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.

    16/78 (page 10)
    Respirations, 30 per minute. Slight cough; no expectoration. Chest well shaped ; right moved better than the left side. In front there was dulness over the left side of the chest, with the exception of the clavicular supra-clavicular, and the upper part of the infra-clavicular regions. (See diagram, Fig. 1.) The dulness extended across the sternum opposite the second and third costal cartilages nearly to the right mammary line. The upper border of the liver dulness immediately outside the right mammary line was in the fourth intercostal space. There was good resonance over the greater part of the manubrium stemi, the right supra-clavicular and clavicular regions, and over the outer part of right infra- clavicular and upper part of the mammary regions. (See diagram, Fig. 1.) Posteriorly there was good resonance over the upper part of the chest on both sides, but there was dulness at both bases which extended nearly as far as the spine of the scapula on the left side, whilst on the right side it only reached to a little above the inferior angle of the scapula. On auscultation in front there was vesicular respiration over both supra-clavicular regions, whilst adjoining the left border of the sternum over third costal cartilages and the third intercostal space there was perfect bronchial breathing. More to the left over the dull area at the outer part of the left mammary region, the respiratory murmur was weak. In this latter region also were audible either fine crepitations or a flue friction sound, we could not be certain whether the adventitious sounds which were there audible were of pleural or pulmonary origin. No adventi- tious sounds over the right side or elsewhere over the front of the chest. Posteriorly INSPR I Fig. 2. Sphygmographic tracing showing the effect of the respiration on the pulse (pulsus paradoxus) in the case of J. L., set. 14. Case 1. Inspr, = period at which a deep inspiration was made. there was weak respiration over the dull area on either side, and over that of the left side were a few very small moist rfiles. An exploring needle was introduced into the left side near the inferior angle of the scapula and a small quantity of clear yellow fluid withdrawn. Pulse 120, small. A sphygmographic tracing showed that it was markedly aflfected by deep inspirations. When a deep inspiration was taken the two subse- quent pulse waves were very much smaller than the preceding or subsequent ones, and the phenomenon was manifested on each succeeding deep inspiratory act. (See sphygmogram, Fig. 2.) The cardiac apex beat could not be seen or felt, but from auscultation it appeared to be in the fifth intercostal space just internal to the left nipple. The cardiac dulness could not be defined from the dulness over the left side of the chest previously mentioned. On auscultation the heart sounds appeared feeble, bub unaccompanied by any murmur. The liver dulness extended from the fourth intercostal space immediately outside the right mammary line to a point about l^in. below the costal margin, and in the median line the lower limit was just above the umbilicus. The surface of the liver appeared smooth and the organ was slightly tender on palpation.