CHAPTER XXV. 

 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, 

 from the presence of mosaic-like groups of flat epithelial cells (often 

 packed with bacteria). The pulmonary secretion is either frothy 

 mucus or mucopurulent material, 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, Curschman spirals besprinkled with 

 Charcot-Leyden crystals, and haematoidin and fatty acid crystals may 

 also be observed. 



It may facilitate the examination of the sputum for elastic tissue 

 and actinomycosis 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, it can be burned. When dry, the 

 smear is best fixed by pouring on a few drops of alcohol, allowing this 



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