Licence: Public Domain Mark
Credit: The heart massage / by M. J. Breitmann. Source: Wellcome Collection.
![ae This paper was read at the Seventeenth International Congress of Medicine, London, August 1913. [Monday Afternoon, August 11] He Lege. 3 ee ; of 2 feity, Sat oD ee wee SECTION V dey, .. THERAPEUTICS THE HEART MASSAGE By M. J. BREITMANN, M.D., St. PETERSBURG ‘THE various conditions at work when cardiac failure arises emphasize the importance of their recognition in order that appropriate treatment may be pursued. ditions which produce heart failure, as this question was very well eluci- dated by Professor Sir Clifford Allbutt in the Chelsea Clinical Society. I cannot, however, agree with the opinion that the site of the lesions does not give very much help, or with the opinion of Dr. Hector Mackenzie that ‘the clinical recognition of the structural changes of the heart is impos- sible in the absence of symptoms and physical signs’: these symptoms and signs are usually present, but their character is not that of the routine type and deserves special investigations ; indeed, my study of the method of localization of the processes in the heart muscle during the last fourteen years | has shown me that here we can find the key to many mysterious cases of sudden death, and the fact quoted by Sir Clifford Allbutt that ‘fibrosis of myocardium is not infrequently found in hearts which have been quite efficient during life’ shows the necessity of a more complete investigation of such cases. Sudden death was, for instance, observed by me in from 33 to 50 per cent. of the cases of syphilitic myocarditis, where by the careful examination of the patients the nature of their diseases could have been discovered, and the fatal result prevented. I can only congratulate Dr. William Eward and Dr. Hector Mackenzie for their opinion on the mechanical risk of gastro-intestinal distension, which, although it is only one of many, is not the least frequent or the least potent of factors in the etiology of unexplained cardiac failure. A very important group of heart failure, besides syncope, is that which concerns surgical shock and collapse. You know the very conflicting ideas on this subject of Dr. J. P. Lockhart Mummery and of Dr. J. D. Malcolm. Dr. Mummery maintains that the lowered arterial blood-pressure which occurs in shock is due to a dilatation of arterioles throughout the body ; Dr. Malcolm on the other side upholds the view that in shock there is a contraction of arterioles throughout the body; each of them gives, conse-](https://iiif.wellcomecollection.org/image/b33423155_0001.jp2/full/800%2C/0/default.jpg)
