Page:Diphtheria - a lecture delivered at the Norfolk and Norwich Hospital (IA b22345656).pdf/14

 understood, however, that unless the result of caustic applications, there is no ulceration or sloughing, as is seen in those forms of angina known under the names of "ulcerated" and "putrid" sore throat. I insist strongly on this point, because on it rests the opinion that diphtheria is a disease distinct from other and more familiar forms of "sore throat," while, on the other hand, I hear continually of cases described as diphtheria in which ulceration is mentioned as a prominent feature. Wherever the diphtheritic membrane is detached, as it may be accidentally or by the forceps, a bloody and highly fetid sanies exudes. The membrane itself often extends into the nostrils and to the oesophagus, and in addition, in a large proportion of fatal cases, will be found to have invested the glottis, and to have traversed the entire extent of the larynx and trachea, and even to have reached the bronchial tubes, forming an exact cast of these tubes, and more or less completely impeding respiration. Such cases are, as I have said, almost invariably fatal.

But the lesions after death are not entirely confined to the parts above mentioned; the submaxillary glands are also much engorged, and the surrounding cellular tissue infiltrated with a sanious pus. In addition to this, we find a generally congested state of the internal organs, such as is seen in most of the zymotic diseases, together with a dark and diffluent state of blood with transudations in the serous membranes, and other manifestations of what may in general terms be called the typhoid state. But these are not peculiar to the disease in question, and are consequently of no particular interest.

The physical appearance of the false membrane itself