Thirty-third annual report of the directors of James Murray's Royal Asylum for Lunatics, near Perth. June, 1860.

  • James Murray's Royal Asylum for Lunatics
Date:
1860
Catalogue details

Licence: Public Domain Mark

Credit: Thirty-third annual report of the directors of James Murray's Royal Asylum for Lunatics, near Perth. June, 1860. Source: Wellcome Collection.

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    altogether closely resembled those we have repeatedly seen in Typhoid Fever and in Cholera.* One case, fatal by Phthisis, was interesting, in so far as a distinct Cardiac anaemic bruit marked the heart’s action during life, and because the said AmemiTand anaemic bruit serves as a text for a few remarks on the subject of similar Chlorosis- cardiac murmurs not depending on, or connected with, organic disease of the heart. During life the action of the heart had been rapid, irritable, weak; and a prolonged blowing murmur, loudest at the apex, and ac¬ companying the first sound of the heart, had long been distinctly audible. This murmur had been invariably ascribed by us to anaemia, and not to valvular disease; and the necropsy proved the correctness of our conclusions. The heart was found pale and flabby, but the valves were quite normal. The pericardial sac contained nearly half-a-pint of serum. The patient was much enfeebled, and attenuated by advanced Phthisis: the lungs were found riddled by vomicso. Her colour was sallow, her appearance cachectic, and her general condition was that of chlorosis. Over the large vessels at the root of the neck, on the right side, was occasionally heard—what is also not unfrequent in this class of cases [chlorotic femalesj—a musical sound, synchronous with the ven¬ tricular systole of the heart. We have long suspected the correct- Cardiac ness of the prognostications of heart disease, so far as these are founded necessarily solely on bellows murmurs; and a series of cases observed during life, organicVG °£ associated with their relative necropsies, have converted suspicions of °£ correctness into proofs of incorrectness. What we mean is, that so many cases occur of undoubted cardiac murmurs, without the existence of any structural disease to account therefor, as should render the Physician extremely careful in founding his prognosis on such murmurs alone, or, perhaps, as should lead him, in the majority of cases, to give a very guarded opinion as to the nature of the case and its probable issue. For instance, in cases of chlorosis or anaemia, and in states re- Prognosis sembling these conditions or cachexies, and resulting from the exhaustion disease, of protracted and debilitating disease, there are frequently cardiac bruits of considerable intensity, unassociated with any structural lesion. Yet in such cases the action of the heart is often weak and irregular. There may be palpitation and dyspnoea to an alarming extent, and the general symptoms may lead erroneously to the belief in not only cardiac, but also in pulmonary, disease. “ The mere intensity of a bellows sound is,” says Dr Brinton, “ [unless extreme] a bad guarantee for its valvular origin; which again is better suggested by a long [as during systole, diastole, and pause] and unvarying [as during sleep and excitement] character of the murmur.” f * “Clinical Notes on Cholera : its Pathology.”—Association Medical Journal (p. 527), Juno 16, 1854. t Lancet (p. 164), February 18, 1860.