164 HALL, ON THORACIC CONSUMPTION. 



comes from the air-tubes. And, again, in examining the expectoration in 

 certain trades — such, for example, as the grinders of Sheffield — various small 

 particles of stone and of steel may be readily detected. The appearances 

 vary a good deal, however, in these men with the time of the day at which 

 the expectoration has been coughed up, and whether or not they have been 

 working within a short period at the wheel. Pus, blood-corpuscles, claws 

 of Echinococci, and portions of hydatids, are sometimes present, and in the 

 more advanced stages of pneumonia numerous large cells containing oil 

 globules will be seen, together with many finely granular cells, not very 

 urdike pus globules, but which, on the addition of acetic acid, do not exhibit 

 the presence of central bodies. Sometimes the sputa contain small frag- 

 ments of pulmonary tissue, frequently distinct and well defined, but which 

 are easily overlooked without a good deal of care. The small white cal- 

 careous masses which are not unfrequently present in the sputa in cases of 

 arrested thoracic consumption, and of which Mr. Tuffen West has given a 

 good illustration in the plate, as well as of some crystals of cholesterine, are 

 best examined by mounting them as opaque objects, on a black ground, and 

 looking at them through an inch object-glass. Sometimes in the cheesy 

 matter found so largely in tuberculous masses we may not be able to detect 

 crystals of cholesterine ; it is better then to place a little bit of the mass on 

 a slide, and to add a small quantity of alcohol. As this evaporates, crystals 

 of cholesterine gradually form, and may then be easily examined under the 

 microscope. They are very beautifully seen by polarized light. If the cal- 

 careous masses to which reference has just been made be placed in a watch- 

 glass, and tested with a little acetic acid, they will dissolve with effervescence, 

 demonstrating the presence of a carbonate. If to one part of the acetic acid 

 solution an excess of ammonia be added, a precipitate of phosjihate of lime 

 takes place, and a little of a solution of oxalate of ammonia added to the 

 other portion will detect the presence of lime." 



The following remarks apply to the character of the sputa 

 in true cases of tubercle of the lungs. The appearances 

 described in the following paragraphs are iUustrated in 

 Plate X of the present volume of the Journal. 



"The first kind of expectoration observed in thoracic consumption is 

 frothy, and is characteristic of irritation. So far as my own experience 

 goes, it does not enable us to arrive at any correct conclusion as to the 

 existence of tubercle when placed under the microscope; and many of the 

 appearances may arise from other causes. After a longer or shorter 

 period, as the disease may be impending or established, the expectoration 

 oecomes gelatinous, rather transparent, and resembles a solution of isinglass. 

 This expectoration is generally brought up in a morning in the dressing- 

 room, and scarcely noticed by the patient. It consists of a transparent and 

 very tenacious semi-fibrillated matrix, in which we may see imbedded oily 

 matter, molecules, granules, and corpuscles. This kind of expectoration 

 may often be seen in various forms of pulmonary congestion. The investi- 

 gations I have made in numerous cases of phthisis enable me to conclude 

 with certainty that we have, in looking at this kind of expectoration, a 

 diagnostic guide of very great practical importance ; for wlun-e there is no 

 special tuberculous tendency the corpuscles are of one uniform kind, but 

 when the deposit of tubercle has taken place or is impending the corpuscles 

 are of various forms and sizes. Some are ovoidal, some spherical, and 

 resist the action of acetic acid ; others are abruptly defined, obscurely 

 granular or nebulous, requiring tiie application of reagents to render their 



