Failure of the heart in valvular disease / by J. Mitchell Bruce.

  • John Mitchell Bruce
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Failure of the heart in valvular disease / by J. Mitchell Bruce. 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.

    2/20 (page 2)
    frequently remove the parietal weakness, and when we have succeeded in doing this we say that compensation is re- established, and the patient enters \ipon a fresh period of freedom from symptoms although the valvular disease itself remains unchanged. This being the present position of our knowledge of disease of the heart in its prognostic and therapeutical aspects, the time appears to me to have come when we can take another step forward. My object in this paper is to indicate one direc- tion in which this advance may be attempted. The conviction has been forced upon me, not by theoretical considerations but by practical experience, that, after all, failure of the heart is only an eflfect behind which there lie a number of discover- able causes. If cardiac failure make its appearance in chronic quiescent valvular disease, it must have originated in some conditions or circumstances unfavourable to compensation; and prognosis and treatment to be sound and successful must be framed on a full knowledge of what these conditions or circum- stances are. I do not refer to the necessity for a general acquaintance with the causes of broken compensation, but to the application of this knowledge in each individual instance of cardiac failure that comes before us. In my experience it is by no means common for the physician to enquire into the causes of cardiac failure in every case that seeks his advice. When a patient with palpitation, dyspnoea, cough, and threatening dropsy presents himself for treatment, I doubt whether we are always careful to put the question to ourselves —What has happened to this man that he should come to me with these symptoms after twenty years of freedom from suffer- ing since the original rheumatic endocarditis 1 Time was when we were satisfied in such a case with the diagnosis— mitral incompetence. We should now consider this diagnosis as in- sufficient, and would complete it by saying—mitral incom- petence with cardiac failure. I venture to say that this diagnosis is still short of the full truth, and that when we proceed to offer a prognosis based on such a conclusion only, and to apply treatment, we proceed on insufficient information. We must first determine the cause of tlm failure, why the heart has broken down,—whether from muscular strain, or nervous