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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    encc in the development of these secondary evils, while the pre- existing cause of obstruction, whether it be valvular or other, i comparatively unimportant, except in so far as it must be regarde* as the origin or commencement of a series of changes w hich is to result so formidably. In short, while the dilatation is secondary in regard to the period of its development, it !>ecomes primary in it* ultimate importance, acting as the chief cause of all the most (Ireadec evils of the diseases of the heart. The intimacy of the relation which subsists between hypertrophy and dilatation of the heart creates some difficulty in the inquiry, and has occasioned not a little confusion in the attempt to indicate the distinctive signs of these two forms of disease. Without entering into the details of the discussion, it may be affirmed that one of these conditions does not exist in any case without the other, or very rarely ; and that, in consequence of this co-existence of hypertrophy and dilatation, the effects which would arise from one or other of these alterations of the heart arc* materially modified ; they are not however, to be regarded as antagonistic of each other; therefore* the one does not necessarily correct the evil effects of the other. Never- theless, as hypertrophy involves increased ]>oicer, and dilatation in- increased capacity, in so far as the latter induces any diminished power, its evil effects may be counterbalanced and delayed by the hypertrophy. In this want of direct antagonism between these two conditions, we have an explanation of the fact, that no amount of muscular hypertrophy is inconsistent with dilatation of the heart am’ all its most formidable effects, for we see these arising in cases in which the heart has acquired three or four times the normal amount of muscular substance. This fact suggests the question, how far the embarrassment of the heart’s action may be due to a disorganised state of the muscular substance ? but this inquiry is beside the ob- ject of the present memoir, and will not be entered upon. The leaning object of the following reports is to show the supreme importance of hypertrophy and dilatation, especially the latter, in the diseases of the heart; and also to point out their frequent, if not their invariable co-existence. These propositions will bo demonstrate* from the facts of almost every form of heart disease; and, at the same time, the details of the cases will afi’ord many opportunities of con sidering other questions of practical imj>ortance. , In the course of the reports and observations, the degree of hy- pertrophy and dilatation will be of necessity frequently alluded ta It is impossible to convey a precise notion of the state of the heart in regard to these two conditions, and the relative proportion the' bear to each other, because of the indefiniteness of the terms which must be employed in their description. An approximation only can be made to accuracy, by stating the weight along with the genera bulk and capacity of the organ. Hut, after all, the description of th< degree of hypertrophy or dilatation resolves itself very much into expression of opinion, that this or that was the state of the organ.