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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    I an iiTGgnlarly circular opening admitting the point of the finger, and communicating with the oesophagus, was found in the posterior wall of the pericardium. On examining the oesophagus, its upper part was found healthy, but the whole of the lower part from about the middle of the thoracic portion was in a cancerous condition; about two inches and a half of its anterior wall was completely gone, and its cavity was here bounded by the back of the pericardium and by the inner margin of each lung. It was here that the pericai-dium was perforated, and the pleurae covering the lungs in this situation was dull and of a brownish colour, but the lungs were not opened into. “ While the liver was being removed, it was found that the back of its left lobe was adherent to the anterior wall of the stomach in a space about the size of half-a-crown. On separating the adhesions, an opcuing with sloughy margins was found in the stomach, but the firm connectien with the liver had prevented communication with the peritoneum. Tlie whole of the lower part of the oesophagus, the cardiac extremity of the stomach, and the adjoining portion of its anterior wall were cancerous; the cancer was soft and fungating, and in several situations was in a sloughy condition. The intestines were contracted. There was no other lesion.” I conclude Avith a very few remarks on the physical signs of Pneumo-hydro-pericarditis, Laennec, who, as already observed, probably exaggerated the frequency of the occurrence of gas in the pericardial sac, speaks of three signs upon which dependence is to be placed in the diagnosis of air and fluid in the pericar- dium. I. Unusual resonance over the lower part of the sternum. 2. Fluctuation sound {bruit de fluctuation) audible with the action of the heart, and on deep inspiration. 3. As specially relating to the diagnosis of pneumo-pericardium, the circum- stance of the heart’s sounds being heard at a distance from the chest. Upon this sign Laennec placed very considerable reliance. He states, indeed, that his observations respecting it were made some time after those already referred to as one and two, and that he had not been able to determine Avhether it existed in connection with these. Dr. Stokes, whose observa- tions on pneumo-pericarditis are most instructive, noticed the fact of the heart’s sounds being heard at a distance in the case which he has recorded. He remarks, hoAvever, that this sign was not present in either Dr. Graves’ or Dr. M’Dowell’s cases already noticed. I have mentioned that it did not occur in the instance now recorded, and Dr. Walshe has no doubt correctly observed that Laennec’s expressed conviction, that in almost