Diseases of the heart and arterial system : Designed to be a practical presentation of the subject for the use of students and practitioners of medicine.
- Babcock, Robert H. (Robert Hall), 1851-1930
- Date:
- 1910
Licence: Public Domain Mark
Credit: Diseases of the heart and arterial system : Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![express acknowledgnieiiT to Harris's monogra])h, and to thank- fully acknowledge the stininliis derived therefrom. It has en- abled me to give more intelligent and discriminating study to the cases which have come to my notice. I now systematically look for indications of chronic mediastinopericarditis, and discover them many times when otherwise I should probably have over- looked them. Unfortunately, ante-mortem observations of several pronounced cases have been nuide in which post-mortem corrobora- tion of the diagnosis has been denied. Several instructive and typical instances will be narrated in these pages. I wish also to express my indebtedness to John Broadbent's monograph on this subject, as well as to Friedel Pick's paper, Pericarditic Pseudo- cirrhosis of the Liver, in which is particularly discussed the effects on the liver and the production of ascites. Morbid Anatomy.—The morbid anatomical changes found in chronic j^ericarditis are almost always the result of previous acute inflammation. The more common form is the result of the organization of the fibrinous exudate of an ordinary silastic peri- carditis. This process nuiy begin as early as the third or fourth day of the acute inflammation. It is essentially a conservative process, tending to make good the damage wrought by the inflam- mation. This is brought about by the conversion of the inflam- matory exudate into a granulation-tissue, and finally into fibrous cicatrical tissue. The deeper layers of the exudate are first invaded by newly forming blood-vessels and connective-tissue cells with many leuco- cytes, which form the granulation-tissue. This gradually grows into and replaces the entire exudate, and in the course of time the development of intercellular substance converts it into the glisten- ing, white cicatrix. If during this process the two layers of the pericardiuiji arc in contact, union takes })lace and the cicatriza- tion produces firm adhesion between the opposing surfaces. These adhesions mux be general or local, varying with the extent of the original process, and with the conditions obtaining at the time of organization of the exudate. When the adhesion is circumscribed it is most frequently found in tlie parts of the sac where the motion is the least, most frequently, then, at the base of the heart, about the great vessels, less often at the a])ex oi- at the l)orders of the organ. When adhe-](https://iiif.wellcomecollection.org/image/b21229533_0124.jp2/full/800%2C/0/default.jpg)
