Croup; its history, nature, and treatment. Fiske fund prize dissertation of the Rhode Island Medical Society.

  • Newman, Albert.
Date:
1855
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Licence: Public Domain Mark

Credit: Croup; its history, nature, and treatment. Fiske fund prize dissertation of the Rhode Island Medical Society. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    sometimes formed within the bronchi, the appearance of which has been compared by Dr. Cheyne to that of macaroni boiled in milk. And the exu- dation is sometimes so copious in the smaller bronchial tubes that they become tilled with a solid cylinder of plasma. (Peaslee.) The consistence of the false membrane varies much in different cases, and also in the same case. In some cases it is quite firm, and in others so soft that it cannot be removed with forceps. It is generally firm in sthenic cases, and soft when it occurs in the asthenic; it is generally firmest also in the upper part of the trachea, and softest where it terminates below. Its colour is whitish or yellowish white; and its attached surface is often dotted over with numerous small specks of blood. Its thickness is differently estimated by different observers, but pro- bably seldom exceeds a line and a half. It is thickest upon the posterior and superior wall of the trachea. It is believed that two or more membranes have sometimes formed successively on the same surface. The false mem- brane sometimes adheres with considerable firmness; but more frequently it is partially detached, and has beneath it more or less muco-puruleut matter. Upon the removal of the false membrane, the mucous membrane beneath it is seldom found to exhibit signs of severe inflammation ; and not infrequently has nearly a healthy appearance, even when covered with a thick, concrete membrane. Upon this point, Dr. Ilyland observes: It happens but very rarely that we have an opportunity of examining the state of the membrane in the first period of croup, before the formation of the albuminous concre- tion; and it is on this account, in a great measure, that we seldom find any vivid injection of the parts, for the secretion of the lymph weakens the in- flammation most commonly, and in the end puts a stop to it entirely.1 In many cases, however, no false membrane is found. In such cases, the mucous membrane is generally found covered with a considerable quantity of puriform matter. In some cases, terminating fatally in a few hours, it seems as though death had occurred before sufficient time had elapsed for the exudation to become converted into a false membrane. Nature and Pathology.—Croup has been considered by most writers as essentially different from inflammation of the same parts occurring in the adult; and, from its more frequent tendency to the formation of false mem- brane, has been supposed to possess a specific nature. Our own views upon this, and some other important practical points in relation to the nature and pathology of this disease are comprised in the following propositions, which we sjpall endeavour to substantiate as we proceed:— 1. Croup is always an inflammation of the mucous membrane of the larynx and trachea. 2. The inflammation may be sthenic or asthenic. 3. The inflammation is invariably accompanied by an exudation of the plasma of the blood from the vessels of the part, and upon the surface of the membrane; which exudation becomes organized into a false membrane in about one-sixth of all the cases. 4. This exudation is not essentially different from that which occurs upon the same membrane when in a state of inflammation in the adult; nor from that which occurs upon other inflamed mucous or serous membranes. 6. The exudation relieves more or less completely the inflammation which has produced it. 1 Diseases and Injuries of the Larynx and Trachea. By F. Ryland, p. 134.