The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).
- Date:
- 1849-59
Licence: Public Domain Mark
Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
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![learn is that albumen, in different forms and pro- portions, is present; for, whether the expectora- tion be mucus, serum, pus, tuberculous matter, or coagulated lymph, the chemist can discover in these but scarcely discernible varieties of this same principle. There seems to be a considerable va- riation in the proportion of saline matter in differ- ent kinds of expectoration ; and on this depends a distinction, formerly much insisted on, by means of the salt or sweet taste. This criterion certainly fails in distinguishing pus from mucus; but we think that an excess of saline matter may be taken as a sign of inflammatory action in the mu- cous membrane. It is by its mechanical and visi- jle conditions, however, that expectorated matter is most distinctly characterized; and to examine these fairly, the entire sputa should be collected in one oir more convenient vessels of white ware or glass, in which their quantity, colour, and con- sistence, can be minutely scrutinized. In acute bronchitis there is at first a diminution of the natural quantity of the bronchial mucus, with a sense of roughness and dryness in the larynx and trachea; but soon a saltish liquid is secreted, which increases as the inflammation reaches its height. It is transparent, almost col- ourless, and moderately viscid, resembling raw white of egg diluted with water. It generally re- tains a good many air-bubbles within it, and if expectorated with much coughing, it is usually covered with a froth. When poured from one vessel into another, it falls in a stringy or ropy stream. Andral (Clinique Medicale, torn, ii.) con- siders that its viscidity is in proportion to the inten- sity of the inflammation; an increased viscidity be- ing always accompanied with an aggravation of the fever, dyspnaja, and other symptoms. When the bronchitis is attended with fever, he remarks that the sputa become more viscid during the febrile exacer- bation ; insomuch that one inexperienced might be led to suppose that the inflammation had extended to the parenchyma of the lung: after the paroxysm, however, they return to their former state. At the height of the inflammation, and at other times when the cough is violent, they are sometimes streaked with blood: this is produced by the efforts of coughing, and does not tinge the whole mass. These characters are sufficient to distin- guish the expectoration of bronchitis in its first stages; and as long as it remains in this state, there is no improvement of the symptoms; but when the sputa become pearly or opake, or of a yellow or greenish-white appearance, we may be pretty confident that the inflammation is on the decline. This opacity is first perceived in the morn- ing expectoration, and in a few points only; and it is uniformly accompanied with an amelioration of the symptoms. The evening exacerbation some- times brings back the glairy transparency of the secretion ; but, unless there be relapse, the opacity returns on the succeeding morning, and gradually extends to all the expectoration, which is then nearly opake, and greenish or yellowish white : the smoke and dust in the respired air sometimes communicate a grey or dirty tinge. This change is often remarkably conspicuous after the success- ful operation of a sudorific; and, in fact, free per- spiration will sometimes partially accomplish it •early in the disease. After the expectoration has thus become ripened or concocted, it is coughed up readily, and in loose distinct pellets, which, although glutinous in themselves, do not so read- ily unite into one mass as before; they gradually diminish in quantitj^ and in a corresponding de- gree the cough and other symptoms cease : a re- lapse is equally marked by a return of the expec- toration to its glairy transparent state. Sometimes a cold is prolonged by a series of relapses ; and, notwithstanding the length of its duration, the sputa retaining the same character, the affection preserves its chronic form, and does not terminate until the same change has taken place. These successive transitions, which were noticed by Hip- pocrates and Aretaeus, are highly useful to the practitioner in discovering to him the state of the disease, and, taken with the pulse and physical symptoms, will safely guide him in the employ, ment of his remedies. The expectoration in chronic bronchitis is of a very diversified character, and is therefore much less certain in its indications. There is generally in it, opake, yellowish, or greenish-white mucus, like that expectorated at the termination of the acute disease ; but it is usually more difHuent, and often floats in a pituitous or serous liquid. The same mucus is sometimes voided in a more inspis- sated form. Andral describes it as resembling false membranes, and moulded into the shape of the bronchial ramifications ; and Dr. Cheyne (Pa- thology of the Membrane of the Larynx and Bronchia, p. 147,) and Laennec give accounts of a similar expectoration. In the milder cases the mucus thus modified constitutes the whole expectoration; but in a severer form of the dis- ease purulent matter is added, and the appearance, consistence, and odour of the sputa present very great variety. Many tests have been devised to distinguish pus from mucus ; but from what we have before remarked on the close similarity of their chemical composition, it may be judged that they pass by insensible gradations into each other. [Nor docs the microscope exhibit any marked difference in physical character, structure, and apparent com- position between them. (Donne, Cuun dt Mi- croscopic, p. 177: Paris, 1844.)] The utility of minute distinctions of this sort may therefore well be questioned, as they neither enlighten us on the pathology, nor guide us in the practice. Pus IS much less viscid than mucus, and not retaining air-bubbles, as mucus does, it commonly sinks in water, whereas mucus generally floats at the sur- face ; and this test gives us as much as is useful in the distinction. When the two are mingled in various proportions, this and all other tests fail in discriminating them. Proceeding from different parts of the bronchial membrane in different de- grees of inflammation or morbid affection, some portions of the expectoration are mucous and vis- cid, whilst others are purulent and diffluent; some greemsh-white like pus ; others grey, dirty-look- ing brown, or tinged with blood : generally they arc inodorous, but sometimes they exhibit a re- markable fetidity. These characters, however varymg, are unquestionably diagnostic signs of chronic inflammation of the bronchial membrane; but their value in the prognosis and in practice is greatly diminished by the circumstance of such](https://iiif.wellcomecollection.org/image/b21116817_0122.jp2/full/800%2C/0/default.jpg)
