MORE THAN YOU EVER WANTED TO KNOW ABOUT SPUTUM!
I almost hesitate to write about this subject, but I feel it must be included because it was
such an integral part of the daily TB san experience as well as being one of the most important indicators of our
medical progress.
First, let's get the technical term defined. We all know what spit is, but the san patients
never used that term. We always referred to it as "sputum" because that's the medical term which was used by all the
doctors and nurses. The medical dictionary definition is:
Sputum:
Matter coughed up and usually ejected from the mouth, including saliva,
foreign material, and substances such as mucus or phlegm, from the respiratory tract.
Did you get that last part, from the respiratory tract? This includes
the lungs! And men with TB had plenty of matter in their lungs to eject through their mouths. In fact,
this activity was going on 24 hours a day. And no matter where you were, the ward, locker room, solarium watching TV
or sitting by your bed eating a meal, you never got away from it.
But of course, this sputum contained active TB bacillus and was infectious,
so what do you do with it? The answer is the sputum had to be collected and destroyed. There were two methods
used to accomplish this. Each person had a sputum cup sitting on their nightstand at all times which they used when
they were in the vicinity of their bed. The elements of it are shown in the photos below. It consisted of
a metal cup, Photo 1, about 4 inches square, with a hinged lid and a finger tab to pop the lid open.
Inside the metal cup was a folded up disposable cardboard insert, which can be seen at the corners of the cup, usually with cotton in the bottom to absorb the sputum. The cardboard inserts with
the sputum were collected everyday and destroyed. Photo 2 shows the flat pattern for the cardboard insert
with all its fold lines and the finished folded product.
1. Above photo Courtesy of The College of Physicians
of Philadelphia.
2. Sputum Cup Cardboard Insert. (Replica)
But what if you were away from your bed? The metal sputum cup
was too big and ackward to carry around. Well then you used your handy smaller travel sputum box. It was made
from one piece of red cardboard material and it folded up into a slim container about the size of a pack of
cards which easily fit into your pajama top or bathrobe pocket. You carried it with you whenever you were
away from your bed. These were also collected everyday and destroyed.
3. Pattern For The Travel Sputum
Box.
4. Travel Sputum Box Folded Up. (Replica)
Important Tests
But even thought it was pretty disgusting stuff, sputum had a redeeming quality. It,
along with x-rays, gave the patients one of the clearest indicators of their progress back to health. Once a month a
sputum sample was collected from each patient in a travel sputum box. They were sent to the lab and analyzed
to determine if the sputum was positive for the presence of TB bacillus. I forget the actual criteria, but I think
you had to have at least three consecutive non-positive sputum tests before you would even be considered for release
from the ward and put on meals. So your first negative sputum test was an important milestone. It meant you
might be making meals in just a matter of 2 or 3 months. At the san, 2 or 3 months seemed like a piece of cake!
5. Sputum Lab technicians setting up sputum cultures.
On the right side of the Photo 5 are two rows of cardboard
travel sputum boxes each attached to a culture dish. The woman technician has an unfolded sputum box by her left
hand and is putting the contents into a culture dish. As far as I'm concerned, the only thing worse than listening to
all the coughing and spitting would be to work with the stuff in the sputum lab. My hat's off to the technicians for
all their work on our behalf
One final word before I close out this subject. Some of the men in my ward not only had
TB but also suffered from silicosis or "black lung" from their many years in the mines breathing in coal dust. Their
sputum was absolutely black and pretty much grossed out all the patients.
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