MICROSCOPICAL DIAGNOSIS. 37 



.determining the condition of the respiratory passages. The micros- 

 copist must be more or less familiar with all their various appear- 

 ances or ludicrous mistakes will be liable to occur. If, however, the 

 three following suggestions be carefully carried out the necessary 

 difficulties will be greatly overcome. First, during the collection of 

 the sputa, the patient should rinse and brush the mouth thoroughly 

 after each meal, using a stiff brush and taking pains to remove all 

 particles from between the teeth. Second, the dish, in which the 

 sputa are to be received, should be very clean. Third, if the patient 

 places tobacco in the mouth he should be denied his luxury at this 

 time, for particles of vegetable leaf may mislead the observer. If 

 the amount of sputa be small, then all raised during the twenty-four 

 hours should be saved. If large, that first raised in the morning 

 should be preferred. Any little grayish masses should be chosen 

 and placed at once under the microscope. Acetic acid will clear up 

 the mucus, etc., and render more distinct the yellow fibres if they 

 should be present. If this examination reveals nothing, the follow- 

 ing method should be adopted: 



Make a solution of sodic hydrate, 20 grains to the ounce of 

 water. Mix the sputa with an equal bulk of this solution, and boil. 

 Then add to this mixture four or five times its bulk of cold water. 

 Pour into a conical-shaped glass and set aside. Soon the yellow 

 fibres, if present, will fall to the bottom; from here they can be 

 drawn up with a pipette and examined. Several glass slides should 

 be examined at a single sitting, and the examination should be 

 repeated every few days until the presence or absence of these fibres 

 is satisfactorily demonstrated. If these fibres are not found it does 

 not by any means prove that serious trouble may not exist, but if 

 these yellow elastic fibres fragments of lung tissue are found, it 

 proves that there must be a disintegration of the pulmonary tissue, 

 a condition which must denote serious trouble. In 1878 Sokolowski 

 and Grieff made a report on the value of elastic fibres in the sputa. 

 Their report is based upon an examination of seventy patients. 

 The examinations were made by two methods, fresh and by Fen- 

 wick's method. Usually they mixed the sputa with a solution of 

 soda, liquor sodse, i part, distilled water, 2 parts and boiled it for 

 four or five minutes, then diluted it with an equal quantity of dis- 

 tilled water, and fished out and examined the particles suspended in 

 the water. Of the 70 patients, 19 had breaking down of lung sub- 



