On the rarity of pericardial adhesion in comparison with the frequency of pericarditis / by William Senhouse Kirkes.

  • Kirkes, William Senhouse, 1823-1864.
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: On the rarity of pericardial adhesion in comparison with the frequency of pericarditis / by William Senhouse Kirkes. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    RARITY OR PERICARDIAL ADHESION IN COMPARISON WITH THE FREQUENCY OF PERICARDITIS. By WILLIAM SENHOUSE KIRKES, M.D. MEDICAL EEGISTBAB, AND DEMONSTBATOB OF MOEBID ANATOMY, AT ST. BAETHOLOMEW’8 HOSPITAL. Read on Thursday, November 22, 1849. Old deposits of lymph, of whatever size or amount, and whether consisting of false membranes or organised adhesions, when found in the pleural or peritoneal cavities, have long been ascribed to their right cause, namely, a by-gone attack of inflammation. But when oc- curring in the pericardium it has been customary, until very recently, to refer to an inflammatory origin the adhesions only, not the false membranes, or white spots, as they have been termed: these latter have, by some writers, been viewed as inexplicable in then- origin, while others have hesitatingly attributed them to some partial or inflammatory process. By the satisfactory proofs of their in- flammatory origin furnished by Mr. Paget, in the 23d volume of the Medico- Chirurgical Transactions, all doubt on the subject seems, however, to have been removed. 1 need not, therefore, recapitulate the various points of evi- dence by which this correct view of their nature lias been established ; but, assuming as an admitted fact that the deposits are analogous to other false membranes, and therefore have then- origin in lymph effused during an in- flammatory process, I will endeavour to show that such inflammatory process, instead of being either partial in extent, or chronic in degree or duration, as has been supposed, may, at least in many cases, have possessed all the cha- racters of an acute and general attack of pericarditis. I found this opinion almost entirely on the varieties in number, size, and thickness, presented by the deposits: for these varieties seem to furnish a satisfactory clue to the changes which in course of time the deposits undergo. The simplest form in which we meet with traces of old lymph on the pericar chum is that of opaque white lines on the surface of the heart, usually follow- ing the course of the coronary vessels, and their principal divisions: co-existent with these, or even independent of them, we sometimes notice fringes of old lymph on and about the borders of the right auricle, also several small, firm, slightly-elevated granules, rather firmly adherent to the roots of the great vessels at the base. It may seem that such trivial changes as these are scarcely worthy of notice, and perhaps we should not be justified in ascribing to them any relation to a previous inflammatory process, were it not that in other cases they are frequently accompanied, as shown by Air. Paget, by fine bands or threads of old adhesion between the great vessels, and by various sized ]latches of false membrane on different parts of the heart. The patches of false membrane, or white spots, present, as already stated, considerable diversity in different cases. Sometimes we see one or two pale or whitish deposits on the anterior sur- face of the heart, thin, smooth, and of no great breadth, and firmly ad-