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.

    98/288 page 86
    DISEASES OF THE MUCOUS MEMBRANE. believes that sniiiU rooms, and the unfavourable conditions brought about by residcuoo in lioispital, influence tiie number and severity of the cases. The disease occurs in an epidemic and sporadic form, but we do not know to wliat conditions its epidemic occurrence is due. A number of observations favour the tlieory that epidemic and sporadic croup are multiplied by infection. Among- predisposing causes age is tlie most important. Croup is a disease of childhood, seldom attacks children under one year, is most common between the ages of two and seven, and after this diminishes in frequency. Males are more commonly attacked than females (according to Eühle, in the proportion of .3 to 2). It appears that hereditary tendency may favour the development of diphtheria and particularly of croup, and that, on the other hand, it may furnish a certain immunity from the disease. It is completely unproved that robust, well-nourished children are more commonly attacked by croup than delicate ones, and those aflaicted with other diseases. One attack of croup gives no immunity from a second. Cases are recorded of repeated attacks, which are rendered all the more remarkable and important because the number of those who survive the first attack is well known to be small. The specific poison seems to attach itself more readily to a mucous membrane when in a catarrhal state. A remarkable case was observed by the author in 1879, in which a croupous was devel- oped from a catarrhal inflammation almost under his eyes. R., a teacher from Mitau in Courland, thirty-four years of age, consulted us on the 2Gth of June on account of long- continued, but slight, hoarseness. Laryngoscopic examination showed the appearances of chronic catarrh, the interarytenoid commissure in particular being afifected. A 4 per cent, solution of nitrate of sih'cr was applied daily until the 30th. When the ])atient retiu-ned on the following day (1st .July), the hoarseness had increased, the mucous membrane appeared intensely red, and, on the ventricular bands, were seen diffuse white shining spots resembling those which occur after the application of nitrate of silver either in the solid form or in strong solution ; an accumulation of false membrane was, however, not present, and the general health was not disturbed. AYe could not explain the change, for croup was not thought of on account of the patient's age, and also because the mucous membrane of the pliarynx was quite normal. The application of nitrate of silver was given up, and the patient was advised to rest; during the liight, however, his condition got worse, he became aphonic, and suffered from dyspnoea. In spite of this, he came to oiu- consulting-room on the 2nd of July and showed us a membrane almost as large as a small plate, which he had coughed up on his way, and which presented a complete cast of the laryngeal cavity. The dyspnoea was marked, and laryngoscopic examination showed that, in si^ite of the recent expectoration of membrane, the inner surface of the larynx— more especially the ventricular bands near the base of the epiglottis—was covered with false membrane which was partly adherent and partly free. The patient, who was only here on his way and had therefore no home comforts, was advised to go into hospital at once and have tracheotomy performed. Dr Schnabel performed the operation iipon the same day in one of our hospitals, but the patient died after twenty-four hoiu-s. The post-mortem examination showed that the fibrinous exudation extended into the smallest bronchi. A\1iether, or how, tlie patient was exposed to diphtheritic infection was never ascertained ; he had a few days before come from Berlin, and both there and in Breslau the disease is usually present all tlie year round.
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