Memoir on the influence of hypertrophy and dilatation on diseases of the heart : and on some points in their diagnosis and treatment / by A. Halliday Douglas.

  • Douglas, Andrew Halliday, 1819-1908.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: Memoir on the influence of hypertrophy and dilatation on diseases of the heart : and on some points in their diagnosis and treatment / by A. Halliday Douglas. 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.

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    To this state of the left ventricle may be traced the occurrence of cerebral and other hemorrhages from the arterial system, and the greatly increased vertical diameter of the prieconlial space; and pos- sibly the displacement of the apex to the sixth intercostal space is due to the same cause—on this point I cannot speak positively, as I have not noted the precise state of the ventricle in the cases in which the impulse of the apex was displaced. Excessive hy]>ertrophy of one ventricle does not prevent its subsequent dilatation; and the other ventricle usually becomes involved, unless a conclusion is put to the case by some of those accidents to which the subjects of hypertrophy are liable. In many cases in which valvular disease had long existed, symp- toms of obstructed circulation arose only a short time before death; and the progress was steadily and rapidly unfavourable. This fact involves the consideration, already referred to, of the influence of hypertrophy in delaying the embarrassment of the heart’s action, until disproportionate dilatation is developed. In cases where there is reason to believe that heart-disease of old standing had existed, without cardiac embarrassment, I have always found hypertrophy of both ventricles, sometimes in very high degree (Case XIX.); though the degree of the hypertrophy did not always bear a precise rela- tion to the absence or delay of obstructed circulation—a minor degree of hypertrophy proving sufficient, in the absence of dilata- tion, to maintain the equilibrium of the circulation. The necessity of dilatation of the heart, usually involving both ventricles, in order to establish obstruction of the general circulation, is evident from the facts of many cases; but it is also true that a greatly increased capa- city of the ventricles in not a few cases fails to occasion obstruction, and in such cases may be frequently seen the influence of acute local inflammations, or other accidental causes, in developing the effects of dilatation, which, in the previously undisturbed state of the system, had not manifested any of its graver effects. Case XXI.—Incompetence of the Mitral Valve; Hypertrophy of the Heart; Dilatation ; Pleuro-Pncumonia ; Jaundice ; Death by Apncea. Colin Matheson, tet. 36, a shipwright, admitted 22d February 1847. Of temperate habits. Fie had a bloated countenance ; general anasarca ; and he suffered much from dyspnoea; cough, with ha'moptvsis and sickness. Pulse was 120, and irregular; urine scanty, and slightly albuminous. History.—lie had had good health till three months previously ; and had suffered chiefly from cough, with expectoration, and deep-seated epigastric uneasiness. Swelling of the surface had appealed within a fortnight; hicmop- tysis had occurred, for the first time, within three days. Physical Signs.—Heart’s action was tumultuous ; impulse diffused, and communicated to the epigastrium ; the arterial pulse and impulse of the heart were not synchronous. The sounds of the heart were, in the first instance, confused and faint; subsequently, when the action moderated, a murmur with the first sound, at the apex, was distinct. In both dorsal regions percussion was impaired ; the sound of respiration harsh and feeble on the right.