Collection of facts illustrative of the morbid conditions of the pulmonary artery / by Norman Chevers, M.D.
- Norman Chevers
- Date:
- 1851
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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![ventricle and one auricle, the deep sulcus be- tween which was filled up with a process of the left lobe of Llie liver (with, of course, a portion of the diaphragm). The auricle, which was much larger than the ventricle, was nearly spherical, and its sides, which were about one-eiglsth of an inch in thickness, •were furnished internally with strong co- lumnse carnese (musculi pectinati.'). At its posterior part the two vense cavse opened into it by a common mouth, or a sort of sinus, apparently a rudiment of a right auricle. The pulmonary veins terminated in their ordinary manner. The ventricle was of a conical shape ; its walls were much thicker on its left than on its right side. Three openings existed in its base. The auriculo-ventricular closed by a true mitrnl valve, the aortic opening ; and on the right side of the latter an opening into a cylindrical sac which seemed to represent the right ven- tricle, but had no communication with the auricle. The ductus arteriosus was wanting. There was no malformation in any of the vi.-cera except the heart, nor in any part of the arterial system*. Here the circulation must have pursued exactly the same route as in the case by Dr. Favtll, cited at the commencement of this chapter: but, in the present instance, the malformation appears to have been more extreme, especially that of the auricular portion of the heart. M. Hein (op. citat. p. 29) appears to have been the first author who noticed the coincidence of absence of the arterial duct with great narrowing of the pulmonary artery; citing the cases by Otto, Knox, Meckel, and Steno, in illustration of this fact. To these itistances I have added the examples by MM. Lexis, Aran, Muss, Gintrac, and Dr. Blackmoref, which taken together are sufficient evidence of the fact that narrowing of the pulmonary orifice is frequently attended with absence of the arterial duct. It is difficult to account for the occurrence of this coincidence otherwise than by concluding that early obliteration and absorption of the duct has been followed by an imperfect development of the artery ; the canal of which has, up to the period of birth, remained merely of sufficient size to • Gaz. des H6pitaux, Supp. Dec. 1842, and Lancet, 1843. t While citing examples of narrowing of the •pulmonary artery attended with absence of the ductus arteriosus, 1 omitted an example related by M. Ue^uise, and cited by M. Ollivier, Uict. de .M6d., art. Vaisseaux I'ulniouaires, of a woman, a-tat. 20, who sullered from cy:mosis, debility, palpitation, and dyspnoea; a bruit de souffle was prolonged in the course of tlic imlmo- nary artery. Un inspection, this vessel was found to be extremely narrowed. The ventricles and auricles rcBpcctivcly (.•oinmuiiicate<l with each other, and the arterial canal was absent, liie precise nifauin^'of tilt- latter expression is rather doubtful. transmit the slender current of blood which circulates through the lungs previously to the comraencenient of respiration.* The question of the possibility of closure of the arterial duct occwring previously to birth is one of extreme inttrest and impor- tance, especially in a medico-legal point of view. That the passage may become closed during the earlier stages of intra-uteriue life is rendered certain by the facts already adduced ; whether occlusion of the canal and conversion of its tissues into an imper- vious cord can occur at a later period of foetal existence is a more doubtful question, but one which 1 believe may, not improbably, be ere long answered in the affirmative. A case has recently occurred at Ayr, in which there appears to be strong reason to believe that closure of the duct had occurred previously to birth. The medical facts of this case, so far as they have been afforded, are as follow. The body of a female child was discovered buried in a waste ground enveloped in a woollen bag. The body was found to be in a state of putrefaction, with desquamation of the cuticle. It weighed five pounds, and was twenty inches in length. Its mouth and nostrils were stuffed with flax. The umbilicus was in the centre of the body, the cord cut close to the abdomen, and left without ligature. The scalp was covered with hair, and the nails were full- grown ; a large portion of the brain, which had been reduced to a pulpy state, had escaped through the opeuings of the skull. There was an extensive ecchymosis all over the fore part of the neck, and an efl'usion of blood on the exterior of the trachea. The heart and lungs weighed one ounce; the lungs were collapsed : the right was consi- derably decomposed, and sunk when put in water. The left was of a red colour, and firm in texture, and floated on the surface when immersed in a vessel filled with water ; but on pressure there was no crepitation. The ri-lit side of the heart was filled with coagulated blood, the foramen ovale partly open, and the ductus arteriosus impervious. The liver was large, and of a leaden hue ; the ductus venosus almost obliterated, and the meconium was found in abundance in the lower bowels. Strong circumstantial evidence was ad< duced to prove that this infant came into the world alive shortly before G o'clock A.M, and that its body was deposited in the * Otto alludes to other instances observed by Stensoii, Bartholin], Krevsiir, and Ciicnunean in which the duct was cntir'elv absent, and also makes slif,dit ref(!ieiice to the existence of the same defect in u monster, with abdominal cleft and hernia cerebri, but I am notactiiiaiiited wit!) the details of these cases, unless the in- tance b\' Chcinineau be one of non-developnient of the ventriciilurse|)tuin, to which 1 have alluded at the eoiiiuiencemcnt of this paper](https://iiif.wellcomecollection.org/image/b21475350_0049.jp2/full/800%2C/0/default.jpg)
