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.

    61/78 (page 55)
    We will now briefly consider some general features in the clinical history of cases of indurative mediastiuo-pericarditis which the above records appear to warrant. ^^e. I think many physicians have an impression that the affection occurs more commonly in children than in adults. Such an impression may be correct; but if so, a large number of cases in children must have escaped being placed upon record, or have not been followed by a post-mortem examination. From the above tables, which are com- prised solely from cases where the diagnosis has been confirmed by a post-mortem examination, the affection would appear to be somewhat more common in adults than in children. Of the 22 cases, nine occurred in persons under 18 years of age, and thirteen in persons over that age (including one where the patient is indefinitely described as a young man). Only two cases occurred in persons over 30 years of age. (The three cases of chronic mediastinitis whicb appear in the tables all occurred in older people, the youngest being 37 years of age.) Sex.—Males appear to be more frequently affected than females. Of the 22 cases no less than 17 occurred in males and only five in females. Mode of Onset and Causation.—In some of the cases there is a history of an acute illness, usually some acute chest affection, occurring some time previous to that at which the symptoms of mediastino-pericarditis mani- fested themselves. In some instances this acute illness was clearly an attack of acute pericarditis. In these cases it is probable that the acute illness represented the time when the disease commenced, and that the manifestation of symptoms indicative of indurative mediastino-pericar- ditis at a later date represented the commencement of cardiac dilatation and failure, which was brought about by the pericardial adhesions. In some cases the only acute illness which the person is said to have suffered was one of the acute fevers, most commonly scarlet fever or measles. In many cases the onset has been perfectly insidious, and careful enquiry may fail to elicit any symptoms of the patient having had any acute chest affection. This was so in one of my own cases (Case 24 in the table) where, although from the results of the post-mortem exami- nation, it is almost certain that he had had, at some antecedent date, acute pericarditis, we could obtain no history from the mother pointing to any such acute affection. Trauma does not appear to have commonly played a part in the causation of the affection, although the contrary has been stated. (Hare). Tubercle appears certainly to be not an infrequent associate of the disease, but in many no mention is made either of any tuberculosis of the mediastinal lymphatic glands, or of other parts, being found on post-