Licence: In copyright
Credit: The relief of cardiac enlargement by surgical measures / by G. A. Gibson. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![As the patient was suffering very considerably from cardiac] uneasiness and cyanosis, the practical question of treatment became urgent, and although his condition was not promising; it was determined that the operation of cardiolysis afforded him the best prospect of relief from his symptoms. Mr. Caird, who saw the patient witli me, entirely concurred in my views; the position of matters was fully placed before the patient, and as he grasped at any prospect of relief, he was transferred, on 1st November, to the care of Mr. Caird. A few days afterwards wliile the patient was under the influence of ether, administerec by the open method, Mr. Caird made a crescentic incision in the left half of the chest, and removed a few inches of the 4th anc 5th ribs. Neither the pleura nor the pericardium was interferec with, and after the removal of the ribs the soft tissues wen replaced, and the wound in tlie skin stitclied up. The patient’f progress was uneventful, and about a week after the operatioi he described himself as feeling very much better. The breathless ness in particular had l)ecome less troublesome, and he lookei better in every way. This improvement, unfortunately, did not last long, and tli^ cyanosis again became more marked, while oedema showed itsel in the lower extremities. As the wound had been long healec and the patient required no further surgical assistance, he wa readmitted to my ward on 25th November, when it was fouir that the oedema had reached as far as the middle of the thighi The pulse was extremely irregular; the condition of the heai was very much as it had been when he was in the ward befon and there was no enlargement either of liver or of spleen. Thei was, further, no ascites. Some improvement resulted after a fe^ days, but this was followed by a relapse accompanied by nois delirium, for which he had to be transferred to the ward for aeut nervous affections. Here he unfortunately developed erysipek of the face, which speedily brought about a fatal termination. A post-mortem examination was performed by Ur. Shennan o 30th November. It revealed the presence of old-standing mitn obstruction, with incompetence of the valves, and dilatation ( the tricuspid orifice, also attended by valvular incompetenc There was no trace of any pericardial adhesion; the pericardiiu in fact, was absolutely healthy. The interesting point revealc was the existence of very strong extra-pericardial adhesion fixing the parietal pericardium to the sternum, costal cartilage and ribs much more firmly than is commonly seen. The hnq](https://iiif.wellcomecollection.org/image/b21969280_0010.jp2/full/800%2C/0/default.jpg)
