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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![systole or diastole. At the left base, posteriorly, was a dull patch corresponding with Ewart's dull patch in outline, but the harsh, very hurried breath-sounds were everywhere audible. In front, resonance was impaired beneath both clavicles, and the sense of resistance imparted to the finger upon percussion of the prsscor- dium was remarkably intense. In this case the diagnosis was also acute pericarditis, but, unlike the foregoing, there was a massive exudate, occasioning very grave pressure-signs. There was also present the same valvu- lar lesion, mitral regurgitation, but there was very strong suspi- cion of the existence of acute endocarditis, since from the history of scarlet fever in July, with more or less rheumatism subse- quently, with no other previous etiological factor, it was not likely that the mitral disease dated back more than six months. Deglutition gave this little sufferer so much distress that she would hesitate for minutes together before making up her mind to take the proffered medicine or nourishment. In this case the urgency of the symptoms arose from pressure. Dyspnoea was so great that the little thing begged to be allowed to stand up, evi- dently to relieve the thoracic organs, already much compressed, from still greater pressure by the abdominal viscera forced upward against the diaphragm in the sitting position. The contrast presented by these two cases was most instructive. In this latter case paracentesis pericardii was advised without delay. It would have been cruel, if not useless, to postpone the operation until trial had been made of cathartics and diuretics. Far better tap first, and administer these afterward. Suppurative pericarditis generally occasions ])honomena of sepsis, but chills, fever, and sweating are sometimes said to be absent (Koberts). When present they are an indication of sepsis, and as such may be a part of the symptomatology of the primary affection as well as of the pericarditis. When the effusion is foetid, as rarely happens, septic symptoms are most marked, and pros- tration comes on early and is extreme. In some cases there is nothing in the nature of the sym]>toms whoreby one may deter- mine the purulent character of the exudate. The symptomatology of hwrnorrliagic ])(M-ioarditis depends upon the rapidity with wliicli the eftiision takes ])lacc, rather than upon its nature. A lia-iiKirrhngic cff'usion into the pericardial sac](https://iiif.wellcomecollection.org/image/b21229533_0096.jp2/full/800%2C/0/default.jpg)
