The murmurs of mitral disease / by Edward Mansfield Brockbank.

  • Edward Mansfield Brockbank
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The murmurs of mitral disease / by Edward Mansfield Brockbank. Source: Wellcome Collection.

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    9 ending at the moment of this sound and of the apex beat. In this case the murmur is simultaneous with the contraction of the auricles, and I call it auricular-systolic. The interpretation of such a murmur depends on the consideration, that it occurs only when blood is being expelled from an auricle, and when the ventricle is passive. With very rare exceptions, therefore, such murmurs depend upon contraction of the auriculo-ventricular orifices, and consequent interruption to the flow of blood out of the auricle during its contraction. The auricular-systolic murmur may merely precede the first sound, i.e., it may follow the pause of the heart's action; or it may appear to be prolonged out of, or even quite through, the period of rest, being in this last case necessarily associated with a degree of the ventricular-dia- stolic murmur, presently to be described. Its essential character, however, is preserved in every case, as above defined. The nomenclature adopted by G-airdner has a misleading ten- dency, and in 1893 1 he explained that the name auricular-systolic was applied to the latter, or prolonged variety, of the murmur, not because it was produced by the auricle in systole, but simply because the- most characteristic element of the murmur, the so-called presystolic rhythm, was, in fact, coincident in time with the auricular systole. In 1864, Ormerod 2 expressed his doubts as to the truth of Gairdner's views, and thought that there was no insuperable objec- tion to another explanation of the murmur in question. Its seat at the mitral or tricuspid orifice is undoubted, but Ormerod thought that the murmur might arise from imperfection of the auriculo-ventricular valve, allowing regurgitation during the contraction of the ventricle. Fagge3 published in 1871 an important contribution to the discussion, giving a full account of the previous papers on the subject, and supporting the presystolic theory of the rhythm of the bruit. In his experience the murmur is occasionally so short and sudden that it resembles rather a tone, and is in itself hardly to be distinguished from the natural first sound of the heart. The early systolic theory received further strong support from Barclay4 in 1872, and four years later from Charlewood Turner.5 1 Ed'm. IIosp. Rep., vol. i. p. 230, note 1. 2 Med. Times and Gaz., London, 1864, vol. ii. p. 154. s Guy's Hosp. Rep., London, Ser. 3, vol. xvi. p. 247. * Lancet, London, 1872, vol. i. p. 283.