Medical Jurisprudence, Volume 3 (of 3)Paris, John Ayrton
Science
Medical Jurisprudence, Volume 3 (of 3)
Paris, John Ayrton
Medical laws and legislation -- Great Britain
The _pericardium_ may now be laid open by a longitudinal incision, and
we should note the quantity of fluid found in this cavity; in that of a
healthy subject there is generally as much as a tea-spoonful of serum.
It is important also that we should observe the quality, as well as
quantity, of this liquor. Blood has occasionally been found in this
situation, when neither a rupture of the heart, or any of its vessels
could be discovered; in such cases _Dr. Baillie_ is of opinion that the
blood has either passed through the coats of the vessels upon the
surface of the heart, by transudation, or been poured out by the relaxed
extremities of the small vessels opening upon the surface of that
portion of _pericardium_ which forms the immediate covering of the
heart.[32] The general appearance of the heart, as to colour,
flaccidity, size, and external character, should be observed before its
cavities are opened; for the energy of the heart may, in some degree, be
inferred from the tension of its fibres, and the red colour of its
substance; on the contrary, the opposite appearances would indicate a
very different condition of this vital organ, as is well illustrated in
the _asphyxia idiopathica_ of _Mr. Chevalier_.[33] It is not very
unusual to find adhesions connecting the heart more or less closely to
the pericardium; and it is perhaps worthy of remark that the length of
these adhesions will furnish, in some measure, an indication of the
interval that has elapsed, since the occurrence of the inflammation by
which they were produced; for they become gradually elongated by the
heart’s motion. _Dr. Baillie_ has noticed in his “Morbid Anatomy” an
appearance which the author has frequently met with in his
dissections,—a white opaque spot, as if from a thickening of the
pericardium; in some cases, it is not broader than a sixpence, at other
times, it equals in size that of a crown piece; it is most commonly
situated on the surface of the right ventricle, and consists of an
adventitious membrane formed on a portion of the pericardium, which
covers the heart, and may be easily dissected off, so as to leave that
membrane entire. The attention of the enquirer is directed to the
subject with a view to remind him, that the appearance is one that ought
not to be considered as morbid in its origin, or dangerous in its
effects. In acute rheumatism a fatal translation of the disease to the
heart sometimes occurs, in which case, its surface will be found
encrusted with coaguable lymph.—The condition of the blood-vessels forms
the next object of research; and they should be examined previous to the
removal of the heart, as to their calibre, and thickness, and whether
any inflammatory indications are observable, or any aneurism; this
latter disease has often existed without exciting any suspicion during
life. In opening the body of George II, the aorta was found callous at
the lower border of its curvature, and so dilated at its upper border,
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