Epithelial (•oils from various parts of the respiratory tract are often present. Their origin can frequently be determined by their appear ance.
Red blood cells occur in the sputum in acute bronchitis, pneumonia, tuberculosis. and in any condition which is associated by hemorrhage into the respirator• tract.
White blood cells are also readily recognized in methylene blue stained specimens by their irregu lar or multiple nuclei and their unstained cell bodies. They are found in acute and chronic bronchitis. in pneumonia. tuberculosis, abscess. and gangrene of the lung, in fact in any inflam matory condition of the respiratory tract which is marked by a eatarrhal or .suppurative exuda tion.
Mucus, fat droplets, fibrin. elastic fibres, crys tals of calcium carbonate, of triple phosphates, of cholesterin, of the fatty acids. and the so called rhareot-Leyden crystals may lie found in sputum on microscopical examination.
method. For the appearance of certain germs see DISEASE, GERM THEORY OF. • The 'ray' tungus. or tungus of actinomycosis of the lung, is sometimes demonstrable in the spu tum, as are also yeasts. molds, and leptothrix.
Nlieroscopical examination of specimens from the stomach is often of value in determining the condition of that organ. Material is obtained as A large number of harmless species of bacteria are found in sputum, most of these being derived from the month, nose, and upper respiratory tract. (if (Iiseasv•pruducing species the most im portant are the tubercle bacillus. the bacillus of influenza, the pneumo-bacillus of Friedlander. the pnemnococcus. the streptococeses, and the staily locoed's. (For the staining qualities and appear aloe of the tubercle bacillus. see article on The bacillus of influenza is an extretn(•ly minute bacillus measuring only about half the length of the tubercle bacillus. it is apt to occur in dumps and does not stain very readily with methylene blue. A rather weak solution of earbol.fuchsin. however, gives good staining of the micro-organism. The bacillus of Friedlander is the less eomnnon of the pne mie organisms. It is capsulated and decolorizes by (:ram's method of staining. The more com mon cause of ia. the pilemnocoects or diplococcus lanceolatus, is also surrounded by a capsule, but is shorter than the Friedlander bacillus and does not deeolorize by Grain's vomitus or by intro:lnc•ing the stomach tube. In completely digested food may he recognized as muscle fibres, fibrosis and elastic fibres, fat, starch, and various kinds of vegetable cells.
Epithelial cells from the mouth or (esophagus or from the stomach itself may be found. Red blood cells may come from the stomach or may have been swallowed. White blood cells are quite eommonly found. When in large numbers they indicate suppurative inflammation. The condi tion of the stomach may sometimes be determined by the forms of micro-organism which are found growing there. Thug a tong bacillus which Oc curs in chains, the so-called Boas-Oppler is a common habitat of a stomach which is free from hydrochloric acid, and whose contents are Under, ' ig lactic acid fermentation. The villa., on the other hand, a species of cocci which hang together in cubes of eight, sixteen, thirty two. etc.. occur in exactly opposite gastric con ditions, i.e. where hydrochloric acid is present and lactic acid is absent. Yeasts, molds, and leptothrix are also found.
Serous exudates usually show little of diag nostic. import. After standing or after centri fuging.. the sediment may show some epithelial cells, red blood cells, leucocytes, fat globules, cholesterin crystals, etc. Bacteria, if present, are usually in such small numbers as to require culture for their recognition. Fairly frequently, however. the gonococcus may be found in the exudate of gonorrhoea] arthritis, by simply stain ing the sediment. Less frequently the tu bercle bacillus may be identified in a similar manner.
Purulent exudates when examined under the microscope show large numbers of pus cells which are mainly polynuelear lencocytes. Red blood cells and exfoliated epithelium are also often present. Of bacteria may be mentioned the tuberele bacillus, the bacillus of anthrax, the diphtheria bacillus, the streptococcus, sta. phylocoecus, gonoeoceus, and pneumococcus. For methods of examining for tubercle bacillus, see article on TUBERCULOSIS; for streptococcus, and staphylococcus, see article on BACTERIA; for pneumococcus, see PNEUMONIA.
The diphtheria or Klebs-Loefiler bacillus may be found in sputum. For examination it is usually, however, obtained directly from the sus pected membrane. See DIPHTHERIA.
Leptothrix and Oidium albicans are organisms sometimes found in exudates associated with dis eases of the mouth and pharynx. The former is not infrequently the apparent cause of very ob stinate pharyngitis, while the latter is found in connection with the disease known as thrush.