Volume 1
A system of practical medicine / by American authors ; edited by William Pepper ; assisted by Louis Starr.
- Date:
- 1885-1886
Licence: Public Domain Mark
Credit: A system of practical medicine / by American authors ; edited by William Pepper ; assisted by Louis Starr. Source: Wellcome Collection.
34/1084 page 50
![the local application of such irritants as steam or ammonia, as M'ell as occur m the diseases croup and diphtheria. Fibrinous exudations may also be present within tissues, especially in hose whose meshes are wide, provided the essential elements of exjagula- t)on are present The coagulative necrosis of various organs, to be more fully meutaoned hereafter, is closely allied to fibrinous clottinjr the fibrino-plastic element being derived from the death of the parluchy- matous cells of the part. ^ In the existence of a fibrinous pneumonia the conditions are somewhat analogous to those present in the fibrinous inflammation of serous surfaces and of the areolar connective tissue. There is present an abuudaiitly cellu ar exudation, held in the place of its origin, the cells undergoing rapid death and surrounded by a wall whose sui)erficial cells resemble in structure, if not in origin, the endothelial cells lining the smaller lymph- spaces of connective tissue, as well as the larger cavities within the «ame known as serous cavities. ' The diphtheritic inflammation is no more to be confounded with the disease diphtheria than is the fibrinous inflammation with the disease croup. Although diphtheria owes its name to the frequent presence of an apparent membrane, it may be said that the latter is not essential to the existence of the former. Diphtheria, like croup, is an afll-ctiou in ^vlllch various exudations may be present, and the anatomical product aione does not suffice m all instances for the recognition of the disease In croup there may be a swollen mucous membrane, M-ith a slight suiier- hcial mucous exudation, or a more abundant exudation of desquamated epithelium and mucus, as well as a fibrinous false membrane. In diph- theria the same varieties of exudation may occur, and in addition the diphtheritic exudation may also be present. The latter, however, is not limited to the disease diphtheria, for its presence is apparent in other mucous membranes than that of the air-passages, and in the pharyngeal mucous membrane in other diseases than diphtheria. A diphtheritic conjunctivitis, enteritis, cystitis, and endometritis are recognized. The cutaneous surfaces of the body may also furnish a diphtheritic exudation. The diphtheritic inflammations of wounds and of variolous eruptions are instances in point. The characteristics of a diphtheritic inflammation are the presence within the tissues of a clotted exudation, which is associated with a defined swelling and death of the part. The exudation contains not onh- dead leucocytes and interlacing fibres, but is also provided with abundant granular material, much^of which presents the well-known peculiarities of microscopic organisms. The apparent false membrane is thus dead, infiltrated tissue, which may be torn away from the continuous unaflected tissue, leaving a raw, rough surface, but not peeled from a comparatively smooth surfiice, as in other forms of pseudo-membranous infl:unniation. The frequent association of a superficial false membrane, corres]-)onding in area with that of the dccjier-seated changes, in Avhich cells and fibres may be present, is to be recognized. The diphtheritic jirocess. however, is localized within, and not U])()n, the tissues atfectcd. Tlie dii)hlherilic exudation re]->resents a local death, a necrosis, of the part conrernod, and the result hns frequently been compared with the death consequent upon the action of a caustic.](https://iiif.wellcomecollection.org/image/b20415023_001_0034.jp2/full/800%2C/0/default.jpg)
