Clinical and pathological notes on pericarditis / by W.T. Gairdner.

  • Gairdner, Sir William Tennant, (1824-1907)
Date:
1860
Catalogue details

Licence: Public Domain Mark

Credit: Clinical and pathological notes on pericarditis / by W.T. Gairdner. 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.

    6/38 (page 4)
    may be present, when there is no pericarditis; 3d, It is not always easy to recognise friction-sound (as distinguished from other cardiac murmurs) even when it is present, and distinctly heard by the ear. Let me enlarge a little on each of these sources of fallacy. 1. Friction-sound is not necessanly present in pericarditis.—I do not mean by this to assert that cases of pericarditis often occur iu which no murmur of any kind is present from first to last; but only, that for purposes of diagnosis a murmur is not to be counted on. I am not sure, indeed, that absolutely latent pei'icarditis (so far as friction-sound is concerned) may not occur;* at the same time, it is easier to believe, iu a particular case, that we have missed the right moment—that the characteristic sound has been, or will be, there at some other time, than it is to suppose that the pericardial surfaces can have become rough and smooth again—that fluid and lymph effusion, and then adhesion, can take place—without any murmur at all. I am willing to suppose that the earliest period of pericar- dial effusion is not often, perhaps not ever, entirely devoid of friction- murmur. But what it is of practical importance to bring into strong relief is, that in the progress of pericarditis this most characteristic phenomenon may be absent for long periods in some cases, just as it may be present for long periods in others; that its presence and its absence bear no appreciable relation to the intensity of the disease; and that, therefore, you cannot practically make the diagnosis of pericarditis depend on the presence of friction-sound, nor can you gauge the pressure and extension of the disease by the amount and character of the murmur. This is surely a point of very great im- portance ; and if I am correct in supposing that its importance is not fully brought out in the majority of works in the hands of our students and practitioners, it may be worth while to dwell upon it a little longer. I think we may partially, but certainly not entirely, explain the singular diversities that occur in pericarditis as to the manifestation of friction-murmur. It is sufficiently obvious, and is indeed known to most auscultators, that the amount of fluid efi'usion has much to do with this. Once fairly established, the pericardial friction-mur- mur is less easily suppressed by effusion than the pleural; but only less easily. In the pericardium also, a really considerable effusion of fluid generally first muffles, then renders barely audible, and finally removes, the sound;* the friction-sound becoming indistinct as the 1 Dr Mayne has published one, if not two cases, where tliis may reasonably be suspected. I have seen several in which the murmur was so very slight, that the total absence of it in other cases is not, to me, at all improbable. For Dr Mayne's paper, see Dublin Journal of Medical Science, vol. 7. ^ It is curious, and strongly indicative of the insecurity of our knowledge of pericarditis, that two such excellent authorities as Dr Latham and Dr Walshe sliouid be diametrically opposed to each other on this point. Dr Latham has seen a few instances only in which the murmur disappeared during the stage of effusion ; the general fact being *' that the murmur which is produced by lymph deposited upon the surfaces of the membrane, is neither abated, nor