SPUTUM 281 



some instances the pigment is of bacterial origin. Renk *^ has stud- 

 ied the proteins of sputum with special reference to the loss of pro- 

 tein to the body and its relation to cachexia. In three patients (con- 

 sumptives) studied, the daily amount of sputum of two averaged 145 

 grams for each; for the third it was 82 grams. This contained 

 (average) 5 to 6 per cent, of solids; including mucin, 2-3 per cent.; 

 protein, 0.1-0.5 per cent. ; fat, 0.3-0.5 per cent. ; ash, 0.8-0.9 per 

 cent. The daily loss of nitrogen was 0.75 gram, which equals about 

 6 per cent, of the total daily nitrogen output of persons under condi- 

 tion of starvation.^* Wanner *^ found characteristic variations in the 

 amount of protein in sputum from different conditions, as follows : 

 in bronchitis the amount of protein is very small ; in bronchiectasis 

 protein is present, but the amount of uncoagulable nitrogen (due to 

 autolysis) is relatively large; in phthisis as well as in bronchiectasis 

 the amount of protein does not exceed 1 per cent., in pneumonia it 

 may reach 3 per cent., but it is highest in pulmonary- gangrene. Any 

 protein content that causes more than a slight turbidity on boiling in- 

 dicates an inflammation ; e. g., in case of doubt between a diagnosis of 

 I>neumonia and infarct a high protein content speaks for the former. 

 Rogers ^^ stated that the sputum in every case of tuberculosis shows 

 albumin,^*'-'' but this has been questioned, especially as to chronic or 

 quiescent cases. ^^ Albumin, or better, coagulable protein is also pres- 

 ent in the sputum of patients with pulmonary edema and pleurisy. 

 According to Works ^^ in active tuberculosis there is usually 0.2 per 

 cent, or more of coagulable protein in the sputum. The mucin of 

 sputum yields 33.6 per cent, of glucosamin when split with HCl, which 

 gives an index of the quantity of mucin ; this is highest in chronic 

 bronchitis and lowest in pneumonia and phthisis. Kossel found 0.1- 

 0.33 gm. of nucleins in the sputum daily. 



The following table by Bokay (taken from Ott) gives the pro- 

 portion of the organic constituents of sputum in parts per thou- 

 sand : 



On account of the digestion of the exudates by the leucocytes, spu- 

 tum contains proteoses, peptones, and amino-acids, generally in pro- 

 portion to the richness of the exudate in leucoej-tes; they are, there- 



ssZeit. f. Biol., 187.5 (11). 102. 



84Plesch (Zeit. exp. Path. u. Ther.. 1906, Bd. iii. .Tuly) found that 4.8 per 

 cent, of all the absorbed calories were lost in the sputum in an advanced case of 

 phthisis. Under similar conditions the amount of salts excreted by tlie sputum 

 mav equal or exceed that in the urine ( Falk, loc. cit. ) . 



ssDeut. Arch. klin. Med.. 1003 (75). .347. 



ssPresse Mfd., 1910 (18), 289; 1911 (19). 409; also Ganz and Hertz, ibid., 

 1911 (19), 41; Kaufmann, Beitr. Klin. d. Tuberk, 1913 (26), 269; Hempel- 

 Jfirgensen. ibid., p. 392. 



86a RevieAv by Cocke. Amer. Jour. Med. Sci.. 1914 (148). 724. 



8" Fischberfr and Felberbaum, Medical Record, Oct. 21, 1911; Acs-Xagv, A^'ien. 

 klin. Woch., 1912 (25), 1904. 



88 Jour. Amer. Med. Assoc, 1912 (59), 1537. 



