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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    in convalescence from long standing febiile affections'^, I have observed it also in a case of mitral incompetence with dilatation of the heart, and it occurs in cases of great dyspnoea from narrowing of the air passages-, and it is recorded in cases of mediastinal tumour-'. Experimentally it has been produced in animals by compression of the inferior vena cava at its entrance into the auricle during the inspiratory period, and lastly, slight diminution of the pulse has even been observed in sphymographic tracings taken from healthy individuals.-^ * Although, therefore, the pulsus paradoxus can no longer be con- sidered peculiar to cases of indurative mediastino-pericarditis, the detec- tion of it in any case should direct the physician's attention to the possible presence of that aflFection. Engorgement of the veins of the neck is common in cases of mediastino- pericarditis, and such engorged veins may show marked pulsation, as in cases of dilatation of the right cavities of the heart from simple cardiac dilata- tion, or in cases of dilatation of those cavities secondary to mitral or other valvular disease. A particular form of distension of the right external jugular vein, however, is sometimes seen in mediastino-pericar- ditis, and has been considered of great diagnostic value. In this form of pulsation the vein is seen to fill and become distended during the act of inspiration, especially when a deep inspiration is taken. Unfortunately for its diagnostic value this inspiratory swelling of the right cervical vein is sometimes absent in cases of this disease. In neither of the two * At the present time there is a coloured man going the rounds of various cities exhibiting himself to medical men as a pathological curiosity. He is, however, a fraud, in that he has not the two hearts, aa he asserts. A few days ago he called upon me, and I examined him. He stated that, in addition to other anomalies, he had two hearts, and that he could stop the one in the left side of his chest. Whilst he presumes to do this, he allows you to listen with the stethoscope, over the mammary region of the left side, and, at the same time, to feel his left radial artery at the wrist. During the performance, which he then goes through, I certainly noticed that the pulse at the left wi-ist was very small, if not quite imperceptible, and the heart sounds were very indistinct. The explanation appeared to be that he took a very deep inspiration and held his breath. As he was a very muscular man, and contracted the pectoral and other chest muscles, so much muscular noise was produced that the heart sounds were not easily heard, and probably by the deep inspiration and holding his breath, possibly also assiatad by the violent muscular contraction of the pectorals and upper arm muscles compressing the main vessel to the left upper extremity, he actually did render the left radial pulse small. Both myself and a friend found that by a similar action we also could diminish the volume of our radial pulse, and I have since seen that F. Hoppe {ibid.), so long ago as 1854, wrote that any one by an experiment on himself can prove that the radial pulse becomes weaker when the muscles of inspiration are violently contracted whilst the glottis is kept closed, and he also states that this I3 not to be confused with the disappearance of the pulse from the radial artery, effected by the compression of the subclavian vessels, by forcibly elevating the first rib during a prolonged deep inspiration. ' * West (J.). A case of purulent pericarditis treated by paracentesis, etc.—BHlish Medical Journal, 188S. [Disappearance of the pulsus paradoxus after the removal of the fluid.] >» BoEHR (E.). Ueber oinem zweiten Fall von Pulsus paradoxus in Folge von Pericarditis ohne Mtdiastinltls.—ieciincr kli^i. Wochenschrifl, 1883, Nr. 13,