On defective closure of the tricuspid foramen as a frequent cause of dropsy / by Peyton Blakiston.

  • Peyton Blakiston
Date:
[1841]
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Licence: Public Domain Mark

Credit: On defective closure of the tricuspid foramen as a frequent cause of dropsy / by Peyton Blakiston. 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 pericardium, and was continued gradually into the healthy portion of the lungs. The heart was enormously liypertrophied and dilated. On its sur- face was a patch of thick yellow lymph. The dilatation of the right cavities was veiy gi-eat; the circumference of the tricuspid foramen was five inches and three quarters ; one of the valves had short thickened chordtt; tendiniee; they could not close the foramen. The aortic valves were thickened, but acted well. There were many patches of atheroma under the lining membrane of the left auricle. The aorta was a mass of disease, being thickened and puckered, and, in many places, denuded of its lining membrane, and so throughout all the large arteries. The liver M'as of a nutmeg colour. The kidneys and other organs healthy. With this last case I would contrast the following, wherein, in addition to the disease of the arteries, and the hypertrophy and dilatation of the heart, with enlargement of the tricuspid fora- .men, the tricuspid valves were so in- creased in size as to effect its closm-e, and hence there was no dropsy :— Case V.—Priscilla Sturck, set. 50: had a severe illness, with pain in left side, eight years ago, since which time she has occasionally felt beatings extending from her heart up to her head and down her arms, with giddiness. She has had latterly a constant cough, and when examined the pulse was small. Pulsa- tions were felt above each clavicle. The action of the heart was heaving and tumultuous. The carotid arteries pulsated very strongly. Double saw sound was heard, its maximum being under the bottom of the sternum. Single saw sound under each clavicle, loudest under the right, was heai-d, without any second sound. Two years after this, being excited, she suddenly placed her hand over her heart, drooped her head, and died in half an hour. Autopsy.—The heart was very much increased in size, being generally hy- pertrophied and dilated, more especially the left ventricle. The tricuspid fora- men measured five inches in circum- ference ; but the valves were hypertro- phied in substance and extent, so that they effected the closure of the foramen perfectly. The aortic valves were slightly cartilaginous, but acted well. The lining membrane of all the arteries, particularly the aorta, was much dis- eased, being puckered and having much atheroma under it, and being deficient in some places. The arteries of the arms were diminished in cahbre by the deposition of atheroma in their middle coats. The other organs were healthy. Remarks on Cases IV. and V.—In Case IV. the hypertrophy anddilatation of the heart, and the diseased state of the arteries, would seem tohave been in- duced by that sub-acute inflammation of the surrounding and lining mem- brane of the heart and large arteries, to which spirit-drinkers are subject. The tricuspid valves retaining their usual size, while the orifice to which they were attached was enormously dilated, strong regurgitation would take place, and, as the heart was firm and liypertrophied, would be marked by strong venous pulsations. In Case V. a similar state of the heart and arteries was probably the result of an acute attack of inflamma- tion ; but as in this case the valves had increased in size in the same pro- portion as the orifice to which they ■were attached, they were capable of closing it, and no dropsy or venous pulsation ensued. Now if in Case IV., exactly parallel to Case V. in all but the state of the tricuspid valves, the dropsy depended on any other cause than regurgitation through the incompletely closed tricus- pid foramen, why did it not also super- vene in Case V., where the complaint had been protracted through a period of eight years ? A comparison of these two cases goes strongly to prove that venous pulsations are not produced without regurgitation through the tricuspid for,;men, because in Case V. the heart was quite as firm and as much hypertrophied as in Case IV., and yet there w'ere no venous pulsations. Case VI.—V\''illiam Matthews, set. 32, porter: was attacked with acute rheumatism twelve years ago, and again eight years since, when he had very severe pains in the left breast, ti-ouble- some cough, and dyspnoea. Eighteen weeks previous to my %'isiting him, his ankles began to swell; then his legs and abdomen. There was much dyspnoea. The urine was not coagula- ble by heat. Pulse hard, sharp, and vibratory. The jugular veins were swollen, and pulsated. There was dul- ness on percussion at the bottom of
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