CONSUMPTION OF THE LUNGS. 233 



fever, long retain the crude character of the expectoration of acute 

 bronchitis. The development of tubercle in the bronchial mucous 

 membrane is generally attended by precisely such obstinate and dis- 

 tressing cough, and by that scanty sputa which contains few organic 

 forms, the "sputum crudum" of the ancients, the "purely mucous 

 sputum " of more modern writers. 



Should microscopic examination reveal that the deep-yellow, sharply- 

 defined streaks above referred to contain elastic fibres, recognizable 

 through then: arrangement and curve as belonging to the air-cells, we 

 know that the event has happened which the appearance of such sputa 

 would lead us to dread. The profuse formation of cells has extended 

 from the surface of the bronchial mucous membrane into its walls, and 

 the parts surrounding. The discovery of such elastic fibres is a sure 

 sign of phthisis. 



The intimate admixture of blood with the muco-purulent sputa, 

 whereby the latter acquire a uniform yellowish-red color, is pathog- 

 nomonic of chronic pneumonia, and we have good grounds for inferring, 

 from the appearance of such sputa in the course of a chronic catarrh, 

 that the air-vesicles have also become involved. 



When cavities have formed in the lungs, a peculiar form of expec- 

 toration appears, which is generally described as pathognomonic of con- 

 sumption, and is often and erroneously supposed to be characteristic 

 of tuberculosis. Rounded, numulated grayish masses are found in the 

 spit-cup, separated one from another, by a greater or less quantity of 

 clear bronchial mucus. If the sputa have been collected in a some- 

 what deep glass, we see irregularly-rounded opaque lumps, having a 

 ragged outline, sink slowly to the bottom. These sputa globosafun- 

 dum petentia of the ancients are an almost positive indication that 

 cavities exist in the lungs. Under the microscope the lumps are found 

 to consist of young granular cells, showing evidence of fatty metamor- 

 phosis, together with a very considerable quantity of irregular angular 

 bodies, and granular detritus. They also often contain elastic fibres 

 from the walls of the air-vesicles. Their opacity and greenish-gray color 

 are due to the unusual amount of definitely-formed solid constituents 

 which they contain, which has been incorporated with them during their 

 long sojourn in the cavity. The rotundity of form is owing to the gen- 

 eral tendency of the sputa, after their ejection, to preserve the shape of 

 the space in the lung whence they have been expelled. They tend to 

 sink to the bottom of the vessel containing the bronchial secretion, 

 because but little air becomes mixed with them in the cavity while 

 the bronchial secretion, being agitated by the inspiration and expira- 

 tion of air, encloses numerous bubbles, and is of lighter weight. The 

 small, rounded, ill-smelling fragments of caseous matter sometimes 



