A treatise on the diseases of the heart and great vessels : and on the affections which may be mistaken for them : comprising the author's view of the physiology of the heart's action and sounds, as demonstrated by his experiments on the motions and sounds in 1830, and on the sounds in 1834-5 / by J. Hope.

  • Hope, James, 1801-1841.
Date:
1839
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the heart and great vessels : and on the affections which may be mistaken for them : comprising the author's view of the physiology of the heart's action and sounds, as demonstrated by his experiments on the motions and sounds in 1830, and on the sounds in 1834-5 / by J. Hope. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    190/704 (page 146)
    carditis, unless conjoined with an effusion of lymph or sero-puru- lent fluid. As the sub-serous cellular tissue is softened by acute pericar- ditis, the serous membrane admits of being peeled off with pre- ternatural facility. The pericardium, according to my observation, very rarely un- dergoes thickening, and then, only in a slight degree, that which is often regarded as thickening being, in general, nothing more than superimposed and intimately adherent false membrane of old standing, and of opake, bluish-white appearance. I have seen this appearance pervade the whole surface of the heart under a layer of old, cinnamon-coloured lymph; yet, after peeling off the lymph, I could, by further scraping, remove the white layer also, without injuring the surface of the pericardium (See ibid. Fig. 64.) 2. Coagulable lymph adhering to the surface of the pericar- dium.—The inflamed pericardium secretes serum and lymph con- jointly, and in a fluid state, from the same vessels. The process may commence almost simultaneously with the inflammation. The absolute and relative quantities of the serum and lymph vary greatly in different cases. I have known serum secreted in such quantity and with such rapidity as to amount to a pint in twenty- four hours: on the other hand, I have frequently found it so scanty, especially in the early stage, as not to separate the surfaces of the pericardium and prevent the sound of attrition,—a sound which they yield, as will be hereafter explained, when roughened by adherent lymph. Soon after the secretion has taken place, the lymph separates from the serum by concretion, and adheres to the membrane. A small proportion, however, generally remains suspended in the serum in the form of flakes and fila- ments. The adherent lymph, when recent, is of a pale straw colour, and of a soft, tender consistence, becoming firmer and more tenacious as it grows older. Though occasionally deposited in detached lumps and spots, the latter imparting to the surface a rough, papulated or granulated character, it generally forms continuous layers, sometimes covering a portion only, but more commonly the whole, or nearly the whole, of the pericardium. The thickness of the deposition may vary from a line to an inch ;