Diseases of the larynx / by J. Gottstein ; translated and added to by P. McBride.

  • Gottstein, J.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the larynx / by J. Gottstein ; translated and added to by P. McBride. Source: Wellcome Collection.

    256/288 (page 244)
    epithelial surface which have the appearance of pustules; he cannot, however, with reference to their histological characters, recognise them as variola pustules, because on microscopic examination tlie}' are seen to be nothing more than groups of necrosed epithelium infiltrated with micrococci, and he therefore designates tliem pseudo-pustules. Sometimes small abscesses covered by epithelium simulate pustules. These are, however, absolutely subepithelial or still deeper, but never just above the menihrana jyropria, and are nothing more than miliary metastatic or septic abscesses ; they only occur where septic poisoning has already begun, and are liable to cause extensive destruction of the organ. However much vesicles in the larynx may differ from an anatomical point of view, they have this in common, tliat, owing to raising of the epithelium, they may give rise to loss of tissue, i.e. to more or less marked iilceration. The occurrence of hsemorrhage is also intimately connected with that of pustules. It is particularly apt to occur in hsemorrhagic variola, and takes place either into the pustules, so that they become dark coloured, or into the submucous tissue, when the mucous membrane appears ecchymosed. Diphtheritic inflammation of the larj'iix is much more commonly observed than the occurrence of pustules. The mucosa is covered with yellowish—or owing to extravasations—dark coloured, adherent membrane, while the subjacent submucous tissue is oedematous. Such false membranes may form without the previous existence of pustules ; in some cases they occur not in the immediate neighbourhood of these, even when the latter exist ; sometimes they follow the evacuation of their contents, arising from the seat of the pustules, or threads of false membrane may connect the separate pustules (Löri). Gradually the false membrane is peeled off, usually at the time when the pustules dry up, and erosions are left without much loss of tissue. Marked stenosis may result from diphtheritic accumulation. The croupous symptoms never reach such an advanced degree as in pure croup, and the stenosis is sometimes due to secondary' oedema. If the pustules in breaking down give rise to ulcers, the latter may penetrate to the perichondrium and produce inflammation. According to Eppinger, it is principally the varietj* of pustule described by him as miliary septic abscess which produces this result. In other cases perichondritis may become developed owing to diffuse purulent infiltra- tion of the submiicous tissue—as a result of the adjacent variolous process—without any destruction of the mucous membrane. Perichondritis attacks the thyroid cartilage just as frequently as the cricoid and arytenoids, and leads to ulceration either of whole cartilages or of portions of them. After the sec]nostra are thrown off, healing may