Notes on cases of tumour in the mediastinum / by E. Symes Thompson.

  • Symes-Thompson, Edmund, 1837-1906.
Date:
[1865]
Catalogue details

Licence: Public Domain Mark

Credit: Notes on cases of tumour in the mediastinum / by E. Symes Thompson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    G The cougli increased rapidly, the expectoration became san- guineous, and the patient died a few days after his second visit. A post-mortem examination was performed by the House- Physician of King’s College Hospital, and a tumour, as large as two fists, occupying the position indicated during life by the post-sternal dulness, extending upwards on either side of the trachea, as high as the cricoid cartilage, downwards to the peri- cardium and the roots of the lungs, especially the left, and in- volving the large vessels in one mass, which was bounded posteriorly by the compressed oesophagus and vertical column. The tumour was irregularly lobulated, of a white colour, like brain-tissue, but of much harder consistence, exuding milky juice on section. It involved the superior cava, the innominate and azygos veins, the innominate artery, as well as the carotid and subclavian of the left side, and the whole aortic arch. The pneumogastric and recurrent laryngeal nerves passed through the mass, but did not appear to be compressed or flattened. The pulmonary artery vein and bronchus were embraced by the tumour; several large bronchial glands, containing softened tissue, were scattered about. The left carotid, with the pneu- mogastric and sympathetic nerves, were imbedded in a prolonga- - tion of the tumour, which extended as high as the fourth cervical I vertebra. The pericardium contained a few ounces, and the left pleura i a few pints, of serum. There was no lymph or other evidence of pleurisy, save a slight adhesion at the right apex. No disease was detected in the lungs or in any other organ. The abdomen was not examined. On microscopic examination the tumour was found to consist: of fibrous tissue, from which exuded aggregated granules, free nuclei, fat globules, and irregularly-formed cells, resembling pus- globules, contrasting remarkably with the tubercular matter contained in a softened bronchial gland, which consisted of irre- gularly-formed granular corpuscles, all of the same size, whereas the cells contained in the cancerous mass varied from mere granules to two or three times the size of pus-corpuscles. It is not very usual to find so many of the characteristic symptoms co-existing, and the diagnosis can seldom be made so rapidly and confidently as in this case; for, besides the very marked physical signs already detailed, all these genera l symptoms pointed to the existence of mediastinal disease. Gradually increasing dyspnoea; clanging laryngeal cough; feeble voice ; speech and deglutition difficult; face sufiused, eye: red and prominent; throat and neck puffy and cedematous jugular, axillary, and mammary veins congested; left radial pul& smaller than right. Case IV.—A few months since a thin, pallid boy, set. seven