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.

    46/78 (page 40)
    of either an aneurism or a mediastinal growth in addition to the phthisis Ihe chnical diagnosis which we did arrive at, and which was sent down on he usual abstract of the case to the post-mortem department, was Chronic tubercular phthisis-paralysis of the left vocal cord-nephritis and the paralysis of the vocal cord we attributed to thickening of the p eura over the apex of the left lung, just as we see occasionally, paralysis of the right vocal cord in phthisis of the apex of the right lung I must admit that, although I have been for years interested In the subject of mediastino-pericarditis, ond was at the time this case occurred actually engaged in writing a part of this communication, I never even thought of chronic mediastinitis as the cause of the oedema of the left arm and the paralysis of the left vocal cord. The result of the inoculation experiments with the guinea-pigs shows the value of such experiments for diagnostic purposes. The animals were manifestly tubercular, and tubercle bacilli had been found in the niguinal gland of one of the animals before we found tubercle bacilli in the expectoration of the patient. I am perfectly aware that many will be inclined to say that we did not perform our examinations of the sputum carefully enough. That is probably true to this extent, that a few tubercle bacilli were in the expectoration which we examined, but that on account of their scarcity we overlooked them. Too many examinations were made, and with the actual knowledge or strong belief that the case was one of tubercular phthisis, for us to admit that carelessness was the real cause why we did not find the organisms in the sputum before the twenty-first examination. As to whether the dyspnoea was entirely to be attributed to the general bronchitis and to the cardiac dilatation, or to any effect which the chronic mediastinitis had on the vagus or other nerves, I cannot say. The pathological appearances of the lungs show how closely a fibroid lung of tubercular origin may resemble a fibrosis of simple inflammatory origin, and how difficult it may be to distiuguish the two unless regard be paid to the position of the fioroid afi'ection and the condition of the parts of the lung surrounding the old fibroid parts. The pathological history of the case was probably that we had a tubercular phthisis which ran a very chronic course; that this was asso- ciated with thickening of the pleura over the tubercular lung, and that the inflammation extended to the upper part of the mediastinal tissue and produced there the fibroid mass found at the post-mortem examina- tion. This fibroid mediastinal tissue and the thickened pleura compressed the left recurrent and left vagus nerves and the left innominate vein, thus accounting for the paralysis of the left vocal cord, and for the oedema being so marked and at one time limited to the left arm. Dilatation of the heart subsequently followed, probably from muscular degeneration