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.

    65/78 (page 59)
    an amount out of all proportion to the oedema of the lower extremities, or even for a time without the occurrence of any auasarca of the limbs. I have seen several such cases, where I had no reason to suspect any independent hepatic cirrhosis or any other disease, such as a tubercular affection of the peritoneum, which would account for the ascites. In four such cases I have been able to make a post- mortem examination, and have found no marked hepatic cirrhosis, but decided changes in the peritoneum. The peritoneum covering the abdominal wall and the intestines has shown comparatively little change at first sight, very little evidence of thickening being manifest in this part of the peritoneum, and there has not been found any marked mat- ting of the intestines together or general peritonitic adhesions. Some adhesions in the neighbourhood of the spleen and liver have been the chief ones present. The capsule of the liver and that of the spleen has shown the most marked change. The surface of these organs has presented a peculiar opaque white porcelain-like appearance, and usually there have been shallow depressions or pits, due to the thickening of the capsules not having been quite uniform. So that the change in the peritoneum in these cases is somewhat peculiar, aud not what one usually associates with one's ideas of chronic peritonitis ; it is, however, evidently of the nature of a chronic inflammatory process. This form of chronic peritonitis with capsulitis of the liver and spleen is referred to by the late Dr. Hilton Fagge,^ and he says the most common cause of it is Bright's disease. Dr. W. Hale White, ^ also, from an analysis of the cases occurring in the pathological registers of Guy's Hospital, came to a similar conclusion, and says of universal perihepatitis, which is to be regarded in the majority of cases as part of a chronic peritonitis, it is almost invariably associated with granular kidney, and frequently with gout, syphilis, over indulgence in alcohol, and diseases of the heart and lungs, causing backward pressure. 1 have collected fourteen cases of chronic non-tubercular peritonitis, in which there was also universal capsulitis of the liver, from the records of the pathological department of the Manchester Infirmary. In ten out of the fourteen cases there was obstruction, usually from valvular or lung disease, causing backward pressure, and in these cases the kidneys were in no instance of the granular contracted variety. The kidneys were usually large and congested, and although in some instances they showed very slight increase in fibrous tissue in parts, it was only to such a degree as might be expected from chronic venous congestion. In only one of the fourteen cases was there any marked nephritis present, and in that instance the kidneys presented both marked parenchymatous and interstitial changes, and in that case also the heart was dilated. The remaining three cases presented no heart, lung, or kidney disease, which would account for