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.

    66/78 (page 60)
    the chronic peritoneal changes. We shall have occasion to refer to these cases more in detail iu a future communication, but so far as our experience at the Manchester Infirmary bears upon the subject, obstructive heart or lung disease, causing backward pressure and venous stasis, is a more common associate of chronic non-tubercular peritonitis, and capsulitis of the liver and spleen, than is a granular kidney. It would appear, therefore, that the chronic peritonitis with capsulitis of the liver and spleen is found not only in cases of indurative mediastino- pericarditis, but that similar changes in connection with the abdominal viscera are found in various forms of obstructive heart and lung disease, and also that similar changes may sometimes be present independently of such venous stasis. Rosenbach, in consequence of an observation of his own and a case' recorded by Wiess from Bamberger's clinic, calls attention to the pos- sible connection between an adherent pericardium, an enlarged liver, and the occurrence of ascites without general dropsy. He has observed such cases, and followed one to the pathological department. He calls atten- tion to the thickening of the capsule of the liver which is found in such cases, and suggests that possibly the pericarditis spreads along the course of the large veins to the capsule of the liver and results there in the formation of fibrous tissue, or that possibly the process spreads in the reverse direction from the capsule of the liver to the pericardium. He goes so far as to regard the association of an enlarged liver and marked ascites without general dropsy with cardiac symptoms as of some value in the diagnosis of an adherent pericardium. This view of Rosenbach's does not seem to be on a priori grounds a very probable one, and if it were true we ought to meet with the association more frequently in cases of adherent pericardium than is the case. Dr. Kelynack, the Pathological Registrar at the Manchester In- fimary, has kindly looked up the records of the post-mortem examina- tions which have been made at the hospital during the past few years, and we find that out of twenty-five cases of adherent pericardium only one was associated with chronic peritonitis and thickening of the capsule of the liver—a proportion far too small to render Rosenbach's suggestion probable. We also find the peritoneal lesion and the thickened capsule of the liver in obstructive heart disease, such as mitral stenosis, without any pericardial adhesions being present. I am inclined, therefore, to think that the ascites which some- times occurs in cases of mediastino-pericarditis, and which is unaccom- panied by extreme anasarca of the lower extremities, is due, in some instances, at all events, to the onset of a peculiar form of chronic peritonitis. This chronic peritonitis may be possibly due to venous engorgement of the peritoneum, consequent upon the dilatation