CHAPTER XXVI. 

 EXAMINATION OF SPUTUM. 



FREQUENTLY the material submitted for examination as sputum is 

 simply buccal or pharyngeal secretion, or more probably secretion 

 from the nasopharynx, which has been secured by hawking. It should 

 always be insisted upon that the sputum be raised by a true pulmonary 

 coughing act, and not expelled with the hacking cough so frequently 

 associated with an elongated uvula. When there is an effort to deceive, 

 some information may be obtained from the watery, stringy, mucoid 

 character of the buccopharyngeal material and also fiom the presence 

 of mosaic-like groups of flat epithelial cells (often packed with bacteria). 

 The pulmonary secretion is either frothy mucus or mucopurulent mate- 

 rial, and if the cells are alveolar they greatly resemble the plasma cells. 

 At times these cells may contain blood pigment granules (heart-disease 

 cells). 



In the microscopic examination a small, cheesy particle, the size of a pin head, 

 should be selected. This should be flattened out in a thin layer between 

 the slide and cover-glass and should be examined for elastic tissue, heart-disease 

 cells, eggs of animal parasites, amoebae, and fungi. Echinococcus booklets, Cursch- 

 man spirals besprinkled with Charcot-Leyden crystals, and haematoidin and fatty 

 acid crystals may also be observed. 



Curschman spirals indicate bronchial as against cardiac or uremic asthma. 

 Charcot-Leyden crystals have no special significance, except in certain tropical 

 diseases when these crystals often are present in paragonomiasis sputum and in 

 the pus of amoebic liver abscesses discharging by way of the lungs. 



It may facilitate the examination of the sputum for elastic tissue and actinomy- 

 cosis and other fungi to add 10% sodium hydrate to the preparation. 



To make smears for staining, the sputum should be poured on a flat surface, 

 preferably a Petri dish, and a bit of mucopurulent material selected with forceps. A 

 dark back-ground facilitates picking out the particle. A toothpick is well adapted 

 to smearing out such material on a slide. After using the toothpick it can be burned. 

 When dry, the smear is best fixed by pouring a few drops of alcohol on the slide, 

 allowing this to run over the surface, and then, after dashing off the excess of alcohol, 

 to ignite that remaining on the film in the flame and allow to burn out. 



A mark with a grease pencil, about 1/2 inch from the end, gives a convenient 

 surface to hold with the forceps and also prevents the stain subsequently used from 

 running over the entire surface. A piece of glass tubing about 12 inches long bent 



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