THE RESPIRATORY TRACT. 731 



globules from the bioplasson of the epithelia, after we have added a drop of a 

 very dilute solution of chromic acid or "bichromate of potash, pure water being 

 too violent in its action. We see the contents nearest to the top of the 

 epithelia swell and become transformed into a pale, homogeneous mass. 

 Here the shell of the cement-substance bulges out, and is thinned, until it 

 becomes broken at the point of the greatest convexity and allows the 

 escape of the mucus-globule. Not infrequently ' the whole mass of the con- 

 tents is evacuated from the interior of the distended shell of cement- 

 substance, which, being partially or totally emptied, gives the aspect of 

 what has been termed a "cup- or goblet-cell." This lump of bioplasson is 

 now a mucus-corpuscle, and still endowed with properties of life. Where an 

 inflammatory process is established, the living matter of the epithelia is soon 

 increased ; in other words, their contents become coarsely granular, and, if 

 freed in this condition, form what we call a pus-corpuscle. The main differ- 

 ence between a mucus- and a pus-corpuscle, therefore, is that the former 

 looks finely, the latter coarsely granular, though both are essentially the 

 same. Pus-corpuscles, on the average, are also more coarsely granular than 

 colorless blood-corpuscles. The absolute identity of these bodies cannot be 

 maintained, and the assertion of J. Cohnheim, that all pus-corpuscles nay, all 

 inflammatory elements, are merely emigrated colorless blood-corpuscles, is a 

 great mistake. The formation of pus-corpuscles from epithelia and connec- 

 tive tissue can be directly observed, and no one has the authority to call pus- 

 corpuscles altogether emigrated colorless blood-corpuscles, though all of us 

 agree that these share in the formation of pus." 



" We cannot tell, by watching pus-corpuscles in the sputa, from whence 

 they come ; perhaps black pigment-granules in the pus-corpuscles indicate 

 that they have arisen from a pigmented lung. Only the presence of elastic 

 fibers in the sputa is a sure sign of destruction of the lung, inasmuch as such 

 fibers are present in a large amount in the walls of the alveoli. Of what 

 nature the destruction is can be ascertained only if the elastic fibers be 

 accompanied, besides pus-corpuscles, also by shriveled-up and broken lumps, 

 which indicate cheesy transformation of the inflammatory product, so com- 

 mon in. tuberculosis." 



Later observations have demonstrated that, in ulceration of the larynx, 

 the trachea, or the bronchi, elastic fibers and connective-tissue shreds may ap- 

 pear in the sputa, the same as in ulcerative destruction of the lung-tissue. 

 The determination of the nature of the ulcer depends entirely upon the con- 

 stitution of the patient, as diagnosed from the appearance of the pus-cor- 

 puscles. (See page 52, Fig. 20.) If the pus-corpuscles exhibit the features 

 of the series P, indicative of a poor constitution, the diagnosis " tuberculous 

 ulceration " is justified, regardless of the seat of the destructive process. Ob- 

 viously, great care must be taken to have the oral cavity of the patient thor- 

 oughly cleansed before the sputa can be used for microscopic examination, 

 since the shreds of connective tissue found may be the debris of animal food 

 carried along by the sputa. 



In one case echinococcus of the lungs could be diagnosed from the character- 

 istic appearance of the echinococcus sac, emptied with the sputa. 



11 Exceptionally also tltc new formation of myeloma in the lungs can be diagnosed 

 % the examination of the sputa alone, as illustrated by the following case, 

 which occurred three years ago. A justice of this city, about sixty years of 

 agp. had a tumor in his right groin, which, after repeated extirpations, always 



