SPREADING FACTORS 



324 



SPUTUM 



ably true when the permeability of the 

 G.S. is increased. 



Hormonal effects play a very impor- 

 tant part in controlling the permeabil- 

 ity of the G.S. Thus, estrogenic, and 

 some adrenal cortical, hormones de- 

 crease the permeability of the G.S. — 

 that is, increase its barrier value — 

 whereas chorionic gonadotropin hor- 

 mone has the opposite effect. Other 

 hormones have been studied in this 

 respect, sometimes with contradictory 

 results. 



The mechanism of action of these 

 hormones — a crucial point in our sub- 

 ject — is a matter of conjecture. We 

 have three clear cases in which the 

 hormone has promoted the accumula- 

 tion of vast amounts of hyaluronic 

 and chondroitin sulphuric acid in tis- 

 sues of election: estrogens causing the 

 development of the sex skin of monkeys; 

 testosterone inducing the develop- 

 ment of the cock's comb; and thyroid 

 stimulating hormone provoking the 

 formation of periorbital tissue in the 

 guinea pig and pretibial myxedematous 

 tissue in man. In all these cases H. 

 injected into the tissue causes their 

 quick dissolution or collapse through 

 an effect on H.A. 



In the case of the sex skin of mon- 

 keys, at least, the accumulation of H.A. 

 increases very much the barrier value 

 of the tissue to the penetration of 

 foreign matter. However, we do not 

 have any evidence that, in the other 

 cases where the permeability of the 

 G.S. has been diminished by endocrine 

 effects, the effect is due to quantita- 

 tive changes in the tissue polysaccha- 

 rides. This statement holds specially 

 true in the case of the adrenal cortical 

 hormones because their effect is very 

 rapid, being most marked one hour 

 after intravenous injection. There- 

 fore, it is logical to think that qualita- 

 tive besides quantitative changes in the 

 polysaccharides are effective in alter- 

 ing the permeability of the G.S. 



It would also seem logical to suppose 

 that there is a common denominator 

 to the effects of at least some of the 

 hormones effective on the G.S., and, 

 in view of the newer knowledge on the 

 physiology of the adrenal cortex, one 

 could suspect that some of the adrenal 

 cortical hormones are this common 

 denominator. In favor of this sup- 

 position one could quote the fact that 

 a great variety of stimuli which de- 

 crease the permeability of the G.S. 

 are also known to act on the adrenal 

 in the alarm reaction syndrome. 



Of special interest in this respect is 

 the case of infection, notably that in- 



duced by rapidly invading bacteria. 

 Here, shortly after the experimental 

 inoculation of e.g. staphylococcus or 

 streptococcus, the permeability of the 

 G.S. is considerably diminished, and 

 this phenomenon is, in itself, a power- 

 ful element in the defense of the or- 

 ganism against infection, specially in 

 its first phases. 



Whatever hormones are responsible 

 for the diminished permeability or in- 

 creased barrier value of the G.S., we 

 do not know how the effect is brought 

 out, although one could theorize on a 

 direct effect on the polysaccharides or 

 on whatever cells of the mesenchyme 

 responsible for the elaboration of these 

 polysaccharides. 



These problems are of far reaching 

 importance. For, fluctuations in the 

 permeability of the G.S. of the mesen- 

 chyme manifest themselves by parallel 

 alterations in susceptibility or resist- 

 ance to infection, and to a certain 

 extent it is possible to protect against 

 e.g. vaccinia or tuberculosis by treat- 

 ment of the host with estrogenic hor- 

 mones. True, we still do not know the 

 precise mechanisms of the effect above 

 reviewed, but we do know that the 

 harmonious integration of these effects 

 reflects on the G.S., which will main- 

 tain its perfectly physiological tonus. 



If we know so much about acquired 

 immunity, it is, to a large extent, be- 

 cause the natural immunity has failed. 

 Maintaining this tonus of the G.S. 

 would mean controlling of complex 

 mechanisms leading to natural resist- 

 ance, that is to health. (See Duran- 

 Reynals, F., Bact. Rev., 1942, 6, 197- 

 252. Also Symposium on "The ground 

 substance of the Mesenchyme and hyal- 

 uronidase" in: Ann. N. Y. Acad. Sci., 

 1950, 52, 943-1196.) 

 Sputum. Amount, gross appearance, color 

 and odor (if present) are important. 

 Microscopic examination should first 

 be made mounted but unstained. Look 

 for pus, elastic tissue, pigmented heart 

 failure cells, amebae, fungi, ova of ani- 

 mal parasites, colorless, hexagonal 

 pointed Charcot-Leyden crystals, other 

 crystalline material, etc. Stain smears 

 by methods of Giemsa, Gram and for 

 Acid Fast bacilli. It may be necessary 

 to use Concentration methods. Inter- 

 pretation of findings requires much 

 experience . Comparison of chlorox and 

 sodium-hydroxide-alum techniques for 

 tubercle bacilli in sputum (Cameron, 

 G. M. and Castles, R., J. Lab. & Clin. 

 Med., 1946, 31, 361-368). See also Sec- 

 tion on Sputum Examination in Osgood, 

 E. S., Laboratory Diagnosis. Phil- 



