On the pathology and treatment of valvular disease of the heart and its secondary affections : being the Gulstonian lectures, delivered at the Royal College of Physicians in February 1851 / by Edward Latham Ormerod.

  • Edward Ormerod
Date:
1851
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Licence: Public Domain Mark

Credit: On the pathology and treatment of valvular disease of the heart and its secondary affections : being the Gulstonian lectures, delivered at the Royal College of Physicians in February 1851 / by Edward Latham Ormerod. 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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    There are still a few conditions whose ^laiiu to the consideration of causes of k alvidar disease requires to be investigated. The occurrence of inflammation in a leighbouring part—chiefly the lungs or ileura;—is another reputed cause of inflara- jiatory affections and consequent organic lisease of the investmg or lining membrane )f the heart. The grounds of tliis opinion, 13 far as concerns the endocardium, do not ippear to me to be satisfactory. There are necessarily but two sources v^heuce the evidence can be drawn,—namely, ■ases of recent inflammation of these parts, )r, cases displaying traces of its former jresence. Neither of these appear to me o furnish the required data. I. As to previous inflammatory affections »f neighbouring parts. Pi'actically, we are ilmost limited to the observation of the races of such previous action in the pleurce ; or the traces of previous pneumonia are onfessedly of too equivocal a character to »e made the basis of any further inferences. 'Jow, in a very large majority of cases of )leural adhesions, of whatever extent, tuber- les are found in the lungs. But t)ie dmitted antagonism • of the tubercular iathesis* and valvular imperfection, and he equally^admitted fact of the close con- leetion of pulmonary tubercles with pleural dhesions, must tend very much to diminish * Rokitanskv. who has brought a larg;er mass f facts to bear on this subject tlian have hitherto een employed in its examination, spealcs very ecidedly of the antagfonism between tuberculosis ml valvular imperfection (Path. Anat. Bd. i. S. 22). But he finds more reason to connect his pake yellow granular [croupos] tubercle with isei'se of the valv^ s of the heart, ami of the reat vessels (S. 524). Dr. Walshe, in his able report on phthisis Brit, and For. Med. and Chir. Rev., Jan. 1849, . 252) says, I have never once seen cardiac isease, of such kind as to cause haemoptysis, co- xistent with phthisis, using theterni in its prac- cal sense; but in a fair number of instances I ave seen advanced cardiac disease, in persons hose lungs contained crude tubercles and grey raiiulations. It may be, therefore, that the onditions of the system existing in heart dis- ise are unfavourable to the development of iiberde; but the unfrequency with which the vo kinds of disease are found together, doubt- iss depends, in the main, on the dilierence in le periods of life at which each is especially rone to occur. In the notes of my own dissections the number f cases of valvular disease is, from various causes, isproportionately larire. But, where this pecu- arity does not interfere, the numerical conclu- 10118 agree pretty closely with the above. Tubercles or their remains were found in the nigs of 2 in .S9 = 51 per cent, who died of valvular disease. 31 in 145 = 21-3 per cent, who had, but did not die of, valvular disease. 142 in 495 = 28-6 per cent, who died from all causes with all diseases. Valvular disease, of whatever kind or degree, as found in about 30 per cent, of patients hav- g tubercles in their lungs; 37 per cent, of all ses, with or without tubercles. the evidences of the connection between pleural inflammation and valvular disease. Notwithstanding this large deduction, the proportion in which valvular disease of the heart, and the traces of old pleurisy, are found to coincide, is certainly higher than that which is found to exist in patients dying of aU disease, including pulmonary phthisis. In the examination of the bodies of 486 patients, dead of all diseases, of which I have more or less complete re- cords available for the present purpose, plem'al adhesions were found in 225 ; less than one half. In 182 of these 486 patients, who presented evidences of valvular disease of the heart, of whatever kind or degree, pleural adhesions were found in 94; rather more than one half. But before accepting the conclusion from tiieae nimibers, we must allow much for the greater attention bestowed on the ex- amination and description of the thoracic organs, in cases of fatal thoracic disease. A fact this, wliich would obviously raise the proportion in which pleural adhesions have been foimd in connection with val- vular disease of tlie heart. Granting, on the grounds of their fre- quent couicidence, a more than accidental connection between the traces of old pleural adhesions and old valvular disease, we are yet very far from beuig entitled to assume tliat in the pleurisy we see the cause of tlie endocarditis. They may have a com- mon cause; as they have, for instance, in cases of rlieumatic pleurisy. We cannot hope to arrive at any certam conclusions, without a certain knowledge of the cause of the pleurisy, or at least of the date of its occurrence. I cannot, therefore, put any confidence in the deductions from cases of old pleural adhesions only discovered after death, in our present, and what must be, I believe, our perpetual state of uncertainty conceriung the occasion of their origin, in the great majority of cases. II. The examination of recent cases of pulmonary inflammation makes very much agauist the existence of any close connection between inflammation of the endocardium and that of the lungs or pleur®. I have more or less complete notes of the dissection of eighty-eight cases dying with recent pleurisy, and of ninety-five vdth recent pneumonia. Several of the cases of these two affections are identical; but for the present purpose it IS needless to enter into any elaborate analysis, and to set out this distinction with accuracy, for, out of the whole num- ber, only six had coincident endocarditis. Five of tliese six cases had at the time acute rlieumatism. The sixth died oi meningitis. In her the existence of pneu- monia was questionable, and the inflamma- tion of the endocardium was limited to
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