A practical treatise on the sputum, with special reference to the diagnosis, prognosis and therapeusis of diseases of the throat and lungs / by G. Hunter Mackenzie.

  • MacKenzie, George Hunter.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the sputum, with special reference to the diagnosis, prognosis and therapeusis of diseases of the throat and lungs / by G. Hunter Mackenzie. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    Towards the termination of the complaint “sputa cocta” appear, consisting of a thicker, more purulent, and globular form of expec- toration. This variety of sputum, in the early stages, closely resembles that of commencing tubercular disease, from which it is distinguished by the possession of certain negative characters to be afterwards described. According to the nature of the expectoration L.ENNEC1 described catarrh as mucous, pituitary, dry, fetid, etc. and this classification is still adhered to by some authors. The attempt to distinguish between a mucous, a puru- lent, and an epithelial catarrh has not resulted in any diagnostic gain, for all these varieties may alternate in the same case without any material change of catarrhal conditions. The bronchitic and asthmatic sputa possess few features of diagnostic importance. The appearances presented by the former may be mainly mucous, muco-purulent, or purulent, according to the intensity, extent, and duration of the disease. In the “ dry catarrh ” of L.ENNEC is a variety of chronic bronchitis distinguished by severe attacks of coughing, and very scanty expectoration, of tenacious consistence, and greyish colour. It appears to be owing to a catarrh of the smaller bronchi. The seat of the inflammation and the consistence of the secretion account for the great difficulty of expectoration, and the con- sequent exhaustion which it entails. This “dry catarrh” may present various degrees of intensity, even in the same individual. Sanguineous streaks are occasionally present without possessing any evil import: when persistent, however, or of a recurrent nature, they are said to precede the development of phthisis. The pure asthmatic sputum is generally seen immediately after the attack : it is usually viscid, copious, mucous, and frothy, with an admixture of fine plugs and threads. During the in- tervals of the attacks of asthma, sputum may be entirely absent. Microscopical examinations of these sputa show the presence of epithelial cells, fibres, tube-casts, crystals, and the general debris common to most sputa. Ciliated epithelial cells are rarely present. Elastic tissue maybe present in chronic bronchitis (Case 3), without the individual evincing any tendency to phthisis. Fibrinous casts of the minute bronchial tubes are occasionally found, with a straight, branching, dichoto- 1 Trait4 de l’Auscultation, Paris, ]$37.