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 ventricle was no larger than the circum- ference of a goose-quill; and a short canal of this size had to be traversed before it reached the mouth of the pulmonary artery, which was of natural size. Dr. EUiotson believed this malformation to be congenital, as two little supplementary right ventricles existed here: one leading from the pulmo- nary artery, and the second from the first. The heart'is in the Museum cf the College of Physicians. Dr. Craigie details* the case of a railroad labourer, setat. 44, who became a patient of Dr. Graham, with symptoms which were at first mistaken for those of fever. His history was indistinct. About two weeks previously, after a debauch of ten days' duration, be was seized with severe cough, hoarseness, headache, and thirst, and gra- dually lost flesh and strength. When ad- mitted to the Infirmary his intellect seemed rather confused ; he complained of frontal headache, and denied that he had any other local uneasiness ; was very hoarse, and spoke very indistinctly, apparently from a very hurried state of his respiration. He had frequent cough, without expectoration ; pulse 120; face rather livid. After his admission, the respiration continued very frequent— about 60 in the minute. He was delirious and restless at night, and died on the third day. Both lungs were found to contain tubercles, and were much consolidated : the apex of the left was occupied by a large tuberculew cavity. The heart weighed thirteen ounces. The right auricle was much dilated, and decidedly thicker and firmer than usual. The right ventricle was much hypertrophied, its walls being nearly as thick as those of the left usually are, and it cavity was at the same time smaller [than natural?]. The pulmonary semilunar valves were so united as to form a ring, which could only admit the point of the little finger. The artery above was much dilated, and its walls attenuated. The left cavities appeared healthy. The aortic semi- lunar valves were somewhat thickened, but were adequate. The aorta was also dilated at its arch, but not to the same extent as the pulmonary artery. Death seems to have been produced in this individual by the sudden aggravation of his pulmonary disease, rather than in conse- quence of the cardiac obstruction, wliich does not appear to have been excessive. I have met with several instances of heart disease in which the cavity immediately posterior to the seat of obstruction appeared, when first examined, to be in a state of con- centric hypertrophy, but this condition was always, in reality, merely apparent, the cavity becoming expanded so soon as the * Op. cit. p. 271. cadaveric rigidity of the heart had ceased. This is liable to occur in cases where death is rather suddenly induced by accidental causes which do not immediately influence the heart. The following case affords an excellent illustration of the effects of extreme ob- struction to the circulation through the right cavities of the heart, where the embarrass- ment of the over-distended auricle and ven- tricle is not relieved either by an open state of the ventricular septum or by patency of the foramen ovale. M. Fallot has recorded the case of a woman, setat. 63, who, after the cessation of the menstrual discharge at the age of 47, became subject to dyspnoea. The heart beat tumultuously, but the pulse was regular, although hard and vibrating. Re- lief appeared to be afforded by bleeding, which was frequently practised. Three months previously to her death she was seized with violent pains in the region of the heart, and with frequent attacks of vertigo. Her respiration became more embarrassed, and she was unable to stand. Two or three weeks before her death she became delirious. She expired in great agony. The heart was found to weigh 14^ ounces; by its excessive development it had pushed the medias- tinum into the right cavity of the thorax. The right auricle and ventricle, and the two vense cavse, were much enlarged ; and, in consequence of the dilatation of the cavities on this side, the tricuspid valve did not nearly close the auriculo-ventricular open- ing. The walls of the right ventricle were softened, and much thinned, but were covered by a thick lamina of coagulum, composed of different coloured strata, and partially enveloping the columnse camese. In place of the semilunar valves of the pulmonary artery, a thick membrane, at- tached to the circumference of the orifice of the artery, was found ; its concavity, which was directed towards the ventricle, was pierced at its centre with an opening about the size of a goose-quill. The free and attached borders were thicker than the rest of this membrane. The left cavities of the heart were of the natural size, and were perfectly healthy. The tissues of the lungs were much compressed by the enlarged heart* ; the liver and entire system of ab- dominal veins were found gorged with bloodf. * It is probable that in this as well as in other cases where it has been stated that the structures of the lungs have become altered by the pressure of a dilated heart, the pulmonary lesions have not in reality been due to this cause, but have resulted either from imperfect expansion, con- gestion, pneumonic consolidation of the lungs, pleuritic etrtisions, or other Himilar conditions. t As quoted in the London Medical and Sur- gical Journal, vol. v. p. 61.