Clinical memoranda.

  • Jones, Joseph, 1833-1896.
Date:
[1871?]
Catalogue details

Licence: Public Domain Mark

Credit: Clinical memoranda. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The origin of the cardiac disease and the supervening dropsy appears to have been the deposit of fibrinous matter upon the auriculo ventricular valves in some former attack of rheuma- tism, thus causing auriculo-ventricular regurgitation. Case XX.—Dilatation of Cavities of Heart; Universal Dropsy ; Death. Jolm Wilson ; negro man ; apod 57 ; stout, well-built man; native of Virginia. Admitted to Charity Hospital, waul No. 32. September 2d, 1868. Patient, says that be lias always enjoyed good health up to December, 1868, when he was seized suddenly with palpitation of heart, and great difficulty of breathing. Has been ad- mitted several tin es into the Charity Hospital, since this date, suffering with palpitation of the heart and dyspnoea. As soon as some slight, improvement took place, under rest and diuretics and tonics, the patient would ask lobe discharged At the present time, t-eptember 2d, the patient suffers with great dyspnoea, pain in the region of t he heart, dry hacking cough, general anasarca, which however is less in the right arm and hand. The apex beat of the heart is just below the nipple; space of percussion dullness over region of the heart greatly enlarged. First sound of heart prolonged and attended with a distinct regurgitant murmur. Second sound normal. Diagnosis—1 ilatation of both sides of the heart, with auriculo-ventricular regurgitation. General dropsy, and dyspnoea conse- quent upon heart disease. No albumen or bile was found in the urine. Diuretics and tonics were administered, with only temporary benefit, however, as the anasarca increased as well as the oppression of breathing j the lower extremities became immensely' distended; the patient was unable to lie down and finally' died twelve days after his admission, on the 14tli of September. The post mortem examination revealed a similar condition to that described in the preced- ing case No. XIX. Universal anasarca—liver and kidneys and intestinal canal healthy. Heart gieatly dilated and distended with black blood. The dimensions of the organ were fully equal to those given in the preceding case. The mitral valve was thickened with osseous deposit. The aui ieh-s and ventricles were greatly dilated, and the auricular ventricular opening so much enlarged as to render the valves insufficient, and to allow regurgitation of the blood, during the contraction of the ventricles. The following case illustrates tbe fact that we may have de- cided evidence of insufficiency of the aortic valves, without dropsical effusion. Case XXI.—Articular Rheumatism, with derangement of Second Sound of Heart. Wm, Ropers j seaman; aped 21 years ; stout, we'l formed man ; admitted into Cliarity Hospital, wa d Fo. 11, bed 154, January 20th, 1870, suflering with chionic rheumatism, affecting chiefly the upper extremiiies. Patient states that seven years previous to the present attack,'he was confined to his bed six or eight weeks by rheumatism, which affected cbiefly the upper extremiiies. The attack was brought on by exposure. Two years after- wards he had a second attack which was confined to the parts and joints ot the lower ex- tremities; and at this time he suffered severe pain in the lett side, which his attending physician prouounced to be due to pleuritis, with palpitation of the heart. The present at- tack came on in Is’ovember, 1869, with pain in the wrists, joints and hands, and finally affected the shoulder joints. On percussion the heart appears to be hypertrophied; and upon auscultation the second sound is entirely altered, being converted into a prolonged, blowing sound, heard loudest at the base of the heart over the aortic and pulmonary valves, and is tiausmitted up as high as the point of biturcation of the common carotid artery. The sound is loud and distinct. The patient was placed on a mixture of Wine ot Golchicum, and Solution of Iodide of Potassium, so compounded that eight diops of the 'Vine ot Colchicnni and five grains of the Iodide of Potassium should be administered three times a day. Iodine was also used locally and the parts covered with cotton and oil silk. Under this treatment the patient steadily iinproveu, and was discharged from the ward on the ~Gtii of February, 1870. It is worthy of note in this connection^ that tho most extensive