228 DR. THOMPSON, ON PULMONARY CONSUMPTION. 



2. Gelatinous. This varievy is transparent, resembling a drop of isin- 



flass, not stringy. It is indicative of a chronic form of irritation, 

 unlike that from bronchitis or pneumonia, and is usually tubercular. 



3. The purulent, of which there are three marked varieties : — 



(a) Simple purulent. 



(b) Flocculent ; charactei'istic of secretion from a vomica, modified 



by absorption of the thirmer constituents ; very rarely occurring 

 from any other cause. 



(c) Non-coherent. This is thick, scanty, rather firmer than common 



pus ; sometimes brought up without cough ; often accompanied 

 with slight hajmoptysis. It indicates a chronic form of tuber- 

 cular affection, in which the diseased action is checked. 



Can we, by the aid of the microscope, obtain more definite and positive 

 information regarding these different kinds of expectoration? Micro- 

 scopical observers have hitherto given us little encouragement in this 

 attempt, Eainey concludes his paper on the minute structure of the lungs 

 with the remark, that the expectoration in the phthisical " most probably 

 is not to be distinguished from that in ordinary bronchitis." He adds, 

 " It will be only during the breaking up of a tubercle that matter truly 

 tuberculous will be expectorated ; and this, I believe, can be recognised 

 with certainty by no other character than its containing fragments of the 

 membrane of the air-cells." Dr. William Addison, in an interesting 

 work,* published only five years since, observed — " Great attention used 

 formerly to be paid to the expectoration, with a view to determine whether 

 it was pus and came from a cavity in the lung, or whether it was only 

 mueus from the air-tubes. More recently it has been supposed that a 

 microscopical examination would determine the point. But it is now 

 known that the inquiry is useless, mucus and pus being only varieties of 

 the excretion natin-al to all mucous or granulation fabrics." Only last 

 year I published a discouraging opiniouf as respects the prospect of de- 

 riving any practical advantage from this application of the microscope. 

 Since that time, however, I have been induced to change that opinion, and 

 I now hope to show that, with careful attention, the microscope will afford 

 definite and conclusive information regarding the disease in its progress, 

 and open views of pecirliar interest respecting its origin. 



Frothy expectoration contains stringy mucus and the outer layer of 

 epithelium, cilia being often observable. A gentleman whom I visited a 

 few weeks since with Dr. Crosse was affected with obstinate cough. There 

 was some hereditary tendency to consumption ; his aspect was rather un- 

 promising, and there was dull percussion in the right subscapular region. 

 It was doubtful whether this dull percussion depended on tubercular con- 

 solidation ; but the absence of any tubercular element in the purely 

 bronchial frothy sputum, when microscopically examined, encouraged us 

 to give a favourable prognosis, which has happily been confirmed by the 

 successful issue of the case. 



The second variety — namely, the gelatinous, is transparent, not stringy, 

 and resists pressure between the glasses of the microscope. It contains 

 granules, molecules, not aggregated, cells partly devoid of granides, and 

 oil globules. (See fig. 3.) 



A more advanced stage is seen in fig. 4. 



(^f the third kind — namely, the purulent — the flocculent is so charac- 

 teristic of phthisis, that from its external appearances alone we may almost 



* On Healtliy and Diseased Structure, p. 159. 



t Clinical Lectures on Pulmonary Consumption, [>. 49. 



