Notices of the abnormalities of serous membranes / by Lawson Tait.

  • Lawson Tait
Date:
1869
Catalogue details

Licence: Public Domain Mark

Credit: Notices of the abnormalities of serous membranes / by Lawson Tait. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    Might it be malignant disease ? and I was inclined to believe that it was. The fatal issue occurred three weeks after she came under my care, and post mortem examination showed that I was right as to the condition of the valve, but wrong as to the variety of the disease. The valve admitted the middle finger, and both flaps were much ulcerated on the upper surface. The disease was atheromatous deposit, extending completely round the valve, and of a very soft consistence, owing this probably to its rapid deposi- tion. Besides this disease two peculiarities, of a congenital character, were found; but, to my regret, they must be recorded imperfectly, as I was prevented by the friends of the patient from examining anything but the heart, and from removing any part. That which Avill require shortest mention is the fact that the aortic valves consisted of only two ])0uches, quite healthy, and Avith the corpora arantii but faintly marked, and a coronary artery arising from each sinus. This pccullarit}' is described by Meckel, Cruveilhier, and Henle, as being very rare; variation in the number of pouches being much more con:imon in the pulmonary valves than in the aortic, and increase of the number to four being commoner than its reduction to two. There existed, also, the somewhat rare condition of absence of the pericardium. On removing the sternum and costal cartilages no peculiarity was apparent, as I had not opened into either pleura, and a mass of loose connective tissue seemed, as usual, to occupy the anterior mediastinum. When I endeavoured to pinch up the pericardium, that I might make an incision into it, I found that I could only get a hold of the substance of the heart. I Avas under the impression that I had made a mistake in my diagnosis, and had to do Avith a case of pericarditis and consequent adhesion. On making an incision, almost in the middle line, I came upou a nerve, Avhich a slight dissection showed me to be the left phrenic. I then slit open the left pleura and at once exposed the lung and the left side of the heart. On opening the right pleura, I exposed the right auricle and its ajipendage. I was a little puzzled at first, but soon came to the conclusion that it Avas a condition, the occurrence of which I had not before been aware of, viz., absence of the pericardium. On the left side the parietal pleura Avas continued from the vessels doAvnAvards, to about an inch from the apex, and forwards as far as the anterior coronary artery, thence to the cartilages. On the right side its relation Avas much more limited, being confined entirely to the auricle. This abnormality, although