A manual of the diseases of the heart : their pathology, diagnosis, prognosis and treatment / by Robert Hunter Semple.
- Robert Hunter Semple
- Date:
- 1875
Licence: Public Domain Mark
Credit: A manual of the diseases of the heart : their pathology, diagnosis, prognosis and treatment / by Robert Hunter Semple. Source: Wellcome Collection.
Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.
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![because, even with our advanced knowledge of the indications afforded by the stethescope, it is not by any means easy in some cases to distinguish between the sounds caused by structural mischief and those produced by altered conditions of the blood. It has been already pointed out (p. 59) that the murmurs or morbid sounds of the heart are all due to friction of some kind, either of one solid part against another, or of healthy blood against unhealthy valves, or of unhealthy blood against healthy valves, or perhaps (though this is not so certain) by the mere collision of the particles of attenuated blood against one another. Nor is it to be forgotten that both of the usual causes of friction-murmurs, namely, diseased structures and diseased blood, may be co-existent. For instance, when there is a history of rheumatic fever, which has lasted for a long time and has been perhaps treated by depletory measures, it is often very difficult for the practitioner who has never seen the case before, to determine whether a murmur over the aortic valves be due to disease of those valves or to an anaemic (spansemic) condition, or to both those causes, and probably the result of treatment will alone clear up the difficulty. Again, the question has been proposed even by the most distin- guished auscultators, as, for instance, by Dr Walshe^ and Dr Plint,^ whether simple palpitation may not produce a murmur, although the heart be healthy and the blood in a natural condition. Both these authorities admit the possibility of such an occurrence, although they consider it to be rare; and Dr Walshe seems to agree with Dr Stokes in believing that even a systolic mitral murmur may be produced at the apex of the heart without organic disease.^ Still, in the great majority of cases, the two facts of the inorganic murmur being systohc in time and basic in seat, will afford valuable diagnostic information, and more especially if this murmur, heard over the base of the heart and also in the carotid arteries, be associated with a continuous murmur in the veins, to which attention will now be directed. Chlorosis and, Spanmmia.—Many cases, more especially in females, present themselves with apparent symptoms of disease of the heart, in which, however, that organ, although weak, is sound in structure. The disease, in fact, is in the blood, which is deficient in red cor- ' ' On Diseases of the Heart,' p. ]72. Flint on ' Diseases of the Heart,' p. 468. •'' Loco citato—note at bottom of the page.](https://iiif.wellcomecollection.org/image/b21447214_0279.jp2/full/800%2C/0/default.jpg)
