| OCR Text |
Show DISEASES OF THE lIE.\l\"l‘ A N1) l'l'S MEMBRANES. l'osl-n/m'hw .111fn/1s]/.-111 incision was accidentally opening the thorax. 2111 dilatation with hypertrophy of the heart. 111 pericardial distentious alone. the litptid presses upon all sides with an equal force and depresses the diaphragm (which is the most yielding) Very much. and hence the protru- sion forward is thereby lunch diminished. Nymph/ms (/m/ l't/l/Iolof/.//.-l11 relation to the rr/in/o'r/f/ of pericarditis. it is necessary to state. that Mfupr/i/u'c pericarditis is of Very rare occurrence. It is. as :1 rule. a. lesion associated with many varieties of i1111ammatio11s of other serous 111e111branes. such as the pleur: . the peri- toneum. ete.. and the syuoyial structures. It is a most conunou complication of inllauunatory rhelm1atis111. liouillod. (‘ruyeillhieia and Hunter have sullicieutly indicated the 2ctiological relation of rhemnatismal syno- \'itis to pericarditis. Diseases of the lungs of the grayer forms. which are always complicated with iullanuuation of the pulmonary pleura. are. not seldom. the primary 'ause of pericarditis. l)ieulafoy. in his repot't of two cases of pericarditis. complicated with purulent pleuritis. remarks. that in acute pericarditis exudations are Very seldom found: in twenty-two cases which he obser\ed. in only four was there exudation in quantity sullieieut to clinically diagnose. Two of these were complicated with tubercular.one with purulent pleuritis. and one with acttte rheumatism (ff/Lactic llc/u/rnmul. No. 2.0). "less calls attention to a sy111ptom. which has seldom beett noticed. indicating attachment of the pericardium or synechia of both plates; that is. a metallic ring of the sounds of the heart. following the cardiac rhythm. attdible at a distance of 21 yard or more from the patient. "hen the pericardimu is iuunoy'ably attached to the diaphragm. the made in the pericardium. and about 5111) grams of a brownish serum ran out and eattsed a partial collapse of the sac (_ Fig. 1). The peri- cardium \\':ts Very much dilated. l‘librinous strings of dill'erent thickness ( .1. .11.) extended from the heart to the pericardituu. They were most numerous at the apex. The whole surface of the heart. the pericardiac portion coyering the aorta and the pul111o11ary artery. were coy- ered with a whitish. blistery 11seudo-111emltraue. of little cohesion. which had a \‘elyety appearance. ()u the posterior surface of the heart. thick pseudo-111cmbranous cords running from the base to the. apex. The pseudomembraue lining the pericardium was much thinner than the cardiac. Fig. 2 represents a section of the heart. showing the thickness of the pseudt1-111embrane. Its deeper layer. apparently of older date. was far more dense and firm than_ the newer or superficial. which was loose and friable. The pericardial pseuth1-111embranc was of the same character. The lungs were compressed and pushed backward. and only of half their ordinary size. for the pericardium occupied the greater part of the anterior thoracic 'a\'ity. The base of the left lung and the cor- responding pleura wer- also iuyested by a similar exudation as the pericardium. which seemed of recent formation (11'. /. I'.-Fig. l). The basis of that lung presented on its ciremnfercnce t'aces of superficial pulmoni‘ apo- plexy. The right was so adherent to the costal pleura. especially at the apex. which was indurated 21nd bore traces of old tubercttlotts deposits. that it could not he sepa ‘ated from it without tearing. This whole lung was oulematous. congested. and barely permeable to air. The absence of protrttsion of the thorax over the distended space, notwithstanding‘ the considerable quantity of effusion within the pericarditttn. is remarkable in this case. There is 21 great ditference in ditl'erent individuals in regard to that. ()11 SUIIIU £11 very distinct, ridge is formed over the costal cartilages and left: rib. correspond- ing with the region of the heart. 111 others the enlargement of the heart and pericardial distention is formed at the expense of the lung. which it compresses. and whose space it will occupy. and therefore no protrusion anteriorly will be formed. 111 fact. a clear distinction must be made between an aueurism of the heart with 2111 hypertrophy and enlarged organ 21nd an aneuristn with attenuation of its walls; between diseases of the heart proper and exudation within the pericardimn. The greatest protrusion of that region of the thorax was mostly observed in cases of l, S1-tc'1‘1/ox lI. same sound exists, but is not so lottd as the 1‘or111er (Ber/in [Hints/1. 1lV()I‘]//'IIN(‘/l'l'llflf. iVn. 5/). \Vidman cott- siders the drawing in of the intercostal space. during the systole ot' the heart, a Valuable symptom of attachment: of the pericarditun ( l'irc/mur‘s ..‘1rc//fr. l'ol. LAZY). Riegel and Tuczeck call attention to the fact that the so-called cxtra-pericardial attachments manifest themselves by 21 weakening of the heart-pulse during expira- tion. (‘ertain cordiform attachments between the lung and pericardium become relaxed in inspiration and tense during expiration. The heart does. therefore. become free in its motion during inspiration. whilst during expiration the pericardium is retracted with the reced- ing lung. and the heart-pulse is therefore reduced in force (: Berlin, Ifh'm's/I. lfl'l‘lil‘llf. No. 2."). Francois Erauk ((i'uzcz‘fc III/Inlomad, AV). 2.0) states that a pericardial pressure (as prodttccd l by pericardiac etl'usiou) ‘auses enormous reduction of the arterial pressure. whilst the heart continues its rhythmic action unchanged. TA,BLE III. TubercH/m‘ I'm'icard'it‘is 111-1771 degeneracy (ll/(l tulnv'culur I'I/fiUHt/[mt of Hie rig/11‘ Nitric/c. No clini "211 history of patient. contractions of the auricles are not absolutely indispensable to carry on circulation.) lireituug found. in 111) cases of pericarditis. only two cases of idiopathic tuber- The pathological speci- cttlosis of the pericardium. and only our case of tubercles men represented here sutiicieutly explains the nature of the lesion. The right ventricle (‘ 1'. I). '1'. 1).) is in the pericardium alone. and nowhere else. Associated with other tubercular atfections. and as complications. he laid open and spread out. found about forty eases (Berlin, hiss/Art ). The pericardium is dissected Biron (Tb/st: away front the left ventricle. to which it firmly adhered. (/11 Parts. A7). 61) states that this rare idiopathic form is The conm‘actiy'e tissue which united the two plates was exceedingly dense, and was tilled with tubercular masses ()1. T). In the auricle the tubercles were more abund- found mostly in early childhood. lle (litterentiates two forms of that lesion. ()ne without Ill/.I/ m'mlutimz. but. always producing adhesion of the two plates or of ant than in the ventricle. synechia The pericardium was com- pletely blended with the auricle. the aorta, the puhnonary artery and the superior yena 1am. Not only was the fibrous tissue of the attricle perfectly filled with tubercles. but the muscular tissue of the attricle was completely obliterated by the large tubercular masses. Only the endocardium was not atfeetet". by it. The. superior Vena caya was almost, altogether changed by the same mass. whilst around the aorta and the pulmonary artery it formed a perfect cylinder. without. how‘eycl'. injuring the arterial tissue proper. The circulation within these arteries must have been tnuclt impeded. The contraction of the right auricle must have become impossible. (This fact may lead to the conclusion, that exudation. with the whole heart; and one with profuse, The first form is impossible to be diagnosed unless it be. associated with 21 tubercttlar diathesis. when the general cachexia might lead to surmise such a lesion. The secottd form is the exudatiye. bttt does not dill'er in its symptoms front ordinary etfusions within the peri- 'ardium. Fm. :2. .Iculc [[mnmrr/m_r/1'c Jfl/ucrrrrlit‘fs writ/1 Alto/JIMtic [duct/sex, (‘.\s1‘:.-.\ wot11:111.about sixty years old: showed symp- toms of dilatation and hypertrophy of the heart for some Died suddenly. .\ pt_1st-111orte111 exa111i11ation showed the heart co\'c1‘c(1 all over with clotted blood. )'k‘ill'S. which tilled tip the whole cavity of the pericardium. |
