To make smears for staining, the sputum should be poured on a flat surface, preferably a Petri dish, and a bit of mucopurulent material selected with forceps. A dark background facilitates picking out the particle. A toothpick is well adapted to smearing out such material on a slide. After using the toothpick it can be burned. When dry, the smear is best fixed by pouring a few drops of alcohol on the slide, allowing this to run over the surface, and then, after dashing off the excess of alcohol, to ignite that remaining on the film in the flame and allow to burn out.
In beriberi we have shortness of breath with the early cardiac palpitation. In acute pernicious beriberi the pulmonary congestion and oedema divide with the heart the terrible manifestations of such an attack. The diaphragm may become paralyzed in beriberi. Some authors refer to the dyspnoea of beriberi as the beriberic corset.
Paragonomiasis gives rise to a chronic cough attended with the expectoration of more or less bloody sputum containing ova. Haemoptysis is not infrequent. The physical signs on percussion are slight but may be more marked on auscultation.
Hirudiniasis.—In Northern Africa, as well as in many islands of the Orient, the drinking water of ponds may contain leeches and these water-leeches tend to attach themselves to the pharyngeal mucosa. They may also attach themselves to the tissues about the larynx. In these cases we not only have cough and haemoptysis but dyspnoea from laryngeal oedema. It is probable that cases of dyspnoea called halzoun, and due to the attachment in the region of the larynx of flukes (Fasciola hepatica), as the result of eating raw liver, may often be due to leeches, as the two affections occur in the same regions.
Plague pneumonia is characterized by profound prostration in a patient whose physical signs do not seem to justify such extreme illness. The rather abundant and watery sputum soon becomes sanguinolent. Herpes labialis is absent. Besides primary plague pneumonia which develops directly from contact with a former case we have a secondary pneumonia which develops in the course of a typical case of bubonic plague.
In malaria we have a slight bronchitis in the ordinary types and many recognize a pulmonary type of pernicious malaria.
Malta fever tends to show a bronchial involvement about the twelfth day of the disease. Crepitant râles, a moderate cough and slight dyspnoea may be noted. It was the presence of pulmonary signs along with the profuse sweating and anaemia of the disease that justified the designation Mediterranean phthisis.
In liver abscess the crepitation at the base of the right lung, following congestion incident to the abscess of the right lobe of the liver, is of value in diagnosis. Rupture of a liver abscess into the lung occurs in about 10% of cases.
In heat stroke we may have Cheyne-Stokes respiration and pulmonary oedema.