Pericarditis / by T. Lauder Brunton.

  • Brunton, Thomas Lauder, Sir, 1844-1916.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Pericarditis / by T. Lauder Brunton. 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.

    12/21 (page 6)
    the heart, or else for something very much wrong with the nervous system, in eases where the pulse rate goes up to 150 per minute. You will notice, then, as the result of these observa- tions in the wards, that the symptoms of pericarditis are very slight indeed, and may very easily be overlooked. In consequence of the slightness of the symptoms, cases of peri- carditis are very frequently overlooked, and therefore no record is taken of them. I believe that in many cases the patients may have pericarditis and get well again, and that no notice will ever be taken of it, so that you may get adherent pericardium years afterwards without finding any history whatever of the occurrence of pericarditis. There was one patient who came for a considerable time to the out-patient department. He was a man remarkable in appearance, because he was tall, clean-shaven, and wore gold spectacles—a very unusual thing in out-patients. He was a hair- dresser by occupation, and had no symptom to complain of, except that he was feeling a little weak, and that he perspired violently when he was attending to his customers. On examina- tion of the thorax we found an enormous cardiac dulness of a triangular shape, the apex above and the base below. The apex beat was hardly felt, and, in fact, we found all the signs of very great pericardial effusion. Gradually the effusion became absorbed, and the man returned to his work; in fact, I believe he had continued to attend to his business the whole time. He ceased to attend at the Hospital, and we found that the effusion had nearly disappeared; but, if anyone else should see that man in years to come, he will probably find that there is evidence of pericardial adhesion, and, except for the fact that the man attended at the Hospital, he would get no indication in the history of the existence of great pericardial effusion. Now, on inspection, you may, I believe, occasionally see bulging at the chest. There was, however, no marked bulging of the chest in any of the patients in the wards; but in the case of the hairdresser there was a certain amount of bulging, though not very great. It was chiefly the dulness which had attracted our attention. The only sign that we have observed by inspec- tion in any of those cases was in the boy E., not during the period when the effusion was great, but when the effusion liad begun to be absorbed. We then noticed a sort of wriggling movement over the greater part of the cardiac area, apparently from the fluid having been absorbed and the front surface of the heart having become attached to the pericardium, and, through the pericardium, having given rise to a movement of the chest wall during the contraction of the heart. On palpation we found no definite sign, excepting the one which I have mentioned. In the other case, on admission there was a distinct systolic murmur; there was a distinct thrill at the apex, such as is usually associated with a presystolic murmur and obstruction of the