Malignant disease of the oesophagus succeeded by sudden pericarditis and ultimately by pneumo-pericardium with effusion / [J. Warburton Begbie].

  • Begbie, James Warburton, 1826-1876.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Malignant disease of the oesophagus succeeded by sudden pericarditis and ultimately by pneumo-pericardium with effusion / [J. Warburton Begbie]. Source: Wellcome Collection.

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    noise, a churning splash, audible over tbe whole cardiac region, and rendered more distinct when, for an instant, the patient holds her breath. This sound is not distinguishable at a distance from the chest. The dulness on percussion over the heart has vanished, and now a clear and nearly tympanitic note prevails, with increased fulness in precordial region. The patient’s extreme weakness forbids any attempts to alter her position in bed; the effect of change of posture on the percussion note cannot therefoi'e be determined. 30th.—Physical signs remain as yesterday. 31st.—Patient died at 9 a.m. In endeavouring to explain the remarkable physical pheno- mena connected with the heart, which presented themselves during the closing days of this poor woman’s life, I considered it probable that the pericarditis, of which, on the 23rd of August, the signs were perfectly distinct, was determined by the progress of the cancerous affection of the oesophagus to the posterior Avail of the pericardium; and when, on the 29th, the friction sound over the heart was replaced by the gurgling rale, limited to the cardiac region, and altogether unlike any sound connected AA’ith the heart’s action previously familiar to me; and Avhen, in addition to the evidence thus afforded, there had occurred an unmistakable alteration in the percussion note over the heart, dulness having yielded to clearness, I concluded that perfora- tion of the oesophagus had taken place, and that, besides the presence of lymph and fluid in the pericardial sac, there was also air. The diagnosis then formed and expressed Avas as follows :—Cancer, affecting the loAver portion of the oesophagus where in contact with the pericardium; pericarditis Avith effusion from extension of disease in the former ; finally, rupture of the oesophagus and passage of gas into the pericardium. The mortem examination, conducted on ist September by Dr. Hal- dane, determined the correctness of this opinion in all essential particulars. I subjoin Dr. Haldane’s report. “ The body was much emaciated: the surface very pale. “ When the chest was opened the pericardium, mai'ked by the pressure of the ribs, bulged forwards, and on being punctured air escaped. There were no adhesions of the pericai'dium, but in its cavity were about three ounces of a dark-brown fetid fluid. Both surfaces of the serous mem- brane were coated with lymph of a yellowish-grey colour, of leathery appearance, and evidently of some standing; there was also some softer and more recent lymph, which could be readily scraped off Avith the nail. When the heart, which was of natural size and structure, was removed,