Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    267/976 (page 247)
    adherent exudation visible in any part of the pharynx or tonsils : some enlargement of the tonsils has been noticed, and if it be sufficient to press forward tlie anterior arcli of the palate a slight irregularity of outline will be occasioned, but the membrane is continuous, of uniform colour, and smooth. Before this inspection is ended, the tongue should be sufficiently depressed to bring the epiglottis into view ; the vivid redness and turgescence of its apex contrasts strongly with the surrounding textures, and indicates the condition of the subjacent orifice. The disease attains its height by the end of the third day at the latest, but the intensity of the attack may hasten the stages of its advance, and death may occur within forty-eight hours of its com- mencement. The characteristics of this second period are high vas- cular excitement, and an ever-increasing difficulty of respiration ; the cough is now almost incessant, or frequently recurring in shocks of convulsive violence, there is no free secretion, a little viscid phlegm, clear or muco-purulent, may sometimes be expelled, or an opaque mucus be seen in the lower part of the pharynx. Pain is complained of in the front of the larynx or nearer the top of the sternum; the voice may become whispering or suppressed from the effort to speak being evidently painful; the stridulous inspirations are louder and more continuous, the laboured and sonorous breathing being audible at a distance ; and now, though the thirst is great, deglutition is not always easy, in some cases, from imperfect closure of the glottis, the liquid provoking great dyspnoea ; in others the urgency of the dyspnoea itself not permitting the effort. Even at this stage, if the attacks of dyspnoea have neither been too severe nor too frequent, and air sufficient to maintain life be yet admitted to the lungs, the pulse will steadily maintain its force and frequency; there will be great heat of surface and profuse perspiration, especially on the face and forehead, which parts will be of a bright red colour; the veins of the neck and temples may become distended and dark, and the face and lips at times purple, but if they quickly assume a brighter tint it may not be too late for the disease to take a favourable turn. The first evidence of this is a change in the character of the cough ; it becomes lower in tone and less dry, not less in force nor much less in frequency, but be- coming moist and gradually effecting the expulsion of some thick semi-opaque mucus in which not unfrequently small whitish opaque flakes are discernable. At the same time the sibilant inspiration is neither so loud nor so persistent, it is still heard before each couo-h, and it will be.audible during sleep or on first waking; the voice°at tunes regains its natural quality, at others is only hoarse or dissonant in its higher tones; the accessions of dyspnoea are rare and less marked, the febrile excitement subsides, a more equable perspiration dPS!ai?edj becomes abundant and frequently affords large 811 f urate of ammoma aud sometimes of oxalate of lime • the m ICO nmden0it’ ^ and leSS tumid- a loose c°Purulent secretion is often seen m the gullet; the tongue is