1. Acute Bronchitis.—There is at first a small amount of tenacious, almost purely mucoid sputum, frequently blood-streaked. This gradually becomes more abundant, mucopurulent in character, and yellowish or gray in color. At first the microscope shows a few leukocytes and alveolar and bronchial cells; later, the leukocytes become more numerous. Bacteria are not usually abundant.
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 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.
8. Pulmonary Tuberculosis.—The sputum is variable. In the earliest stages it may be scanty and almost purely mucoid, with an occasional yellow flake, or there may be only a very small mucopurulent mass. When the quantity is very small there may be no cough, the sputum reaching the larynx by action of the bronchial cilia. This is not well enough recognized by practitioners. A careful inspection of all the sputum brought up by the patient on several successive days, and a microscopic examination of all yellow portions, will not infrequently establish a diagnosis of tuberculosis when physical signs are negative. Tubercle bacilli will sometimes be found in large numbers at this stage. Blood-streaked sputum is strongly suggestive of tuberculosis, and is more common in the early stages than later.