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.

    279/976 (page 259)
    The false membrane may extend into the bronchi; its transition to a soft and less tenacious substance is so gradual that it may become at any point indistinguishable from the muco-pus covering the surface which seems to be undergoing the same inflammatory process. The false membrane of Group differs from that formed during the specific inflammation of diphtheria, both in its chemical and physiological relations ; it is not simply fibrine, but consists of effused lymph in which the presence of albumen can always be chemically demonstrated, microscopically it is a mass of cytoid corpuscles; it is not the result of an interstitial change in the substance of the mucous membrane, but an exudation from its vessels and glands, so that the structure of the membrane producing it remains singularly free from pathological injury. This point has attracted the attention of many of the ob- servers of Croup ; Albers, of Bremen, records the absence of all traces of inflammation of the subjacent mucous membrane in some of his cases, and considers that the plastic exudation being accomplished, the inflammation not only diminishes but probably ceases altogether. He notices also cases of another kind, and it is probable that two classes of disease were before him. MM. Barthez and Billiet,* who represent the French school, in applying the terms Croup and pseudo-mem- branous laryngitis to cases of diphtheria only, remark “ that the mucous membrane beneath the false membrane presents very various conditions, it is sometimes perfectly healthy; this is a fact we have ourselves established.” And again, alluding to the number of cases of severe Croup on record where mere shreds of false membrane were found in the larynx and trachea, an instance of wdiich they them- selves observed, they ask, “ may there not yet be a disease which pre- sents, so great a similitude to Croup that it has been confounded with it by most authors, and in which there is found after death either no alteration in the mucous membrane of the larynx, or a simple inflammation, without swelling enough to obliterate the air passages?” It is such a disease that we mean by Croup ; and while in young children simple turgescence of the mucous membrane conjoined - with spasm may be too soon fatal for the special products of inflam- mation to be found, and in others these products collected near the iase of the arytgenoicl cartilages and in the sacculus laryngis may [ occhide the glottis at an early period of the disease; yet a more or less continuous membranous exudation may in other cases completely ml the trachea, and even extend into the bronchi; whether it is ever I 80 ? ly identified with the mucous structure, or so purely fibrinous as is the special product of diphtheria, will require further observa- 1011s to decide. In some cases the false membrane rapidly forms again i q er expulsion ; Dr. Watson relates a case j- where after tracheotomy as completely re-formed in six or seven hours : the raniditv of its nSto ardevel0P?d sPec]'ality rather thanTnTrigtotl i density of inflammation, and numerous instances prove that the Tifiite des Maladies des Enfants. Paris. 8vo. 1843. Vol i n ion i + Lectures on the Principles and Practice of Physiolf p^O. »S Ji