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.

    6/6 (page 22)
    saved his life; but, with an organ like the kidney extensively diseased, they seemed but to accelerate bis death. The next point of interest in the ex- amination was an universal adhesion of the pericardium through the medium of a thin layer of moderately recent lymph. The adhesion readily admitted of sepa- ration, yet the force required for tho purpose was probably greater than dur- ing life was exerted by the action of the exhausted heart,—an action scarcely sufficient to give rise to a sound in the cardiac region. So far had the process of adhesion extended, that, had t he man recovered, and the healthy action of his heart been restored, the surfaces pro- bably would never have separated, and the case would thus have terminated in permanent obliteration of the sac of the pericardium; and in this way probably arise many other cases of permanent pericardial adhesions,—the condition being that, formally days after the sub- sidence of tho inflammation, the heart should remain with its action so en- feebled as to be unable to prevent agglu- tination of the two approximated sur- faces of the lymph-besmeared pericar- dium, until the adhesion has become strong enough to resist its restored action. In addition to what lias been said re specting the rarity of permanent peri- cardial adhesion, it may be remarked that the very ingenuity displayed by Nature in the reparation of her damaged structures might reasonably lead to the supposition that, in repairing a mischief inflicted on the pericardium by inflam- mation, some more simple and less inju- rious method would be contrived than that of cementing the two surfaces toge- ther, and thereby irreparably crippling the movements and impeding the func- tions of one of the most important organs of the body. It is obvious that the for- mation of false membranes, instead of adhesions, is, next to complete absorp- tion of the effused lymph, the most effectual method by which repair of the injury could be accomplished ; for such false membranes, unlike organised ad- hesions, would probably afford but little obstacle to the ultimate removal ot tlie greater part, or perhaps even tlie whole of the inflammatory products. Even supposing them to remain, as possibly they often do, they cannot be considered as very prejudicial to the functions of the heart, for we frequently see them passing into a perfectly harmless condi- tion, becoming thin, blending with the natural investment of the heart, and de- veloping a layer of epithelium on their exterior, whereby the smooth polished secreting surface belonging to the healthy pericardium is restored. More- over, the heart does not seem to resent their presence; for their existence is not found attended by enlargement of this organ, unless there be coincident affec- tion of the valves, or some other lesion, such as degenerated kidneys, whereby such enlargement may be explained. HI. On the last point little need be said; for, if what I have endeavoured to prove be true, that inflammation of the pericardium terminates far less fre- quently in the formation of permanent and organised adhesions than is usually supposed to be the case, the prognosis in this disease is evidently more favour- able than if such results more commonly ensued. From the general opinion at present entertained on this sub- ject, the prognosis in even the most favourable cases of acute pericarditis attended with effusion of lymph is gloomy enough ; for most writers seem to agree with Dr. Hope, that “adhesion, so far from being a perfect reparation, gives rise to another form of organic- disease, which, in a vast proportion of cases, ultimately proves destructive to the patient.”* * Since the above remarks were communicated to tlie Abernethian Society, I have obtained what seems to be conclusive evidence in favour of the opinion I have ventured to express, namely, that inflammation of the pericardium, attended by effusion of lymph, does not necessarily terminate, as is commonly supposed, in the formation of permanent adhesions. A girl, a^ed 13, was ad- mitted into St. Bartholomew’s Hospital, about the middle of last October, for acute rheuma- tism, in the course of which both endocarditis and pericarditis ensued. The pericardial friction sound was distinctly audible tor four or five days, and then disappeared, and the child left the hos- pital early in December. In leis than three months, however, she was re-admitted in a state of great exhaustion, with mdematons legs,cough, palpitation, and pain in the cardiac region. She died within a fortnight; and, on examination of the body after death, the only evidence of the pericardial inflammation four months previously was the existence of numerous vascular tufts and fringes of fine cellular tissue about the base, and of several patches of equally fine and vnscu- lnr tissue spread over the surface of the heart, especially in front. There whs not a trace of ad. hesion between the opposed surfaces of the pericardium.