TUBERCLE 



65 



Method of Collecting the Sputum. 



This is of some importance, and the method recommended 

 should be carried out in all cases. 



Get the patient to wash out his mouth thoroughly with warm 

 water before going to bed. Let him spit into a clean bottle, jar, 

 or tin, and employ only the sputum coughed up before food is 

 taken in the morning. 



It is often impossible to get sputum from children, but in them 

 it is often possible to pick masses of sputum out of the vomit and 

 to demonstrate tubercle bacilli therein ; and when no such masses 

 are seen, bacilli may occasionally be found if the whole vomit be 

 carbolized in the manner described subsequently and the sediment 

 examined. In some cases in which there is no vomit it is occa- 

 sionally justifiable to give an emetic for the purpose of securing 

 sputum and establishing the diagnosis. 



Method of Preparation of the Film. 



Sputum. — Pour the sputum into a Petri dish or watch-glass, 

 and place the vessel upon a dark surface. Examine it closely, 

 looking out for .small yellow particles ; these consist of caseous 

 material, and will probably contain tubercle bacilli in large 

 numbers. The advantage of getting the patient to wash out his 

 mouth and using only fasting sputum is obvious, for particles of 

 food may present exactly the same appearance. 



Having found such a mass, pick it out by means of a platinum 

 loop or pair of forceps, and transfer it to the middle of a clean 

 slide. Now place another slide on the top of the first, squeeze 

 them together, and then slide them apart. You should get two 

 good uniform films. Allow to dry spontaneously, and fix by heat. 



If there are no caseous masses, pick out a mass of the sputum 

 at random and proceed as before. 



If no bacilli are found at the first examination, and you still 

 suspect tubercle, proceed as follows : Half fill an ordinary 

 medicine bottle with carbolic lotion (i in 20), and add a drachm 

 or two of the sputum. Shake thoroughly for a few minutes, and 

 place the bottle where you can give it an occasional shake during 

 the next few hours. Then pour the milky emulsion which results 

 into a conical urine-glass, and allow it to stand for twelve hours 

 or more. Remove some of the deposit which will form with a 

 pipette, and spread it into a thin film on a slide. Dry and fix. 



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