Indurative mediastino-pericarditis / by Thomas Harris.

  • Harris, Thomas.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Indurative mediastino-pericarditis / by Thomas Harris. Source: Wellcome Collection.

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    of the sternum, was a yellowish-white, fairly firm, caseous-looking mass, which measured one and a half inches in length and two inches transversely. It was surrounded by firm fibrous tissue, bands of which, with the caseous mass, occupied the whole anterior and middle parts of the mediastinum, and extended backwards to the trachea and oesophagus. There were no signs of any recent activity around the periphery of the caseous-looking mass, or in the surrounding fibrous tissue. Both the caseous-looking mass and the fibrous tissue were evidently of very old standing. The caseous mass and fibrous tissue of the mediastinum were very firmly adherent to the sternum in front, to the lungs on either side, and to the outer aspect of the peri- cardium. No other caseous mass existed in the mediastinum except the one above described. Lungs: Both congested, but otherwise presented nothing abnormal. No signs of any disease in either apex. Liver : Large, but not enlarged to an extreme degree. Surface smooth. On section it presented a marked nutmeg appearance. Spleen : Normal. Kidneys : Congested, but otherwise healthy. Heart : An autero-posterior section was made through the heart and the mediastinum, so as to demonstrate the lesions in the latter part. As the preparation was required for museum purposes, no further dissection of the heart was made. (See plate.) As far as could be ascertained, however, there was no valvular disease, and the muscular substance of the organ was of a healthy colour, though somewhat soft. Microscopically the caseous mass in the mediastinum presented a homo- geneous, granular appearance, and would not stain with logwood or carmine. A few isolated nuclei here and there among the granular material were the only structures which stained at all. A number of sections taken from the periphery of the mass were stained and examined for tubercle bacilli, but with negative results. Microscopical examination of sections made from the liver showed very marked venous congestion, but no increase of fibrous tissue at any part. Remarks on tke case of J. L.—The total duration of this boy's illness appears to have been at the most about one year and nine months. For the first three mouths his symptoms were very indefinite, as he only complained of feeling unwell and of pain in the left side. It was not until these indefinite symptoms had existed for about three months that he became seriously ill, the illness being apparently acute pericarditis and pneumonia. Between four and five months after the onset of this acute illness he first came under my observation. At that time his chief complaint was shortness of breath. He then had marked eyidence of venous engorgement, the lips and ears being very blue, and