooth, a bit battle scarred but my skin is as thick as that of a
rhinocerous. Any little thing that you might say about me I’d be
delighted to jot it down.”
“Let’s see,” reflected Jack, “when we left off yesterday I had just
been discharged from the hospital and was back with my folks in
Montclair. When I was able to get around I wanted to see Broadway
and came over one morning with dad. I was feeling bully as I was
strolling down the trail when suddenly I spied a man I once knew
although I hadn’t seen him in years, no, not since I was a kid
operator learning wireless.
“He was a tall, spare man like yourself, whose legs, as honest Abe
once said, were long enough to reach to the ground. He might have
been anywhere up to a hundred and five, by which I mean his age
and not his weight; at any rate he had surely seen fifty summers
and heaven only knows how many hard falls.
“He was slightly stoop-shouldered, which I suspect was due to his
sticking to his desk too closely, or, perchance, because he couldn’t
shake the weight of his own tragedies from them. His face was pale,
quiet and cadaverous, but whatever troubles he may have had and
however many, they seemed not to have attacked his hair for it was
all there, nearly,—though I didn’t count ’em—with not a gray one to
mar their beautiful mouse-like color. In truth, he dressed like you,
looked like you and, by gravy, he was you, Mr. Collins.”
Jack laughed heartily at this photo-impression of his old friend
and I was glad to know that after all he had gone through with here,
there and everywhere and the pain he had suffered and was
suffering even then, he was still able to see the humor in so grisly a
subject. I laughed, too, just to show him that I had not yet given up
the ship and, hence, there was still hope for us both.
 “Turn about is fair play and now that you have given a word
picture of me I’ll give one of you. As I remember our meeting it was
like this: I was hurrying up Broadway one morning when suddenly a
young soldier stepped abruptly in front of me thereby barring any
farther progress on my part. I observed he had a trim fighting figure
and wore the uniform we love so well. He wore puttees and limped
somewhat but from the medals he wore on his breast I judged that
he had met the enemy and that they were his—and ours.
“His was a fine, heroic face and the very way his overseas cap set
on the side of his head, his smiling eyes, his hearty laugh and the
firm, smooth grasp of his hand was enough to show me that he was
one of the brave boys from over there who had caught ‘the torch
from failing hands and held it high in Flanders fields.’
“‘Don’t you remember me, Mr. Collins?’ he cried. ‘I’m Jack Heaton,
and you used to let me make things in your laboratory over in
Newark when I was a kid!’
“‘Of course I remember you but, my, how you have grown. I
never would have known you. You were rather a frail chap then and
now you’re such a powerfully built young fellow.’ And then we talked
about you and all your experiences since I last saw you. I told you
that you ought to write a book and you said that there wasn’t much
to write, and that if it was done I’d have to do it for you.
“Then we agreed we’d collaborate, you to furnish the experiences
and I to write them out and I wanted to give you whatever was
made from the sale of the book and that I would take the glory of
having written it for my share of the profits; but you wouldn’t have it
any other way but that we would divvy fifty-fifty.”
“That part was all right,” put in Jack, “but what made a hit with
me was that you said you knew a publisher who would take the
book and forthwith we drew up a provisional table of contents. Then
we went over to your publisher; you explained the idea to the editor
and gave him the table of contents and we got the contract the next
day. And do you know, Mr. Collins, that my leg began to feel better
right away!”
 “That was some weeks ago, Jack, but I’ve enjoyed your company
so much and have been so interested in what you’ve told me I wish
we had it all to do over again. Well, Jack, we must to work again.”
“All right, but before we get busy I want to tell you of a séance I
once had with King Solomon. Do you believe in spirits—in wireless
spirits?”
“Heard of all kinds of wireless and several kinds of spirits but
don’t know the breed called wireless spirits,” I admitted.
“I was introduced to one in London. One evening an operator
from one of the Red Star liners who was interested in magic,
spiritualism and all that sort of thing, wanted me to go with him to
see a performance of Maskelyn and Devant’s Mysteries at St.
George’s Hall in Langham Place, W. C.
“The mysteries of these mystifiers were mystical enough to
mystify the most mysterious and I saw everything from the
wonderful East Indian rope trick to the equally wonderful spirit
rapping table. David Devant, the celebrated conjurer, exhibited the
table and he said—and nobody in the audience disputed him—that
the table possessed the ghostly property of connecting this world
with the next, the quick with the dead, that which is now with that
which is to be, and that it would rap out answers to any questions
which might be asked to prove it.
“Some of the wiseacres present laughed lightly at the conjurer’s
immaterial remarks but he assured them on his honor as a
gentleman its guiding spirit was no lesser an (astral) light than that
of old King Solomon himself. Thereupon Mr. Devant invited the
audience to ply the immortal part of the departed wise man with any
questions that might be fit and proper.
“Strangely enough while nobody believed in spirit communications
as exemplified by the rapping table everybody was most anxious to
ask some question which no one on this side of the borderland could
answer. The replies that King Solomon rapped out were deep and
philosophical although not always conforming to our ideas of ethics
and morals. Indeed, his very first reply to a question, which was put
by some guileless suffragette, nearly broke up the show. She asked
him, as Bill Adams would say ‘as man to man,’ how many wives a
man should have, and in that she thought she had trapped him even
though he was beyond the pale of the law. But Solomon showed his
superior wisdom as usual and rebuked the lady by rapping furiously
on the table until he had nearly eight hundred wives to his credit.
“To convince the audience that the table was just a common,
single legged, three footed one of the milliner’s variety the conjurer
invited a committee to step up on the stage and examine it; I went
up with several other men and we nearly had a private séance with
old Sol. We examined the table and found it O. K.; to me it seemed
a little top heavy but I made due allowance for this because King
Solomon was a brainy man.
“Now when the conjurer held it at arm’s length, or I did so as one
of the committee, it kept right on rapping out replies from the gone
but not forgotten spirit of the ancient King. Even when the table was
passed through the audience—”
“You mean among the audience, don’t you, Jack? Even a spirit
table would have hard work passing through the audience.”
“I stand corrected. Even when the table was passed among the
audience it kept up its dark rappings to the great enjoyment of the
audience. To me the rappings had a more or less mechanical sound
as if King Solomon’s knuckles had turned to spirit gold, or common
brass would do.
“I figured it out that the raps were done wirelessly, by which I
mean that the top of the table was hollow and contained a small but
sensitive receiver with a single stroke tapper and as the top of the
table was made of a sheet of burnished copper and the three footed
base was of iron with the connecting leg between them of wood it
seemed reasonable to suppose that these formed the aerial and
ground.
“Although I listened hard I couldn’t hear the faintest sound of a
spark-gap working but it is an easy matter to put the transmitter in a
sound-proof booth.”
“And thus doth a little science make big skeptics of us all. Now tell
our young readers, Jack, how S O S came to take the place of
C Q D, as the ambulance call of the sea.”
“It came about in this way. In 1896 the International Wireless
Telegraph Convention was held in Berlin. Germany’s wireless men,
from her greatest scientists down to her lowly operators hated
anything that had to do with or was used by Marconi, so instead of
C Q D, they suggested that the letters S O S be used. Unlike C Q D,
the letters S O S have no especial meaning in themselves but they
are easy to send and to read and make, as a matter of fact, a good
distress call.
“While S O S, was probably sent out many times by various
operators from that time on it did not become famous until the s. s.
Kentucky went down off the Diamond Shoals. Her operator did as
many an operator had done before him and has done since, that is,
he kept sending the S O S call. Her engine room was rapidly filling
with water but before her dynamos were submerged and put out of
commission the operator on the Alamo of the Mallory Line, ninety
miles away, heard the call. The Alamo reached the sinking ship just
in time to save her passengers and crew before she went down.”
“Do you think it is possible to send a wireless message around the
world?”
“Not without relaying it. You remember back there in 1909 when
all the small fry who were following in Marconi’s footsteps were
trying to do something more wonderful than the great inventor? One
of them made the statement that he had sent out a train of electric
waves from his high power station which traveled completely round
the world and in a small fraction of a second he received the signals
on the same aerial; and he was backed up in it by a college
professor, too.”
“I agree with you that college professors may sometimes be
wrong, indeed they are nearly always so,” I assured him.
“Now any kid operator knows,” continued Jack, “that electric
waves are radiated to every point of the compass around an aerial
and hence even if the waves sent out by it had enough power to go
around the world they would meet on the opposite side of the earth
and neutralize each other.
 “What do you think about signaling from the earth to Mars, Mr.
Collins?”
“Not very much. It is never safe to predict, especially to make a
negative prediction, by which I mean to say that a thing can’t be
done. Simon Newcomb, the great astronomer and mathematician,
proved by figures and the known laws of nature, to his own
satisfaction and a good many others, that it was a physical
impossibility to build a man-carrying airplane.
“Langley who was just as big a figure in the world of science
believed that the thing could be done, built model after model that
flew but when he built his big machine to be piloted by a man it fell
before it got fairly into the air. Yet the same year that he failed, the
Wright Brothers, a couple of bicycle mechanics, put a gasoline
engine in a glider and flew. Since then bombing airplanes have been
built that will carry a ton or more.
“The moral is that if you must predict it is better to do so in favor
of rather than against a proposition unless you’re betting on a horse.
My opinion is that signaling to Mars will not be done by long electric
waves set up by electric sparks. Some years ago Tesla, the
electrician, was reported to have received signals from Mars by long
electric waves, that is wireless waves, while Pickering the
astronomer got up a plan to reflect signals to the red planet by short
electric, that is light waves. All he needed to do it with was ten
million dollars’ worth of mirrors and by forming these into a gigantic
reflector he opined he could concentrate the light of the sun into a
beam and throw it on the surface of Mars.
“And this puts me in mind of Tesla’s scheme to transmit power
wirelessly. To transmit power to run machinery and to control power
at a distance by wireless are two entirely different things. Since
wireless waves tend to radiate in all directions parallel with the
surface of the earth from an aerial, it is a very difficult matter to
transmit enough energy wirelessly in any one direction to have a
sufficient quantity left after it has passed through even a short
distance to do useful work such as running a motor.
 “As early as 1905 Tesla took out patents for a system of wireless
transmission of power in which he proposed to use the free ether of
space instead of the ether in and around a wire to guide and carry
it. He built a great tower at Wardencliff, Long Island, New York, for
the purpose of radiating power but nothing came of the experiments
he made and after some years the tower was torn down.”
“You don’t believe then that it will ever be possible to transmit
energy for power purposes by wireless?”
“On the contrary, I believe it is possible but other discoveries must
be made before it can be done successfully and this is also true of
many other things which have been and are still looked upon as
physical impossibilities. As to controlling apparatus at a distance by
wireless that is, of course, just as easy as sending a signal, in fact
it’s the same thing.
“Tesla was the first to control the movements of a boat at a
distance by wireless and after him came many others. Even
submarines have been so equipped and controlled but since the
surface of the sea reflects most of the energy of the waves and
absorbs the rest of it the boat must have its aerial above the surface
at all times or the waves will not reach it.
“Attempts to control airships by wireless have been made time
without number but to no useful purpose for no effective distance
can be had between an airship and the sending station. Even
sending wireless messages from airplanes as you said yesterday is
only done over a very short distance and these limits are quickly
reached because there is no way of grounding it.”
“How do you think the distance could be increased?” Jack wanted
to know.
“You are asking a hard question, my boy. It might be done by
finding a certain length of wave that would have a carrying capacity
through the ether comparable to that of light, yet be longer than a
light wave and shorter than the wireless waves we use for
transmitting over land and sea. But this is sheer speculation on my
part. Well, Jack, we’re all done and you see it wasn’t such a hard job
as you thought. Before we go, though, I should like to know just
what you expect to do in the future.”
“Really, I don’t know, Mr. Collins, though I’ve been thinking pretty
hard about it lately, too. You see, I’ve reached an age where I’ve got
to boil down to business and make some money, but I don’t want
any of that swivel-chair-at-a-desk-on-the-’steenth-floor-of-an-office-
building for mine. I’d get into the airplane game but there’s no more
money in it than there is in wireless.
“My one best thought is to get a little party together, go down to
Brazil and open up a diamond mine,” and he looked fondly at the
glittering stone in his ring.
“What I’d like to do is to get Bill Adams and a few other kindred
spirits to go with me, clean out the Capunicas, and,” his eyes
brightened, “if you’ll join us I’ll make you King of the cannibals
instead of old Oopla.”
“Declined with thanks,” I bowed regally, that is as regally as a
man can bow whose back is already bent. “I haven’t the slightest
desire to king it over any tribe of man-eaters, but if you will let me
go with you in the capacity of adviser, medicine man and book-
maker I’ll consider it.”
“Done, signed and sealed,” said Jack and we shook hands till we
should get together on the proposition.

THE END
*** END OF THE PROJECT GUTENBERG EBOOK JACK HEATON,
WIRELESS OPERATOR ***

Updated editions will replace the previous one—the old editions

will be renamed.

Creating the works from print editions not protected by U.S.

copyright law means that no one owns a United States
copyright in these works, so the Foundation (and you!) can copy
and distribute it in the United States without permission and
without paying copyright royalties. Special rules, set forth in the
General Terms of Use part of this license, apply to copying and
distributing Project Gutenberg™ electronic works to protect the
PROJECT GUTENBERG™ concept and trademark. Project
Gutenberg is a registered trademark, and may not be used if
you charge for an eBook, except by following the terms of the
trademark license, including paying royalties for use of the
Project Gutenberg trademark. If you do not charge anything for
copies of this eBook, complying with the trademark license is
very easy. You may use this eBook for nearly any purpose such
as creation of derivative works, reports, performances and
research. Project Gutenberg eBooks may be modified and
printed and given away—you may do practically ANYTHING in
the United States with eBooks not protected by U.S. copyright
law. Redistribution is subject to the trademark license, especially
commercial redistribution.

START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE
 PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the

free distribution of electronic works, by using or distributing this
work (or any other work associated in any way with the phrase
“Project Gutenberg”), you agree to comply with all the terms of
the Full Project Gutenberg™ License available with this file or
online at www.gutenberg.org/license.

Section 1. General Terms of Use and

Redistributing Project Gutenberg™
electronic works
1.A. By reading or using any part of this Project Gutenberg™
electronic work, you indicate that you have read, understand,
agree to and accept all the terms of this license and intellectual
property (trademark/copyright) agreement. If you do not agree
to abide by all the terms of this agreement, you must cease
using and return or destroy all copies of Project Gutenberg™
electronic works in your possession. If you paid a fee for
obtaining a copy of or access to a Project Gutenberg™
electronic work and you do not agree to be bound by the terms
of this agreement, you may obtain a refund from the person or
entity to whom you paid the fee as set forth in paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only

be used on or associated in any way with an electronic work by
people who agree to be bound by the terms of this agreement.
There are a few things that you can do with most Project
Gutenberg™ electronic works even without complying with the
full terms of this agreement. See paragraph 1.C below. There
are a lot of things you can do with Project Gutenberg™
electronic works if you follow the terms of this agreement and
help preserve free future access to Project Gutenberg™
electronic works. See paragraph 1.E below.
1.C. The Project Gutenberg Literary Archive Foundation (“the
Foundation” or PGLAF), owns a compilation copyright in the
collection of Project Gutenberg™ electronic works. Nearly all the
individual works in the collection are in the public domain in the
United States. If an individual work is unprotected by copyright
law in the United States and you are located in the United
States, we do not claim a right to prevent you from copying,
distributing, performing, displaying or creating derivative works
based on the work as long as all references to Project
Gutenberg are removed. Of course, we hope that you will
support the Project Gutenberg™ mission of promoting free
access to electronic works by freely sharing Project Gutenberg™
works in compliance with the terms of this agreement for
keeping the Project Gutenberg™ name associated with the
work. You can easily comply with the terms of this agreement
by keeping this work in the same format with its attached full
Project Gutenberg™ License when you share it without charge
with others.

1.D. The copyright laws of the place where you are located also
govern what you can do with this work. Copyright laws in most
countries are in a constant state of change. If you are outside
the United States, check the laws of your country in addition to
the terms of this agreement before downloading, copying,
displaying, performing, distributing or creating derivative works
based on this work or any other Project Gutenberg™ work. The
Foundation makes no representations concerning the copyright
status of any work in any country other than the United States.

1.E. Unless you have removed all references to Project

Gutenberg:

1.E.1. The following sentence, with active links to, or other

immediate access to, the full Project Gutenberg™ License must
appear prominently whenever any copy of a Project
Gutenberg™ work (any work on which the phrase “Project
Gutenberg” appears, or with which the phrase “Project
Gutenberg” is associated) is accessed, displayed, performed,
viewed, copied or distributed:

This eBook is for the use of anyone anywhere in the United

States and most other parts of the world at no cost and
with almost no restrictions whatsoever. You may copy it,
give it away or re-use it under the terms of the Project
Gutenberg License included with this eBook or online at
www.gutenberg.org. If you are not located in the United
States, you will have to check the laws of the country
where you are located before using this eBook.

1.E.2. If an individual Project Gutenberg™ electronic work is

derived from texts not protected by U.S. copyright law (does not
contain a notice indicating that it is posted with permission of
the copyright holder), the work can be copied and distributed to
anyone in the United States without paying any fees or charges.
If you are redistributing or providing access to a work with the
phrase “Project Gutenberg” associated with or appearing on the
work, you must comply either with the requirements of
paragraphs 1.E.1 through 1.E.7 or obtain permission for the use
of the work and the Project Gutenberg™ trademark as set forth
in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg™ electronic work is

posted with the permission of the copyright holder, your use and
distribution must comply with both paragraphs 1.E.1 through
1.E.7 and any additional terms imposed by the copyright holder.
Additional terms will be linked to the Project Gutenberg™
License for all works posted with the permission of the copyright
holder found at the beginning of this work.

1.E.4. Do not unlink or detach or remove the full Project

Gutenberg™ License terms from this work, or any files
 containing a part of this work or any other work associated with
Project Gutenberg™.

1.E.5. Do not copy, display, perform, distribute or redistribute

this electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1
with active links or immediate access to the full terms of the
Project Gutenberg™ License.

1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form,
including any word processing or hypertext form. However, if
you provide access to or distribute copies of a Project
Gutenberg™ work in a format other than “Plain Vanilla ASCII” or
other format used in the official version posted on the official
Project Gutenberg™ website (www.gutenberg.org), you must,
at no additional cost, fee or expense to the user, provide a copy,
a means of exporting a copy, or a means of obtaining a copy
upon request, of the work in its original “Plain Vanilla ASCII” or
other form. Any alternate format must include the full Project
Gutenberg™ License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying,

performing, copying or distributing any Project Gutenberg™
works unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or

providing access to or distributing Project Gutenberg™
electronic works provided that:

• You pay a royalty fee of 20% of the gross profits you derive
from the use of Project Gutenberg™ works calculated using the
method you already use to calculate your applicable taxes. The
fee is owed to the owner of the Project Gutenberg™ trademark,
but he has agreed to donate royalties under this paragraph to
the Project Gutenberg Literary Archive Foundation. Royalty
 payments must be paid within 60 days following each date on
which you prepare (or are legally required to prepare) your
periodic tax returns. Royalty payments should be clearly marked
as such and sent to the Project Gutenberg Literary Archive
Foundation at the address specified in Section 4, “Information
about donations to the Project Gutenberg Literary Archive
Foundation.”

• You provide a full refund of any money paid by a user who

notifies you in writing (or by e-mail) within 30 days of receipt
that s/he does not agree to the terms of the full Project
Gutenberg™ License. You must require such a user to return or
destroy all copies of the works possessed in a physical medium
and discontinue all use of and all access to other copies of
Project Gutenberg™ works.

• You provide, in accordance with paragraph 1.F.3, a full refund of

any money paid for a work or a replacement copy, if a defect in
the electronic work is discovered and reported to you within 90
days of receipt of the work.

• You comply with all other terms of this agreement for free
distribution of Project Gutenberg™ works.

1.E.9. If you wish to charge a fee or distribute a Project

Gutenberg™ electronic work or group of works on different
terms than are set forth in this agreement, you must obtain
permission in writing from the Project Gutenberg Literary
Archive Foundation, the manager of the Project Gutenberg™
trademark. Contact the Foundation as set forth in Section 3
below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend

considerable effort to identify, do copyright research on,
transcribe and proofread works not protected by U.S. copyright
law in creating the Project Gutenberg™ collection. Despite these
efforts, Project Gutenberg™ electronic works, and the medium
on which they may be stored, may contain “Defects,” such as,
but not limited to, incomplete, inaccurate or corrupt data,
transcription errors, a copyright or other intellectual property
infringement, a defective or damaged disk or other medium, a
computer virus, or computer codes that damage or cannot be
read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except

for the “Right of Replacement or Refund” described in
paragraph 1.F.3, the Project Gutenberg Literary Archive
Foundation, the owner of the Project Gutenberg™ trademark,
and any other party distributing a Project Gutenberg™ electronic
work under this agreement, disclaim all liability to you for
damages, costs and expenses, including legal fees. YOU AGREE
THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT
LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT
EXCEPT THOSE PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE
THAT THE FOUNDATION, THE TRADEMARK OWNER, AND ANY
DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE LIABLE
TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL,
PUNITIVE OR INCIDENTAL DAMAGES EVEN IF YOU GIVE
NOTICE OF THE POSSIBILITY OF SUCH DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you

discover a defect in this electronic work within 90 days of
receiving it, you can receive a refund of the money (if any) you
paid for it by sending a written explanation to the person you
received the work from. If you received the work on a physical
medium, you must return the medium with your written
explanation. The person or entity that provided you with the
defective work may elect to provide a replacement copy in lieu
of a refund. If you received the work electronically, the person
or entity providing it to you may choose to give you a second
opportunity to receive the work electronically in lieu of a refund.
If the second copy is also defective, you may demand a refund
in writing without further opportunities to fix the problem.

1.F.4. Except for the limited right of replacement or refund set

forth in paragraph 1.F.3, this work is provided to you ‘AS-IS’,
WITH NO OTHER WARRANTIES OF ANY KIND, EXPRESS OR
IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF
MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied

warranties or the exclusion or limitation of certain types of
damages. If any disclaimer or limitation set forth in this
agreement violates the law of the state applicable to this
agreement, the agreement shall be interpreted to make the
maximum disclaimer or limitation permitted by the applicable
state law. The invalidity or unenforceability of any provision of
this agreement shall not void the remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the

Foundation, the trademark owner, any agent or employee of the
Foundation, anyone providing copies of Project Gutenberg™
electronic works in accordance with this agreement, and any
volunteers associated with the production, promotion and
distribution of Project Gutenberg™ electronic works, harmless
from all liability, costs and expenses, including legal fees, that
arise directly or indirectly from any of the following which you
do or cause to occur: (a) distribution of this or any Project
Gutenberg™ work, (b) alteration, modification, or additions or
deletions to any Project Gutenberg™ work, and (c) any Defect
you cause.

Section 2. Information about the Mission

of Project Gutenberg™
Project Gutenberg™ is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new
computers. It exists because of the efforts of hundreds of
volunteers and donations from people in all walks of life.

Volunteers and financial support to provide volunteers with the

assistance they need are critical to reaching Project
Gutenberg™’s goals and ensuring that the Project Gutenberg™
collection will remain freely available for generations to come. In
2001, the Project Gutenberg Literary Archive Foundation was
created to provide a secure and permanent future for Project
Gutenberg™ and future generations. To learn more about the
Project Gutenberg Literary Archive Foundation and how your
efforts and donations can help, see Sections 3 and 4 and the
Foundation information page at www.gutenberg.org.

Section 3. Information about the Project

Gutenberg Literary Archive Foundation
The Project Gutenberg Literary Archive Foundation is a non-
profit 501(c)(3) educational corporation organized under the
laws of the state of Mississippi and granted tax exempt status
by the Internal Revenue Service. The Foundation’s EIN or
federal tax identification number is 64-6221541. Contributions
to the Project Gutenberg Literary Archive Foundation are tax
deductible to the full extent permitted by U.S. federal laws and
your state’s laws.

The Foundation’s business office is located at 809 North 1500

West, Salt Lake City, UT 84116, (801) 596-1887. Email contact
links and up to date contact information can be found at the
Foundation’s website and official page at
www.gutenberg.org/contact
 Section 4. Information about Donations to
the Project Gutenberg Literary Archive
Foundation
Project Gutenberg™ depends upon and cannot survive without
widespread public support and donations to carry out its mission
of increasing the number of public domain and licensed works
that can be freely distributed in machine-readable form
accessible by the widest array of equipment including outdated
equipment. Many small donations ($1 to $5,000) are particularly
important to maintaining tax exempt status with the IRS.

The Foundation is committed to complying with the laws

regulating charities and charitable donations in all 50 states of
the United States. Compliance requirements are not uniform
and it takes a considerable effort, much paperwork and many
fees to meet and keep up with these requirements. We do not
solicit donations in locations where we have not received written
confirmation of compliance. To SEND DONATIONS or determine
the status of compliance for any particular state visit
www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states

where we have not met the solicitation requirements, we know
of no prohibition against accepting unsolicited donations from
donors in such states who approach us with offers to donate.

International donations are gratefully accepted, but we cannot

make any statements concerning tax treatment of donations
received from outside the United States. U.S. laws alone swamp
our small staff.

Please check the Project Gutenberg web pages for current

donation methods and addresses. Donations are accepted in a
number of other ways including checks, online payments and
credit card donations. To donate, please visit:
www.gutenberg.org/donate.

Section 5. General Information About

Project Gutenberg™ electronic works
Professor Michael S. Hart was the originator of the Project
Gutenberg™ concept of a library of electronic works that could
be freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg™ eBooks with only a loose
network of volunteer support.

Project Gutenberg™ eBooks are often created from several

printed editions, all of which are confirmed as not protected by
copyright in the U.S. unless a copyright notice is included. Thus,
we do not necessarily keep eBooks in compliance with any
particular paper edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg™,

including how to make donations to the Project Gutenberg
Literary Archive Foundation, how to help produce our new
eBooks, and how to subscribe to our email newsletter to hear
about new eBooks.