Diphtheritic ulceration of the air-passages and its relation to pulmonary phthisis / by John N. Mackenzie.

  • Mackenzie, John Noland, 1853-1925.
Date:
[1882]
Catalogue details

Licence: Public Domain Mark

Credit: Diphtheritic ulceration of the air-passages and its relation to pulmonary phthisis / by John N. Mackenzie. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    seems to be their most frequent seat, though the whole mucous membrane of the trachea may be covered with them. I have seen the trachea in its entire length and circumference, together with the bronchi of both sides, almost completely destroyed and its mucous membrane converted into a gangrenous mass. In my experience they are never found in the bronchi of the unaffected lung; but where both lungs are disorganized the bronchi of both sides are studded with them, and in most cases they can be traced directly into the cavities themselves. They are met with less frequently in the larynx and pharynx. In the former they select the laryngeal aspect of the epiglottis, the anterior surface of the arytenoid cartilages and the inter-arytenoid fold as their favorite seats. In the pharynx I have seen them most frequently in the pyriform sinuses, where they sometimes assume a considerable size. Their occurrence here is most probably explained by the accumulation in these cavities of the irritant sputa. In the larynx they lose to a great extent their characteristic appear- ances and approach more closely the type of simple catarrhal ulcera- tion. They are sometimes found associated with or in the neigh- borhood of tubercular ulcers, and I have seen them more frequently than tubercular ulceration in the trachea. Microscopical Appearances.—In the histological examination the diseased structures were with the greatest possible care hardened in Muller’s fluid and alcohol and cut into a series of consecutive sections. All were in like manner colored with borax-carmine, and after wash- ing out in absolute alcohol were examined in oil of cloves and Canada balsam. The sections presented in general the typical picture of circum- scribed diphtheritic inflammation of the mucous membrane. At those situations where sloughs were present, the epithelium and upper layers of the mucosa were converted into a finely granular detritus, and the neighboring connective tissue of the mucosa, and also to a great extent the submucosa, highly infiltrated with lymphoid cells. This round-cell infiltration invaded the tissues between the mucous follicles, without, however, involving them in a marked degree in the inflammatory process. The spots where ulceration had already occurred presented in the base and edges of the ulcer likewise a granular detritus, and the surrounding tissues were also the seat of a high grade of round-cell infiltration. Here and there it was pos- sible to recognize transition stages of both the above-described pro- cesses, viz. nodules, so to speak, of necrobiotic tissue, in which the