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 / by Robert H. Babcock ... with three coloured plates and one hundred and thirty-nine illustrations.

  • Babcock, Robert H. (Robert Hall), 1851-1930.
Date:
1903
Catalogue details

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 / by Robert H. Babcock ... with three coloured plates and one hundred and thirty-nine illustrations. 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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    cardiiim, or from a chronic proliferative inflammation of the me- diastinum itself, either alone or associated with pericarditis. Ex- tensive fibrous adhesions may bind the heart-sac inseparably to the diaphragm, or the sac may be united to the anterior chest-wall, to the pleura, (esophagus, spinal column, or to all these structures. In some instances the contents of tlie mediastinum are so matted together by dense fibrous' tissue that they cannot be separated without laceration of the organs. When such extensive adhesions exist they may be found to form but a part of a chronic inflammatory or proliferative process which has led to extensive or general adhesions between the two layers of the pleura, or between the lungs and the diaphragm. In exceptional cases fibrous adhesions have formed only at the roots of the great vessels, and have led to partial or complete oblit- eration of the superior vena cava, either alone (Roberts), or in combination with involvement of the main trunk of the pulmo- nary artery, or the ascending aorta (Kussmaul). At the present writing I have under observation a female patient, in whom, to judge from physical signs, chronic mediastinopericardial adhe- sions have led to such retraction of the borders of the lungs that the entire anterior surface of the heart is uncovered. The apex- beat is held immovably fixed in the seventh intercostal space, anterior axillary line. The normal excursion movements of the diaphragm in front are entirely abolished, and the respiration is of purely costal type. The secondary effects of this form of the disease are not lim- ited to the heart, as in the simple adherent pericardium. As the disease is usually combined with chronic valvular disease, it is diflicult to say how much importance is to be attached to this, and how much to the fixation of the pericardium in the production of the great hypertrophy and dilatation found in these cases. The changes in the lungs of chronic bronchitis and brown induration are due partly to the passive hypericmia secondary to the cardiac disease, and partly to the retraction and innnobility of the lungs incident to the pleuro-pericardial or associated pleuritic adhesions. Cirrhosis of the liver is generally present, and is largely re- sponsible for the ascites so frequently observed as a terminal event. There may be also thickening and contraction of the capsule of the liver and spleen, and more or less evidence within the abdom-