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Show DISEASES OF THE ORGAXS OF RESI'IR ATION. SEC'I‘on 11].] cartilage and very numerous exereseences at (at. At (b) abrasion. .\ smooth base and projecting rims of the ulcer. beginning to cic- TA nu: XV. Fro. 1.--]'rr«'r/nmrlriii's of ('rh-m‘z/ ('«o-l/luf/r. Beneath the vocal atrme. cords a thick layer of connective tissue is formed. visible at (a). the cartilage is obliterated and only a portion of it is left attached at (b). The. connective tissue around it is thickened. ltformed a stricture of the air passages, leading to death by asphyxia. Fig. 2.-Po.\‘fC}‘fo/' HN/ltl'f of. Lil/'j/HJ‘. 15 The thyroid and A circular ulcer on cpiglottis (c). FILL 5‘).--1//I/"{/II.I‘ (ff. (I Ill/ll) (Infillr‘flV/ i L .sli/lr/uilfie (l/H/ [HI/IIIIIIII/I‘I/ fit/n I'I'HlU-WN. In the pharynx and on the uvula cicatrices and recent ulcers. ()n the base of the ulcers with hypera‘mic basis and sharp edges of irregular form at (a). el‘icoitl ((‘ff/i The mucous membrane covering the arytenoid cartilage is swollen, the connective tissue infiltrated. eartilagcs are destroyed by perichondritis and abscesses consecutive ()n the lou'er surface of the epiglottis there are two ulcers (b). to typhoid laryngitis. The laryngeal orifice is constricted by con- siderable infiltration into the ary-epiglottal folds. Tbc exudalte was emptied into the (esophagus. which it bad perforated. and through the orifice thus formed a portion of the cricoid cartilage projects. Fig. 3.-E.rtcnsfre lazy/"gull u/mvo‘mn "sumo/(ml it‘d/2 pulmemo'l/ fuller-«allows. The ulcers have destroyed the right ary-ej'iiglottal fold, the right vocal cord, the right half of the epiglottis and the right Fold of Morgagni, and a great portion of the. left vocal cord. (in the surface over the vocal cord another abscess (e). The death of the individual was caused by lnemoptvsis. i Fig, li.- Veryuric/«sire rlcs-frI/clfrm (cf-II/l‘ll/HJ‘ lri/ aim/ova, (a) \velnm palati drawn to one side. the uvula is destroved. (b) (‘icatrix of the bottom of the ulcers connective tissue nodules are visible at (a). At tb) a densely swollen part of the left side of the orifice of the larynx projecting upon the apex of the arytenoid cartilage (c). Fig. ~l.--'l‘ubercular ulcer over the region of the left arytenoid destroyed portion of the pharynx. (c) Ci-africial contraction of the mucous surfaces converging at (d). (0) presents the remnant of the. destroyed epiglottis. .Fig. 7.- VII/«ms- (‘III/(‘I‘I‘ In Mr boy/Hr. An opaque white mass con- stituting verymunerousvegetations upon the mucous surface. nearlv closing the glottal opening. on the free surface of larynx. individual died of suffbcation. At (a) new formation of vegetatioiis Tracheotomv was performed. ‘ The The fibroid por- there is a network of very fine meshes formed bv highlv ref‘ae- tiVe and very thin fibres. \\'ithin the meshes are. found aifew well the relative quantity of each and their relation to the mucous membrane differ under different circumstam'es. ()n tions form a. network of different sized fibres. and in their meshes, defined epithelial nuclei. a great many granular degenerated col- which also vary in dimension. there are found exudate cells. The number of cells is usually in inverse ratio to the quantity of the fibroid substance. In primary croup the threads are thicker. and a orless blood corpuscles. and finely grained detritus." I11 consequence of the removal of the epithelium in whole lavers. the microsporon penetrates into the mucous tissue proper. and often lesser number of cells exist; in secondary the threads are very fine, forms. ven and a greater number of cells are contained in the meshes. In the metastatic form both exudated cells and decayed epithelial cells till the meshes. Both fibroid masses and exudate cells are derived from the blood. as qu'lr/rrf has experimentally proven. The deeper layers of the mucous membrane are always more or less infiltrated time it takes from the initial state to complete formation of the with cellular elements. which occasionally fill up the sub-mucmts inter-muscular spaces. The mucous glands are filled with secretion and their epithelial lining granular. The causes of croup may be mechanical, chemical. or living irritants. which are capable of producing that peculiar form of fibroid exudation upon the surface of a mucous membrane. and at the same time cellular infiltration into its deeper layers. Secondary and metastatic croup are attributed speedily. a coherent and very massive exudation. extensive exudation is from three to twenty hours. The After this it gains constantly in thickness. (Le/scroll. r/fe 'Dfplzflicrir.) Diphtheritic patches in other cavities differ from these in their containing more pus corjmscles. I11 the larynx the patches are most frequently only found upon the upper sections of the mucous membrane situated above the voeal cords. They are softer than in the upper portions. The fungi are capable of penetrating not onlv into abdominal viscera. and then produce cha ‘acteristic diphtheritic patches (Lauge), but also into the lymph vesselsand lymph glands, and thus spread over the whole organism. In the kidneys they produce \vell cha 'acterized changes. Croupous exudationsjas often F/sc/u'l, states that he discovered as they appear, are only in laryngeal diphtheria; in pharyngeal. reat numbers of monadinze in croupous membranes. Bu/«n. Gerim'll, and Sclziucio'nf/cr have shown it to be of infertious origin. The termination of the disease differs in diopathic and secondary. nasal, buccal, glossal diphtheria they are never produced. tLrtzrrz'c/ed In the first, the formation of extensive membranes in the air there is nothing remarkable in the local condition. "'hcn the swelling is considerable it produces a very transitory feverless angina. \Vhen the surface of the tonsils becomes white and opaque, there is an intermittent sense of pain in the throat. increased in swallowing. The pain often extends into thcinternal and middle ear. Difficulty of and pain in swallowing increase steadily with the formation (if to inim'osporrm sepl/mon by K/clls. passages, Which usually happens in little children. is usually fatal (although occasionally saved by laryngotomy.) The narrowncss of the glottis, the want of power. the excessive prostration which so speedily supervenes, the quick spread of the exudate upon the trachea and bronchi hinder the removal of the exudate from the air passages, and brlng on speedy asphyxia. In the secmnlary and metastatic form. the membrane being neither continuous nor so adherent, nor isit so speedily formed. danger from suffocation seldom exists; and when the patient makes any efforts the exudated masses are readily removed. The infiltration of the sub-mucous Sympi‘mns mo] (lull/‘5'}? of [lip DAM/59. Besides redness and swelling of the tonsils in the earlv stages. the diphtheritic patches and cmn'omitaut exudation. Upon the lunch-swollen tonsils appear large 1n'oiccting plaques, which are often removed by strong cough or strangulation in the attempt to swallow anything. They are of a very dirty yellow or grayish color. and often produce vomiting when they happen to lodge in tissue, and the decomposed and gangrenous nature of the exudate the fauces. and of the tissues, alone form dangerous contingencies. Cessation oftheirritated state ofthe sub-epithelial layer brings about loosening of the croupous masses, which are easily removed 'by coughing or otherwise. There is usually complete restitution of the epithelial swelling of the sub-nnlxillaiy glands. extending to the surrounding covering. unless the tissue has undergone very extensive destruction, and the deeper layers have become quite altered by excessive infiltration. The regeneration of the epithelium begins in the nearest unaffected part of this tissue. which gradually spreads over the denuded ones in the same manner as the epidermis is restitutcd over granulatiug cutaneous tissue from adjacent unaffected portions of the epidermis. (KIL'OS and Arnold.) Laryngeal Dip/«flmrz'rz. That diphtheria is I‘n'oduced by miere-organisms is a well-established fact. It usually affects children of both sexes far oftencr than adults, and of these those who atteml and nurse children are far more liable to be affected with it than others. \Vhether the diphtheritic nzfc/‘m/Joroa, as it has been named by Klebs. is peculiar to this alone or not. is not yet quite settled. That it has been found in the blood, in the exudates. in the kidneys of persons affected It with diphtheria would seem to indicate its specific nature. possesses the power to destroy the mucous membrane. and is the cause of the exudation through which it cxtemls locally aml diffuses through the whole system. For not only does it increase in the destroyed mucous membrane. but penetrates into the whole circulation, from which itis eventually driven out by the kidneys, but not before it has produced more or less morbid alterations and The microscopic great functional disturbance in those organs. appearance is shortly described by T/u'uj‘i/«lrr (in his AM"... of PrLf/m/oq. Iffsmlng/y) as follows: "In the many-layered pavement epithelium there. is lifted up like a flat ridge-interrupting the continuity of the upper stratum --a number of exceedingly fine granular layers. irregularly placed one upon the other. the lowest stratum sending a munbcr of icneatb these. and projections into the sub-epitlu-lial structures. surrounding them, are vessels highly dilated: near them are some few emigrated colorless corpusclcs. The connective tissue fibres are pressed asunder by sero-purnlent exudations. and appear soft and amemic. The acini oftbe mucous glands are equallyinfiltrated with serum." The croupous patches very often combining with if present the follo\\'ing‘ appearance: "Tbc basement membrane imperceptibly passes into a thin purulent layer: facing the epithe- lium is a strongly marked line. In place of the epithelial tissue. which has undergone fibroid alteration. and has been obliterated. The patients breath is extremely fetid. Very often soft tissues, causes a great deal of pain. The swollen tonsils are usually also very painful. Rigors and alternate sensations of heat and chilliness exist at first. Should formation of new patches 01' reformation of those removed take place. it will indicate a general infection of the body. and the symptoms will often change very suddenly to a very high grade of fever. often delirium, flushed face alternating with extreme palcness. injected conjunctiva, head- ache. vomiting occasionally intestinal tenesmus. Children. other- wise very lively. lie very quietly or in a stupor, and indifferent to everything going on around them. In most cases ccmstipation and nicteorisme exist. The seat of pain is usually around the navel. l'artial suppression, or very scanty urination. and pain on pressure upon the region of the kidneys. The urine contains more or less albumen. The microscope shows fibroid casts and vast numbers of mierosporon in different groups and several stages of development. (‘onvulsions very often attack young children-they are sometimes the first symptmns alarming parents and nurses. when others have been overlooked; at first they are intermittent. but gradually be» come continuous. until coma and general anaisthcsia set in. As a rule diphtheritic nephritis sets in after development of diphtheritic patches, and croupous cxudations have formed upon the respiratory surfaces and other mucous membranes: or these may form subse- \Vlien massive laryngeal exudations quent to the nephritis. become complicated with the diphtheritic process death is usually the result. and that very speedily. l'aralysis of the vocal cords is often associated with diphtheria and may persist for a long while after recovery from the first. Motor paralysis of the lower extremities and <u~casionally of the upper are often the result of the general toxicaunia of this insidious disease. (Le/zirz'c/i.) 1 (Eda/m Clan/(ls, Sub-mucous Loni/[Will's of (Til/'1 Wife/2 It is characterized b ' an abundant accumulation of liquid transudate in the sub-mucous connective tissue. the fibrous bundles of which become much separated from each other and also filled with serum. There is a chronic and an acute form of this disease. The last occurs in the vicinitv of acutely-inflamed tissue. is local. and gcncrallv assvmetric. The mucous membrane in the mlemaWell tousi part isiturg'id and pale. aml is surrounded by tissue in :1 only fnarked state of iutlannuation. It is of solid consistence. and it. discharges its liquid contents on pressure after cutting through The transudate is made up of a slightly turbid coagnlunr. H] which o-dcma a number of lvmphoid bodies are suspemlwl._ ('hromc ligaments, usuallv affects 'both sides. especially the ary-epiglottal |