DEATH FROM AN ABSCESS IN THE SUBMUCOUS TISSUE. 133 
case would consequently prove fatal. The treatment from this 
time consisted in keeping the patient as quiet as possible, and 
freeing the nostrils and mouth, and also the tracheotomy tube, 
from the mucus, so as to relieve the breathing. He continued 
to suffer for about thirty hours, when death took place. 
Post-mortem examination .—On exposing the thoracic viscera, 
no structural change was observed, nor couhl anything ab¬ 
normal be seen by an external examination of the trachea. I pro¬ 
ceeded consequently to lay open the trachea by a longitudinal 
incision on its anterior surface through its entire length, which 
at once disclosed the cause of death. Upon the internal and 
posterior part of the tube, commencing at about twenty-two 
inches from the larynx, an abscess had formed, which measured 
nine inches long by two and a half broad. It contained a 
large quantity of thin, light-coloured pus, and completely filled 
up the portion of the trachea in which it was situated. I 
next made a longitudinal incision through the whole of the 
posterior surface of the trachea, and found that the mucous and 
submucous tissues were here thickened throughout, and in 
some places to as much as an inch in thickness. The cut surface 
had a dark, mottled, and tuberculated appearance, the latter of 
which I found to be referable to small portions of lymph, ar¬ 
ranged in regular order, each piece corresponding to a ring of 
the trachea. This lymph was in different stages of change, 
some portions being firm and having abright red margin, others 
resembled pieces of adipose tissue, while some were softened 
and beginning to degenerate into pus. Around the whole of 
the parts the tissue was infiltrated with serum. I ought, 
however, to state that it was only by a microscopical exami¬ 
nation that the true characters of the deposit could be ascer¬ 
tained. 
Reflection on the case has led me to conclude that acute 
inflammation had at first been present in the mucous mem¬ 
brane ; that effusion of lymph had followed, and which, as is 
generally the case in mucous membranes, had degenerated 
into pus; and that, even if 1 had been able to diagnose or 
even to empty the abscess by means of a trocar, death would 
have followed; for, in addition to the large diseased surface 
that would still have been left, other abscesses were found 
to be in the process of formation. 
There are two other points to which I w T ould wish to draw 
attention—first, to the mild character of the symptoms, from 
the commencement of the illness up to the evening of the 
third day ; and secondly, to the circumstance that the disease 
was all situated at the posterior portion of the trachea. 
xxxm. 
18 
