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.

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    usual amount. The thickened fibrous capsule did not send prolonga- tions of fibroid tissue into the substance of the organ, the thickening being limited to the peritoneal covering of the liver. Remarks on Case The boy was under my observation between ten and eleven months. On no occasion had it been observed that there was any swelling of the veins of the neck during inspiration, nor a pulsus paradoxus, although attention had been repeatedly directed to both these signs. The temperature had been variable. Often for days together, and sometimes for weeks together the temperature charts show that there was no rise of temperature above normal, but frequently there was a slight evening rise, whilst the morning temperature was normal or sub-normal; the evening temperature on such occasions rarely reaching lOrF., and more commonly it was below 100°F. The most marked feature of the case was always the ascites, associated with only very slight oedema of the lower extremities. The abdominal dropsy needed frequent and repeated tapping, but the relief afforded on each occasion was of short duration, fluid rapidly accumu- lating, and it was chiefly on account of the ascites that he sought hospital treatment. During the period he was under observation he also presented marked evidence of cardiac dilatation, as shown by increased area of precordial dulness. There never were any cardiac murmurs. The veins of the neck were always immensely distended, and although at first there was no cyanosis of the face, this became marked at a later period of his illness. Generally, he had a slight cough which frequently became troublesome for one or two weeks, during which time he presented signs of bronchitis and of catarrhal pneumonia. He also presented well-marked signs of tubercular disease of the right elbow and slight enlargement of the axillary glands, but otherwise there were no signs of a tubercular affection of any part of the body. The onset of the illness had been a gradual one, the distension of the abdomen having been the most prominent symptom even before he came under our observation. No history could be obtained of the child having been acutely ill, of having presented any signs of acute peri- carditis or other acute malady. The total duration of the illness was about three and a half years. The post-mortem examination revealed an adherent pericardium with a dilated heart, general pleuritic adhesions, a certain amount of indura- tive mediastinitis, chronic peritonitis, and venous engorgement of the liver and kidneys. The enlargement of the heart was evidently the result of the adherent pericardium, and the venous engorgement of the veins of the neck, which had been such a prominent sign during life, was probably the result