Paracentesis of the pericardium : A consideration of the surgical treatment of pericardial effusions / By John B. Roberts.
- John Bingham Roberts
- Date:
- 1880
Licence: Public Domain Mark
Credit: Paracentesis of the pericardium : A consideration of the surgical treatment of pericardial effusions / By John B. Roberts. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![pounds of blood were discovered in this situation. Re- cently, Dr. Alonzo Clark, of ]New York, has related* the history- of a patient, in whose pericardium was contained one gallon of sero-purulent fluid. Viry found at the au- tops}' of his case (ISTo. 55) that the capacity of the sac was two or three litres, and that there was on each side a sort of cul-de-sac, which was on a lower plane than the central part of the pericardial cavity. In cases of this kind it would be difficult to get the fluid to flow from the trocar. A case of purulent pericarditis is recorded,t where the tension of the distended sac was so great that a puncture, made at the post-mortem examination, caused the pus to spurt up to the ceiling. In this patient there was an ac- companying empyema.' Dieulafoy states that the pericar- dium of a well-grown adult can contain one thousand to twelve hundred grammes of water, and that the sac when injected overlaps the left edge of the sternum from seven to twelve centimetres. The pericardium of an adult male with.a normal-sized heart is capable, according to Sibson,| of holding from fourteen to twenty-two ounces of water, while that of a boy of six to nine years can contain about six ounces. Under the influence of the pressure exerted by the quan- tities observed, as mentioned above, the pericardial sac becomes greatly distended and At times thinned, though the irritation is more apt to give rise to such inflammatory proliferation that the walls are thickened. When the effusion is great, it is usual to find at the autopsy that the heart lies at the back and upper part of the sac, as would be supposed from the attachments of the organ, and the fact that it is heavier than the fluid. * Phila. Med. Times, Nov. 9, 1878, p. 60. t Lancet, 1863, vol. ii. p. 160. X Keynolds's System of Medicine, vol. iv. p. 305.](https://iiif.wellcomecollection.org/image/b21209352_0021.jp2/full/800%2C/0/default.jpg)
