Constituents of the Sputum

Some idea of the constituents of the sputum can be obtained by attention to the points already mentioned; but in cases in which there is any obscurity, a careful microscopical examination of the sputum is of the greatest importance, as by this means much positive information can be gained that will be sought in vain in any other way. The microscope always shows the presence of more or less epithelium in the sputum, which usually comes from the mouth, as shown by its character. See Fig. 302. In Fig. 303 may be seen a representation of the peculiar ciliated epithelium which comes from the bonchial tubes. It is sometimes found, also, in mucus from the nasal cavity. In red or rusty sputum, red blood corpuscles, as shown in Fig. 304. are usually found. Pus cells are found in putrid bronchitis and in all cases in which there is a destruction of tissue in the throat or lungs, either from consumption or ordinary ulceration. They resemble the white corpucles of the blood; and, indeed, it is believed that they are, at least in part, identical with the white cells of the blood, which find their way out of the blood-vessels. When destruction of the lung is taking place, fragments of tissue may be recognized by the microscope in the sputum.

Fig. 302. Pavement Epithelium from the Mouth.

Fig. 302. Pavement Epithelium from the Mouth.

Fig. 303. Cylindrical Epithelium.

Fig. 303. Cylindrical Epithelium.

The most characteristic of these is yellow elastic tissue, fibres of which are shown in Fig. 304. In cases of advanced consumption, these fibres are always found in the sputum, and constitute a sure means of distinguishing the stage of the disease, and of confirming a diagnosis. This means may also be used as a means of determining the rate of progress of the disease. When the fragments of tissue are abundant, the lung is breaking down rapidly; when scanty, the destruction is less rapid; and when they disappear altogether, the destructive process is checked.

Fig. 304. Yellow Elastic Tissue Fiber from the Lungs.

Fig. 304. Yellow Elastic Tissue Fiber from the Lungs.

In croupous bronchitis, the sputum frequently contains casts of larger or smaller portions of the bronchial tubes, which may be easily made out by examination of the expectorated matters. A very large cast of this kind is shown in Fig. 305.

Fig. 305. Cast of Bronchial Tubes.

Fig. 305. Cast of Bronchial Tubes.

The sputum often contains various foreign matters, and when putrid, always shows the presence of bacteria and various other low organisms which accompany the putrefactive process elsewhere.