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.

    35/78 (page 29)
    credible. I therefore very carefully enquired into this point, and he stated that he was quite sure of the fact, because up to 27 years of age (13 years ago) he was an amateur boxer and weighed lOst. 81b,, which was his usual weight at that time, and he was classed in those days in competitions as a middle-weight. Shortly after that time he gave up boxiug and began to increase in weight, which he attributed to better living and lighter work, as he was made, about that time, manager of his lithographic department. For fully the last eight years he had been 12st., and affirmed most strongly that during his illness he had gained rather than lost in weight. Ou the day after his admission into hospital he weighed 128t. 51b. in his shirt, slippers, and a dressing gown.* The hoarseness came on only a week ago, and although he states he has occasionally been hoarse before, it never lasted so long as seven days. The family history was as follows : Father died when about 40 years of age, the cause of death being given as some chest complaint; mother alive, 68 years old, in good health ; two brothers and sisters living, aged 27 and 36, in fairly good but not very robust health ; two brothers and sisters had died, one at 21 years of age, the cause of death being believed to be consumption, and the other at 25 years, of acute inflammation of the bowels after her confinement. Condition on the day after admission (June 7th, 1894) : Patient is a big muscular man, with marked orthopnoja. He has great difficulty in lying down in bed, and sits propped up, breathing somewhat noisily, distinct bubbling sounds being audible, and which are apparently produced in the throat. He keeps blowing out his lips with each respiration, making a noise very similar to what many grooms do when cleaning a horse. His cough is somewhat but not very troublesome. There is very little expectoration, only two or three small purulent masses being in the spittoon, which was emptied about 14 hours ago. He is decidedly hoarse. Respirations, 40 per minute. Pulse, 114 per minute, regular, but small. Temperature last night, 99'8° F.; this morning, 98'8 F. (Further details of pulse, respirations, and temperature are given in the appended table and by the sphymographic tracings.) The face is pale and the lips not markedly blue. The fingers are, however, decidedly clubbed, and the bed of the nails slightly livid. No fulness of the veins of the neck. There is slight anasarca of the lower extremities, which readily pit on pressure. No ascites. No cedema of the upper extremities. The chest is a broad, well-shaped one. There is possibly slight flattening of the left infra-clavicular region, but the difference between the two sides is very slight. There is very little movement of either side of the chest, the respiration being chiefly abdominal. Percussion : In front there is dulness all over the left side of the chest from the supra-clavicular to the infra-mammary region, the latter region not being absolutely duU but giving impaired resonance on percussion. The dulness extends across the median line to the right border of the sternum. The right supra- clavicular, clavicular, and upper part of the right infra-clavicular regions show decidedly impaired resonance, but are nob absolutely dull. (See Fig. 9.) The vocal fremitus over the left infra-clavicular region is less marked than over the corres- ponding region of the right side, but it is not absent. Posteriorly, there is dulness over the left supra-scapular, supra-spinous, infra-spinous, and inter-scapular regions, the dulness being more absolute above than below. Below the inferior angle of the left scapula the resonance is impaired, but there is not absolute dulness, and on the right side there is dulness over the supra-scapular, supra-spinous, and upper part of In reference to this question of weight, it is to bo romomborod that he had on admission slight anasarca of the lower extremities.