Collection of facts illustrative of the morbid conditions of the pulmonary artery / by Norman Chevers, M.D.

  • Norman Chevers
Date:
1851
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Licence: Public Domain Mark

Credit: Collection of facts illustrative of the morbid conditions of the pulmonary artery / by Norman Chevers, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    ductus arteriosus was diminished in size, but not obliterated. These are the only examples with which I am acquainted where permanence of the ductus arteriosus has been observed coinci- dentaily with narrowing of the pulmonary orifice. In the wliole of the instances of this lesion which I shall neat have to eite the duet was found impervious, V.—TJiepulmonary artery small. An abnor- mal communication existing between one of its branches and the subclavian. It may be considered that, in the follow- ing instance, as well as in the case by M. Obet already cited, the arterial duct re- mained pervious; but it appears certain that, in both of these hearts, the communi- cating vessel was not in reafity the canalis arteriosus, but the remains of the commu- nication which, at a very early period of intra-uterine life, while the circulation of the upper portion of the body is carried on through the branchial arches, natunilly exists between the vessels which afterwards form * Si n ce th e appearance of the preceding' eeetion of my paper I have met with a report of the foUowinp^ case of extreme narrowing of the pulmonary orifice attended luith an unclosed state of the auricular and ventricular septa and arterial duct. The subject of this, rare malformation was a boy, who, for the first two years of his life, did not manifest any peculiarity of appearance or dis- order of function beyond occasior.al attacks of hronchitis, during: which hisface appears to have assumed a congestetl appearance. When he had entered his fourth year Dr. John Bell, who nar- rates the case, found him suiferina: from the usual symptoms of the blue disease, but apparently not in a very extreme degree. The stei'nuin and anterior part of the thorax were unduly promi- nent. The pulse was frequent, and ratlrer full, but easily compi-essed. Impulse and the bel- lows sound well marked over the sternum. Dultiess on percussion was of limited extent. The respiration was hurried and panting, but he usually ran about and amused himself like other children of his age. From this period up to the time of his death, which occurred when he was somewhat under tlie age of S years, he con- tinued to suffer from repeated attacks of pul- monary oppression and congestion, which, within the last two years of his life, became more violent. The prominence of the sternum and left side of the chest went on increasing; the distension of the jugulars and their pulsa- tions were still more perceptible. Usually, tlie [heart's] sounds were not strong, although those of regurgitation were quite distinct. Dur- ing a paroxysm there was, however, a loud bellows and rasping sound, with another less evident, and comparable to a subdued gurgling or churning. The pulse all the while was fre- quent, but without force. At two different pe- riods, together with great praxordial and pulmo- nary comi)ression, dyspnoea, &c., there was tym- panitis, with obstinateconstipation,andanasarca, against which all the usual diuretics and means of indirect reduction were utterly powerless. But tlie abstraction of a few ounces ot blood, either from a vein or locally, exerted an immediate and benc'licially controlling influence oyer I he disease. Tlic common purgatives, diuretics, and the right and left pulmonary and subclavian arteries. The occasional permanence of this communication between the canals in question has been very clearly described by Dr. Paget.* M. Holstf relates the ease of a girl who enjoyed perfectly good health until she was two years old, when her skin began to assume » blue appearance, especially at the parts most distant from the heart. Slxe then experienced feelings of suffocation, giddiness, and spasms. These arttacks were usually followed by sleep, after which the blue- ness of the skin was less. Violent palpita- tions of the heart, with difficulty of breathing, coldness, and frequent epistaxia, gradually succeeded ;. and though the frequency of the seizures diminished, yet their violence and duration gradually increased. During the paroxysms, the left side became colder than the right, and the pulsations of the arteries at the wrist of the left arm could not be felt. She died suffocated in one of these at- tacks. The heart was found very large; the right side larger than the left. There expectorants, would then manifest their custo- mary effects. Little or no benefit was derived from digitalis. The appetite was generally good, and the craving for various articles, some of them of an indigestible nature, inconveniently great. He died somewhat unexpectedly, after having in great measure recovered from two very severe attarcks, which were relieved by venesection. It was found that each pleural cavity contained five or six ounces of serous flnid, the pericardium a small quantity. The heart was very much enlarged in consequence of the hypertrophy of its right ventricle, the pa- rietes of this cavity being twice their ordinary thickness. Nothing peculiar in the appearance of the right auricle. The left cavities were atro- phied, but otherwise natural. An opening about half an inch in diameter existed at the upper part of the ventricular septum common to tlpe two ventricles and the aorta. The ascending aorta was nearly twice its natural size. The ductus arteriosus was open, and large enough to admit a gooae-quill. The pulmonary artery was of its natural size at the entrance of the arterial duct, but gradually tapered towards the right ven- tricle, with wliich it communicated directly by an opening so small as scarcely to admit the introduction of a common probe. The foramen ovale was not closed, but evidently not suffi- ciently open to allow of any deleterious admix- ture of'venous and arterial blood. (As quoted in the Bullet, de Sci. Mid. August 18+5.) The extreme minuteness of the right ventrf- culo-arterial opening, and the absence of any valvular appearance'at its mouth, led Dr. Bell to consider that, during life, blood passed from the pulmonary artery into the ventricle, and not in the contr.an' and usual direction. This opinion is certainly favoured by the fact of the existence of a regurgitant sound during the p.-iroxysms. * On the Congenital Malformations of the Heart, Kdinburgli Medical and SuigicalJournar, vol. xxxvi. p. 287; an essay to which (in common with most recent writers on malformations of the heart) 1 am indebted for much valuable informa- tion. t Hufcland's .Journal, Jan. 1837; quoted ii> Ainer. Jourii. of Med. ycicnce, vol. xxi. p. 452.