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 heart or venous obstruction in the mediastinum, or it may occur so early in the case as to be probably independent of such venous stasis. In my second case (Case 24 in table) the ascites was a prominent symptom from a very early period of the illness, and probably was independent of venous engorgement, which only appeared as a marked feature some time after the development of the ascites. The False in cases of mediastino-pericarditis presents different characters in diff'erent cases. We may have it differing very little from the normal, but usually it has been found small and frequently also irregular—one form of irregularity was formerly regarded as a pathognomonic sign of mediastino-pericarditis, viz., the pulsus para- doxus, the pulse becoming smaller during the act of inspiration. Pulsus Paradoxus:—It is stated (0. Eoseubach)'^ that P. Hoppe (1855) was the first to observe the phenomen of the pulse becoming small during the act of inspiration. Hoppe's observation was made in August, 1853, in a person affected with pericarditis, dilated heart, and emphysema, and was published in 1854.^^ The phenomenon had, however, been observed some years previously by Dr. C. J. B. Williams, and published by him in the London Journal of Medicine for 1850. At page 464 of the second volume of that periodical (1850), in a article on The Prognosis and Treatment of Organic Diseases of the Heart, the following may be found: Advanced stages of pericarditis and adhesions of the pericardium present a remarkable kind of inequaUty, and even intermission, in the radial pulse, whilst the heart's pulsations are quite regular ; in fact, some of the latter are too weak to reach the wrist, hence the irregularity ; and I have distinctly ascer- tained that the weak, or deficient beats, are those corresponding with inspiration, whilst the stronger pulses are those enforced by the expiratory act, which thus helps the weak heart, and augments its propulsive power. It appears, however, that Widenmann's case (1854), from Griesinger's clinic, was the first case of mediastino-pericarditis where this form of pulse inter- mission was detected and published, although it was not until Kussmaul pub- lished his cases of mediastino-pericarditis in 1873 that special attention was directed to this form of pulse in that disease. This form of pulse, however, is seen occasionally where we have no mediastinal affection, and mediastino-pericarditis may exist without causing the production of this peculiar form of pulse (see several of the cases in the table—e.g., Case 19), The first of my cases presented it in a marked and typical form, my second never presented it during the time the case was under my observation, although it was repeatedly examined for. This form of pulse has been observed not only in mediastino-pericarditis but in different forms of pericarditis without mediaatinitis in cases of large pleuritic effusions (Bauer^*), in great cardiac weakness, Williams (Chakles J. B.). On the prognosis and treatment of organic diseases of the heart.- Journal of Medicine, Vol II., 1850, page 464. »■■> Hoppe (P.). Ueber einen Fall von auseetzon des Radialpulses wahrend der Inspiration und die Uraachen dieses Phenomena. —jSeitJsc/ie Klinik, 1854, s. 33. [Under the action of digitaUs when the pulse became slower and stronger, the intermission disappeared, and reappeared later when the pulae became quicker and weaker.]