The Bradshaw lecture on the causation of functional heart murmurs : delivered before the Royal College of Physicians, London, on November 2, 1899 / by Arthur Foxwell.

  • Foxwell, William Arthur.
Date:
1899
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Licence: Public Domain Mark

Credit: The Bradshaw lecture on the causation of functional heart murmurs : delivered before the Royal College of Physicians, London, on November 2, 1899 / by Arthur Foxwell. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    fourth left spaces, but an occasional systolic murmur was heard at, and a little outside of, the apex beat. There was vertical dulness at the third cartilage and right dulness at the mid- sternum. Case 29.—The patient, a youth, aged 17 years, had never been very robust, but he entered into games well. There was no evidence of anaemia. He sought advice because he did not feel up to his work. The apex beat reached the fifth rib and the left vertical nipple Ifne. There was vertical dulness in the third space and right dulness at the left edge of the sternum. A systolic murmur sprang up in the second, third, and fourth left spaces on sharply walking or on lying down. 3. If it were due to changes in the blood then similar murmurs should arise in all parts of the body to a greater or less extent, especially where there are angles or sharp curves; but there are no such murmurs. 4. Immediately after severe haemorrhage such generalised murmurs do arise, these cease in a day or so when the vessels are again sufficiently distended with (what must be) hydrsemic blood, but later, if debility sets in as a result of the haemorrhage, the pulmonary murmur appears and persists till the patient is restored to his customary vigour. 5. Persons convalescing from exhausting diseases—e.g., typhoid fever—whether suffering from anaemia or not, may have no murmur so long as they are confined to bed, but when suffi- ciently recovered to be up and about a murmur not seldom arises. An instance of this is Case 18, but a very interesting and to my mind more convincing example is the following :— Case 30.—A married woman, aged 29 years of age, was admitted to hospital with enteric fever. Seven days prior to her discharge, before she had been allowed up, the following was the note made of her heart:—The apex beat reached the fourth space, half an inch outside the left vertical nipple line. There was vertical dulness over the upper border of the third left cartilage and right dulness to the right of the left edge of the sternum. A harsh systolic murmur was heard at the apex beat
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