Clinical diagnosis : the bacteriological, chemical, and microscopical evidence of disease / by Rudolf v. Jaksch ; translated from the second German edition by James Cagney ; with an appendix by Wm. Stirling.

Cagney James.

Date:: 1890

Credit: Clinical diagnosis : the bacteriological, chemical, and microscopical evidence of disease / by Rudolf v. Jaksch ; translated from the second German edition by James Cagney ; with an appendix by Wm. Stirling. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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$the fact of mo.st importance is the thickness and exuberance of the coating, and a comparison of instances has shown that such I’edundancy is especially connected with pyrexia.] IX. COATING OF THE TONSILS.—The examination of morbid deposits upon the tonsils is sometimes of the utmost importance in diagnosis. 1. Croupous and Diphtheritic Tonsillitis.—The membrane covering the tonsils both in croup and diphtheria is composed of glis- tening homogeneous fibrin, disposed in the form of a network, of which the meshes vary in shape and size, and enclose epithelial cells, blood- and pus-corpuscles, and micro-organisms of every description. The differences between croupous and diphtheritic membrane cannot be dis- tinguished by microscopic examination alone, as was formerly taught. In both cases whitish layers are found on the tonsils. It should be mentioned, however, that E. Wagner discriminates between croupous and diphtheritic tonsillitis, in that the removal of the membrane in the former affection leaves the underlying tissues simply hypersemic and infiltrated with serum, while in the diphtheritic form a haemorrhagic or even sero-purulent infiltration remains. Hitherto even the newer bacteriological methods of investigation have not thrown much light on the subject. The researches of Luffler,^'^ and the discovery by that author and Klebs of supposed distinctive bacilli, gave rise to the hope that we had attained to an easy method for the diagnosis of diphtheria; but more recent investigations, and espe- cially those of G. V. Hoffmann- Wellenliof^^ have shown that the difliculty is not yet solved. Petei's'^^ discovered gregarina-like bodies {Cocciclium oviforme; see chapter on the Fseces) in diphtheritic membrane stained with alum car- mine and picric acid. This fact is noteworthy, but further observation must show in what relation these forms stand to the disease in man. 2. Phapyng’omycosis Lsplothricia.—A special intei’est has recently come to be attached to the nature of the plugs which block the tonsillar crypts. They are found in almost every healthy person, and consist of epithelial cells and of long segmented fungi, which stain bluish-red with the iodine-potassic-iodide solution. In certain conditions these micro-organisms extend outside the follicles, and cover the surface of the tonsils with patches of varying size. They then give rise to subjective symptoms, and their appearance may be mistaken for a com- mencing attack of croupous or diphtheritic tonsillitis. They may be readily recognised under the microscope by their reaction with the iodine solution, as mentioned above, and the course of the disease will afford a further indication of their nature {Th, Ilering'),^^ 0. Chiari$