Abstract
In a previous report concerning rusty sputum from cases of lobar pneumonia, 3 types of phagocytosis and the effect of serum therapy were described. 1 The present communication deals with the number of extracellular capsulated pneumococci in rusty sputum as an index of the severity of the pneumonia. No attempt will be made at present to relate the counts to therapy.
Seventy-eight roentgenographically proved cases of pneumonia with the following type distribution have been studied: 20 cases of type I, 30 type II, 3 type III, 2 type V, 1 type VI, II type VII, 3 type VIII, 1 type IX, 3 type XII, 1 type XVI, and 2 mixed. Thin smears were made directly from representative rusty portions of the sputum and treated with Wright's blood stain for 3 to 7 minutes. Without the addition of buffer the stain was flooded off with water and the slides were air dried. The capsules of the pneumococci usually did not stain but were readily visualized as clear or occasionally as pink zones around the dark blue diplococci. The mucin stained pale pink and the leukocytes were differentiated as on a blood smear. At first, samples of rusty sputum were examined at 4- to 6- hour intervals throughout the acute stages of the disease. However, specimens taken every 12 hours were found to be equally satisfactory and most of the cases were followed in this manner.
During the study it was found that rusty sputum, relatively free of organisms other than pneumococci, gave the most consistent results. Frankly purulent specimens contained large numbers of capsulated pneumococci which had no relation to the clinical course or outcome of the pneumonia. Mucoid sputa early in the disease are now under investigation.
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