Contributions to the pathology of diphtheritic sore-throat and other kindred affections / by John Burdon Sanderson, M.D.

  • Burdon-Sanderson, J. (John), Sir, 1828-1905.
Date:
[1860]
Catalogue details

Licence: Public Domain Mark

Credit: Contributions to the pathology of diphtheritic sore-throat and other kindred affections / by John Burdon Sanderson, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    thing except the product of a coagulation analogous to that which takes place in the liquor sanguinis. According to many pathologists, the gi-anular matter which is interstitially deposited in the meshes of thg membrana propria and other similar structures (as, e.g., in the urinary tubules of the kidney), is to be regarded as a concrete debris arising from the disintegration of the tissue, indicative rather of defi- cient absorption than redundant deposition. On the other hand, as it is known to occur in membranes which are in the act of transmitting fibrinous plasma (and here we may again cite the example of the kidney), it is not unreasonable to suppose that it is deposited by a process resembling coagulation in the interstices of the transmitted membrane. In either case it is a consequence of abnormal nutrition having its seat at the surface of the membrana propria. Concrete exudations, either on its surface or in its substance, form the essential lesions of the mucous membrane in the following pathological states—viz. (a) Superficial sloughing of the mucous mem- brane; (6) Superficial true croupous concretion; and (c) SuperKcial granular* concretion. 4. Supei-ficial sloughing of the mucous membrane (Diphth€rite, accord- ing to Yirchow and Rokitausky),—There are certain cases (appai'ently much more common in Germany than they are in this country) to which the term diphtheria is applied by Virchovv and Rokitausky, but which difier entirely in their pathological results from that disease as defined by Bretonneau. Professor Friedreich, of Heidelberg, thus describes the lesions characteristic of diphtheritic laryngitis :* Gray-white or yellowish-white masses are formed in the superficial layers of the inflamed mucous membrane; these take the place of the structure of the mucous tissue in the affected parts, and consist of a granular amorphous substance resembling detritus. As, therefore, the whitish layers actually involve the mucous tissue, they cannot be removed fron the latter without loss of substance, and if daring fife the diphtheritic deposit disappears, there is always loss of substance—that is, ulceration of the mucous membrane is established, which is rendered liable to increase in depth aud circumference by new diph- theritic deposits. We have thus ia diphtlieritis au inflammation accomjianied with partial destruction and necrosis of the mucous membrane, which has been rigiitly distinguished, on account of its malignant cliaracter, from fibriiaous laryngitis. Friedreich speaks of this affection as occurring for the most j^art secondarily, with or without croupous exudation on the surface, after measles, scarlatina, or small-pox.t Rokitansky describes similar lesions. Diphth^rite, according to him, is characterized by an infiltration of the mucous membrane, with exudation and sloughing ( Verschorfung) of the same; that is, it con- sists in a mortification of the membrane, which becomes a whitish, yellowish-brown, greenish-brown, friable, or tenacious sphacelus {Brundachorfe) suffused with blood.^ It need scarcely be observtd that the anatomical changes here described differ entirely from those • Haudbuch der speoicllen Puthologie und Theraple. Ecd. von Rud. Virchow. Erlangcn, 1 8.')8. Hand v. 3, 8. 420. t Ibid., p. 432. X Rokitansky : Lehrbucli dcr i>nlh. Analomie, Band ii. n. 43.