Indurative mediastino-pericarditis / by Thomas Harris.

  • Thomas Harris
Date:
1895
Catalogue details

Licence: Public Domain Mark

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

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    running along Hues suggestive of vascular or lymphatic extension. There is, however, no indication of any recent tuberculous pneumonia uor of the formation of acute tubercles. The aorta presents slight evidences of atheroma. Abdomen: Peritoneum normal. Stomach and intestines congested. Liver: Considerably enlarged; weight, 51b. 6oz., soft and friable, and, on section, of typical nutmeg appearance. Gall-bladder: Normal. Spleen: Slightly enlarged; weight, 5oz., soft, friable, and congested. Kidneys: Both enlarged; each weighs 8oz. ; capsules peel off readily; surface smooth and of mottled congested appearance. On section, both organs much congested, and much blood drips from the cut surface. Slight increase of the cortex, but no distinct evidence of fibrosis. There is evidently considerable parenchymatous degeneration, the change being probably dependent upon the passive congestion. Ureters normal. Bladder and testicles normal. Joints and bones present no abnormal appearances. The muscles of the body generally are not appreciably wasted. Remarhs on Case 5.—During life this case presented many features of clinical interest. The very long history, during which time dyspnoea, rather than cough or expectoration, had been the most prominent feature, together with a gain rather than a loss of flesh, was not what we expect to find in phthisical cases. His appearance too was not the least suggestive of phthisis, but very much so of a thoracic aneurism or other intra-thoracic tumour. In favour of the latter diagnosis was also the paralysis of the left vocal cord, and the occurrence of cedema of the left arm. Except, however, for the two last named signs no others, except his age and general appearance, could be cited in favour of the diagnosis of a thoracic aneurism. The physical signs of phthisis were, however, so distinct that had it not been for the great difficulty of finding tubercle bacilli in the expectoration, we should have had no hesitation in deciding upon the existence at least of one lesion, viz., tubercular phthisis. But at this time, after the repeated examinations of the sputum by different stains and by different persons, I was inclined to regard the case as possibly one of aneurism with secondary affection of the lungs, due to the pressiu-e of an aneurismal sac. When, however, the guinea-pigs showed unmistakable signs of tubercu- losis, the result of inoculation, and when later a few tubercle bacilli were found in the expectoration, we could no longer escape the diagnosis of chronic tubercular phthisis, but whether there was an aneurism in addition we could not say. Paralysis of the left recurrent laryngeal nerve is so uncommon in cases of phthisis that with the recurrent cedema of the left arm I felt we could not exclude the possible presence
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