Clinical diagnosis : the bacteriological, chemical, and microscopical evidence of disease / by Rudolf v. Jaksch.

  • Jaksch, Rudolf v., 1855-1947.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: Clinical diagnosis : the bacteriological, chemical, and microscopical evidence of disease / by Rudolf v. Jaksch. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    149/572 (page 117)
    But there is another variety of epithelium whose appearance in the sputum is a fact of great importance.13 It is known as alveolar epithe- lium, a name which will serve provisionally, although its derivation from the alveoli of the lungs has lately been called in question (Bizzozero).u It consists of elliptical cells, each containing one nucleus, which usually requires acetic acid to make it visible. The body of the cell is of finely granular protoplasm, and very often holds irregular pigment particles in its substance. These particles consist usually of blood-colouring matter, iron dust or carbon (fig. 53, a). In the last case they are unaffected by reagents generally. Iron dust may be known by its turning blackish- green with sulphide of ammonium, or blue with yellow prussiate of potash and hydrochloric acid. These cells often contain one or more fatty granules, readily recognisable by their high refractive power, and at times they exhibit extreme fatty degeneration (fig. 53, a, a), when their protoplasm is replaced by oily drops of varying size. Sometimes large bodies like drops of fat, presumably derived from the rupture of these cells, are to be seen in the sputum (fig. 53, b). They were first observed by Virchow,15 who named them myelin droplets, from the resemblance they bear to similar forms produced in the destruction of nerve tissue. According to Panizza,1® however, this myelin (which is only the outward form of a considerable number of different substances) is probably mucin, Avhile Zujal7 suggests' it is lecithin or a protagon; but no diagnostic importance is attached by them either to myelin or to myelin-holding cells. Buhlls thought that the appearance of alveolar epithelium in the sputum was characteristic of the disease which he has named desqua- mative pneumonia. It is certainly a fact that such cells are to be found in great profusion only in quite fresh specimens of caseous infil- tration of the lung, whether due to bacilli or not; but then they occur also in pneumonia, in chronic bronchitis, and in chronic pul- monary tuberculosis ;19 sometimes, too, in very large numbers. It follows from their manifestation in processes differing so entirely that their diagnostic significance is on the whole slight. [Troup 20 believes that the presence of alveolar epithelium in the sputum belongs especially to obstinate catarrhs of the apex, when it will be found associated with columnar and ciliated cells; he observes that since such catarrhs tend for the most part to run into phthisis, we have in this an early and valuable sign of impending danger.] There is a special form of alveolar epithelium, consisting of large flat cells con- taining a golden yellow and brown pigment (failing-heart cells, Wagner), whose presence in the sputum, according to F. A. Hoffmann,1*1 only occurs in valvular heart-disease and adherent pericardium. They are absent from the sputum in phthisis and pneumonia, and they may