Sputum

“ IN SUCH A CASE THE SPUTUM THAT IS CONSTANTLY BEING COUGHED UP CONTAINS MYRIADS OF THE GERMS, and it is of the utmost importance in order to prevent other persons in the neighborhood from being infected that this SPUTUM BE DESTROYED. The patient should at all times carry about with him either a small receptacle into which the sputum can be expectorated, [Pg 185] or a large cloth which would answer the same purpose, and in either case the sputum should be burned ”

“ This agent is thought to reside in the sputum and the secretions of the nose and air passages of the patient. It is very contagious at the height of the attack. The sputum of the first or catarrhal stage is thought to be highly contagious. The sputum in the stage of decline is also thought to be capable of carrying the disease. It prevails in all countries and climates. During the winter and spring months it is most frequent. At times it prevails as an epidemic. It occurs most frequently in infancy and childhood, but a person can take it at any age. Second attacks are rare. ”

“ There is never the rusty, tenacious sputum of lobar pneumonia. Herpes never appears, according to Childe. Heart failure is a very prominent feature of plague pneumonia.
It is fortunate that this watery sputum teems with bacilli early in the disease as smears from such sputum give an early and sure diagnosis of this terribly contagious and fatal malady. The knowledge that this infection is transmitted from man to man by the droplets of sputum expelled in coughing demands the protection by some form of mask of anyone coming near such a patient. ”

“ On the second or third day the expectoration becomes bloody. Each sputum, spit, or crachat of the French is composed of mucus intimately combined with blood—that is, not simple streaks or striæ of blood, as in catarrh; nor is it pure blood, as in hemoptysis. Each sputum is either of a yellow, or rusty, or even red color, according to the quantity of blood intimately mixed with the mucus. ”

“ After an examination the sputum must be destroyed by heat or chemicals, and everything which has come in contact with it must be sterilized. The utmost care must be taken not to allow any of it to dry and become disseminated through the air. ”

“ The disease when it occurs in youths and young persons rarely lasts longer than a year, often terminates in less time, and may sometimes, by the aid of medicine, be prolonged for a greater period. If the sputum received during the night in a vessel is flushed in the morning with warm water, while some impurities remain upon the surface, the putrid matter will sink to the bottom (sputum fundum petens) , and the indications are fatal. Likewise sharpness of the nose, hollow eyes, slender nails, falling hair, flattened temples and diarrhoea are of evil omen. ”

“ Patients should be urged not to spit about carelessly, but always use a spit cup and never swallow the sputum. The destruction of the sputum of consumptives should be a routine measure in both hospitals and private practice. Thorough boiling or putting in the fire is sufficient. It should be explained to the patient that the only risk, practically is from this source.
The chances of infection are greatest in young children. The nursing and care of consumptives involves very slight risks indeed, if proper precautions are taken. ”

“ The patient's handkerchiefs should be thoroughly boiled, and his clothing should receive like treatment. Every precaution should at all times be observed in order to prevent the sputum getting onto the furniture or floors, as, under such circumstances, it quickly dries and being broken up into small particles is carried by means of the air to other parts of the house. ”

“ 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. ”

“ The care of the sputum (expectoration) is, however, the essential means of preventing contagion. Out of doors, it should be deposited in a bottle which is cleaned by rinsing in boiling water. Indoors, paper bags or paper boxes made for the purpose are used to receive the sputum, and burned before they become dry. The use of rags, handkerchiefs, and paper napkins is dirty, and apt to cause soiling of the hands and clothes and lead to contagion. ”

“ To find elastic fibers when not abundant boil the sputum with a 10 per cent. solution of caustic soda until it becomes fluid, add several times its bulk of water, and centrifugalize, or allow to stand for twenty-four hours in a conical glass. Examine the sediment microscopically. [p. 29] The fibers will be pale and swollen. Too long boiling will destroy them entirely.
2. Curschmann's Spirals.—These peculiar structures are found most frequently in bronchial asthma, of which they are fairly characteristic. They may occasionally be met with in chronic bronchitis and other conditions. ”

“ This, then, the dried, uncared-for sputum of those suffering from pulmonary tuberculosis, is the great source of danger; this the means so long concealed by which a large part of the human race prematurely perishes. ”

“ When the sputum almost from the first is tinged with venous blood, or even when the sputum is very bloody, of the prune-juice variety, the heart is in serious trouble, and the right ventricle has generally become weak and possibly dilated. ”

“ This symptomless interval is followed sooner or later by ever increasing cough and expectoration of sputum, finally by bronchiectasis and pulmonary abscess, chronic sepsis, and invalidism.
Pathology.—If the foreign body completely obstructs a main bronchus, preventing both aeration and drainage, such rapid destruction of lung tissue follows that extensive pathologic changes may result in a few months, or even in a few weeks, in the case of irritating foreign bodies such as peanut kernels and soft rubber. Very minute, inorganic foreign bodies may become encysted as in anthracosis. ”

“ This will soon reduce the inflammation and effect a cure.
PNEUMONIA, Sometimes called Lung Fever, is an acute inflammation of the lungs, usually caused by a cold, and commencing with a chill and feverish symptoms. At first there is a dry cough and what is known as the brick dust sputum, and in the advanced stages a peculiar dark tint in the cheeks, known as the mahogany flush. The breathing becomes very hurried, rising as high as forty respirations per minute. It is an exceedingly rapid and frequently fatal form of disease. ”

“ If the emergency is excessively urgent, the lungs filling up with blood, moist rales beginning to occur, and frothy and blood-tinged sputum being coughed up, venesection may be indicated; combined with proper hypodermic medication it may save life, and does at times. ”

“ Bones, animal shells and inorganic bodies after months or years produce changes which cause chills, fever, sweats, emaciation, clubbed fingers, incurved nails, cough, foul expectoration, hemoptysis, in fact, all the symptoms of chronic pulmonary sepsis, abscess, and bronchiectasis. These symptoms and some of the physical signs may suggest pulmonary tuberculosis, but the apices are normal and bacilli are absent from the sputum. Every acute or chronic chest case calls for the exclusion of foreign body. ”

“ When once the disease has obtained a foothold in the body its course, like one of Napoleon's campaigns, is short, sharp, and decisive. Beginning typically with a vigorous chill, sometimes so suddenly as to wake the patient out of a sound sleep, followed by a stabbing pain in the side, cough, high fever, rapid respiration, the sputum rusty or orange-colored from leakage of blood from the congested lung, within forty-eight hours the attacked area of the lung has become congested ”

“ The diseases which may be communicated by dust are manifold. The germs of pneumonia, various forms of tonsillitis, diphtheria, croup, whooping cough, colds and tuberculosis are undoubtedly carried by dust. In fact, probably all infections of the respiratory tract may be carried in this fashion. Germs of the diseases named have been isolated from the air. The germs of tuberculosis are carried chiefly by the sputum of affected persons and communicated either by inhalation of dust or by food on which germ-laden dust is deposited. ”

“ The contraction and expansion of the nostrils indicate active congestion of the lungs.
As a general rule, chronic inflammation of the stomach, duodenum, liver, and adjacent organs, imparts a gloomy expression to the countenance, at the same time the eye is dull, the skin dusky or yellow, and the motions are slow. But in lung diseases, the spirits are buoyant, the skin is fair, and the cheeks flushed with fever and distinctly circumscribed with white, for delicacy and contrast, almost exceed the hues of health in beauty. ”

“ It commences in childhood, and becomes confirmed in adult life, often engendering consumption, chronic bronchitis, relaxed sore throat, or some other disease of the lungs or throat which is set down, usually, to a different cause altogether. In concluding this short article, we venture to ask our readers to judge for themselves. When they step out in the morning into the fresh, but cold, air, let them try the difference of feeling arising from the two modes of breathing — through the nostrils, and between the lips. ”

“ From considering the history of this disease, and comparing it with the appearance of the lungs after death, I cannot but be of opinion, that the violent efforts to vomit occasioned primarily both the emphysema, and the varices of the pulmonary vein. This opinion, I flatter myself, will not, to persons well versed in the animal œconomy, seem ill founded, when they reflect how forcibly the lungs are pressed in violent efforts to vomit, both by the muscles subservient to respiration and the abdominal muscles, as well as by the contents of the abdomen itself. ”

“ If the lungs be specially influenced, then, in addition to the ordinary hepatic symptoms, there may be a dry cough, asthma, hurried respiration, bronchitis, hoarseness, and pain in the chest. If the stomach be the sympathizing organ, the tongue is coated white or brown, there is nausea, loss of appetite, flatulency, acidity, dyspepsia, fullness, and oppression, amounting, sometimes, to pain in the stomach after taking food; the food ferments and gives rise to eructations and various other manifestations of disorder. ”

“ In pneumonia, pleurisy, and in all the affections about the lungs and trachea, the disease is held to be of a dry nature when there is no expectoration from the parts affected; and in any complaints about the liver, the mesentery, the stomach, the small or great intestines, or spleen, when the belly is either entirely constipated, or when the discharges brought away by artificial means are dry and scybalous; and diseases of the arteries and veins are known to be dry by the dryness of the tongue, and the parched appearance of the whole body. ”

“ If there be expectoration, with fever, and tenderness in the chest, or sharp pains when a long breath is drawn, there is reason to fear inflammation of the lungs, or bronchitis. In this case all the above means, except the wine and stimulants, may also be used only more freely, and the mustard poultice must be kept on till it makes a blister. The patient must live low, her feet must be frequently bathed in hot water, and her bowels regularly opened either with saline purgatives or enemas. ”

“ It is accompanied by an increased secretion of mucus, and consequent coughing.
3. Pleurisy is an inflammation of the pleura. It is sometimes caused by an injury to the ribs, and results in a secretion of water within the membrane.
4. Pneumonia (pneuma, breath) is an inflammation of the lungs, affecting chiefly the air cells.
5. Consumption is a disease which destroys the substance of the lungs. Like other lung difficulties, it is caused largely by a want of pure air, a liberal supply of which is the best treatment that can be prescribed for it. ”

“ These symptoms may be so slight as hardly to attract the patient’s notice; at other times they are more severe and distressing. Frequently, on any little unusual exercise, the cough is increased, the patient feels a pain in [Pg 27] the side, and expectorates a frothy mucus, and blood is discharged from the lungs. This, perhaps, is the first symptom which excites the alarm of the patient. Expectoration of blood is generally preceded by a saltish taste in the mouth, and a sense of irritation at the upper part of the trachea. ”

“ A cough is an effort of nature to bring up any secretion from the lining membrane of the lungs, or from the bronchial tubes, hence it ought not to be interfered with. I have known the administration of syrup of white poppies, or of paregoric, to stop the cough, and thereby to prevent the expulsion of the phlegm, and thus to produce either inflammation of the lungs or bronchitis. ”

“ For the chief danger of chronic asthma is the probability of serious pathological complications. The direct result of dyspnœa is the impoverishment of the blood by an impeded process of aeration, and the concomitants of the disease are therefore analogous to those of pulmonary phthisis and protracted in-door life—hypertrophy of the heart, emphysema, or swelling of the lungs, inflammation of the bronchi, dropsical swellings of the extremities. ”