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

  • Norman Chevers
Date:
1851
Catalogue details

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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    the mouth a black grumous blood. She died on the four-and-tweiitieth dcy after the ac- cession of these symptoms. It was found, on inspection, that the contents of the abdo- men encroached so much upon the thorax as to render the capacity of the latter cavity extremely small. The lungs were hard, dry, and contracted ; the left lobe was of a dark livid colour, and adhered to the pleura at the part where the patient had complained of pain. About three ounces of black gru- mous blood were found on the surface of the diaphragm and in the trachea. The shape of the heart was cubical rather than conical; the left ventricle, in its shape and structure, appeared as the right ventricle usually does in a natural state, and vice versa. The valves of the pulmonary ariery were adherent to each other in such a man- ner that water could be pressed into the artery only by a small opening; and this the author supposed to have been made by a probe with which he examined the state of the valves. The pulmonary vein (possibly the veins united in a single trunk) was empty and contracted; the canalis arte- riosus was closed, but the foramen ovale was found open, and larger than it usually is in the foetus. The remainder of the dis- section afforded nothing preternatural. IX.—Contraction of the pulmonary orifice, the ventricular and auricular septa being complete, and the arterial duct oblite- rated. In certain cases of this description it may also be extremely doubtful whether the abiioruial condition of the artery is conge- nital or of later date, the duration and character of the symptoms being the only n:eans bj which a decision can be formed; but, in the examples which I have selected as illustrative of this species of malforma- tion, the appearances discovered after d ath appear to have rendered the congenital origin of the disease a matter of almost absolute certainty. In the following case by Dr. Blackmore, where the appearances disco- vered were of the most rare and singular character, it is probable that the foramen ovale had become closed previously to birth, and that a ductus arteriosus had never been developed, as the arrangement of the parts was such that the presence of those com- munications during the foetal existence of tlie child was rendered wholly unneces- sary :—Here the narrowness of the pul- monary artery does not appear to have been the primary lesion. A female infant began to suffer from the ordinary symptoms of blue disease at the age of 2 months. All her complaints be- oame aggravated after her inoculation at tiie iige of 10 months. Assimilation was iiiperlcclly performed. She never wa ked alone, nor talked intelligibly. The body was extremely puny, and the chest chicken' breasted ; the ])ul8e at the wrist was small, very feeble, but regular. Death occurred at the age of Sg years, after a flow of black blood from the mouth and nose. The heart was found to be so large as to hide and compress the lungs; the right auricle and superior cava were greatly distended with blood ; the right ventricle was greatly hy- pertrophied; the left ventricle was extremely small in comparison with the right. Where the left auricle should have been, only small muscular vestiges were found, without cavity. On attempting to lay open what at first sight appeared to be the tip of the left auricle, the knife entered a large single cavity, between which and the left ventricle no communication existed, except through a small fissure, the natural ventricular open- ing being occluded by a firm adherent fleshy membrane. From the posterior superior part of the right ventricle arose the aorta, much dilated; immediately below the aorta a small pulmonary ariery had its origin. The left ventricle held a small coagulum of black blood, which must have entered it by the fissure above described, and which was its sole outlet Its substance was healthy ; no ductus arteriosus remained. The right auricle proper received the trunk of the superior cava, around the orifice of which was attached a fine delicate membrane. Two small ptilmonary veins entered the inferior part of the left auricle, which was nearly obliterated, and one large vein entered its superior part. The auricular septum pre- sented the fossa ovalis in its natural state, without communication with the right auri- cle. The left auricle had, however, a direct communication with the left ventricle by means of a small fissure through which the blood returning to the lungs must have passed, and thence into the right side of the heart. The lungs were small, particularly the left, and dense, like flesh; but there was no tubercular deposit or confirmed induration.* In the remaining instances of this class which have been observed, the lesions were of a far more simple character than in the above example:— Dr. Elliotsont refers to the case of a very young woman who died in St. Bartholomew's Hospital. A bellows sound was heard in the precordial region, and the patient suf- fered from venous congestion and dropsy. The walls of the right ventricle appeared to have grown up around the mouth of the pulmonary artery, so that the opening from * Edinburgh Med. and Sur. Jour., vol. xxxiii- p. 2t;8. .,.. i Tlio recent Iniprovoments in tlie Art of tinsuishing the various Uisoasus of the Heart, p. 21, i>l. 1, lijr. ii.