A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
2. Chronic Bronchitis.--The sputum is usually abundant, mucopurulent,
and yellowish or yellowish-green in color. Nummular masses--circular,
"coin-like" discs which sink in water--may be seen. Microscopically,
there are great numbers of leukocytes, often much degenerated.
Epithelium is not abundant. Bacteria of various kinds, especially
staphylococci, are usually numerous.
In fibrinous bronchitis there are found, in addition, fibrinous casts,
usually of medium size.
In the chronic bronchitis accompanying long-continued passive
congestion of the lungs, as in poorly compensated heart disease, the
sputum may assume a rusty brown color, owing to presence of large
numbers of the "heart-failure cells" previously mentioned.
3. Bronchiectasis.--The sputum is very abundant at intervals,
sometimes as high as a liter in twenty-four hours, and has a very
offensive odor when the cavity is large. It is thinner than that of
chronic bronchitis, and upon standing separates into three layers of
pus, mucus, and frothy serum. It contains great numbers of
miscellaneous bacteria.
4. Gangrene of the Lung.--The sputum is abundant, fluid, very
offensive, and brownish in color. It separates into three layers upon
standing--a brown deposit, a clear fluid, and a frothy layer.
Microscopically, few cells of any kind are found. Bacteria are
extremely numerous; among them may sometimes be found an acid-fast
bacillus probably identical with the smegma bacillus. As before {45}
stated, elastic fibers are less common than would be expected.
5. Pulmonary Edema.--Here there is an abundant, watery, frothy sputum,
varying from faintly yellow or pink to dark-brown in color; a few
leukocytes and epithelial cells and varying numbers of red
blood-corpuscles are found with the microscope.
6. Bronchial Asthma.--The sputum during and following an attack is
scanty and very tenacious. Most characteristic is the presence of
Curschmann's spirals, Charcot-Leyden crystals, and eosinophilic
leukocytes.
7. Croupous Pneumonia.--Characteristic of this disease is a scanty,
rusty red, very tenacious sputum containing red corpuscles or altered
blood-pigment, leukocytes, epithelial cells, usually many pneumococci,
and often very small fibrinous casts. This sputum is seen during the
stage of red hepatization. During resolution the sputum assumes the
appearance of that of chronic bronchitis. When pneumonia occurs during
the course of a chronic bronchitis, the characteristic rusty red
sputum may not appear.
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