Indurative mediastino-pericarditis / by Thomas Harris.

  • Harris, Thomas.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Indurative mediastino-pericarditis / by Thomas Harris. Source: Wellcome Collection.

    14/78 (page 8)
    Class II. comprises cases of an adherent pericardium with thicken- ing of the sac and adliesion of the exterior of it to surroiuiding parts (sternum, costal cartilages, and lungs), but with very little and some- times no general mediastinitis, a condition which has been termed pericarditis externa and interna. Cases of this nature are probably more common than those belonging to Class I, Class III. comprises those rare cases where there is an increase of fibrous tissue in the mediastinum without any internal pericardial adhesions. To cases of this class the term chronic mediastinitis is appropriate. These cases, as I have said, represent three classes of chronic mediastinal and pericardial affections, which may be separated by the pathologist, but which the physician will have, in the present state of our clinical knowledge, much greater difficulty in separating during life. We may, probably, during the life of our patient, separate cases belonging to the third class from those belonging to the other two, but I think even the most experienced physician will have great difficulty in separating cases belonging to Class I. from those belonging to Class II., 80 as to be able, for instance, to predict that the pathologist will find the appearances of pericarditis externa and interna, and not those of indurative mediastino-pericarditis when the case terminates fatally. It appears also, from a consideration of the records published by various observers, that some of the cases described as representatives of indura- tive mediastino-pericarditis really belong not to Class I. but to Class II., and would be more accurately described as cases of pericarditis externa and interna. During the past five years I have met with cases belonging to each of the above three classes, and three cases, one belonging to each of the three classes, I have been able to follow to the pathological department. I propose, therefore, to first relate each of the cases in their clinical and pathological aspects, to offer a few comments on each, and finally to review the subject of indurative mediastino-pericarditis from the experience gained by the study of my own cases, and of those which have been recorded by other observers, only referring to cases which have been followed by a post-mortem examination. In a subject so difficult of accurate diagnosis as this, it is not advisable to discuss the records of cases, however probable it is that the diagnosis was correct, where no examination after death has been made. Case 1.—Orthopnoea; cyanosis; pidsus ^jamc^oxws/ engorgeme7it oj cervical veins; increased precordial and mediastinal didness. Pleuritic effusion; enlargement of the liver. Later, general anasarca and ascites and death from the effects of cardiac dilatation.