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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    oxislouco of each of tlio two forms respec- tively. The general tcndenoy of microsoopic ob- sci'vutions of the iiitiniato structure of tlie growths by whicli iho difforent forais of vah iilar disease arc ebanu'terizcd, is rather to reduce tliem all to one type tlian to es- tablish any essential diileronccs. 'For many of ( he anatomical distinctions vvliicli appear so i)lain to tlie naked eye fade away under the more rigid, yet more pai-tial scrutiny of tlie microscope. Microscopic cxaminationhas notappeared to me to justify any exact essential dis- tinction of the two forms, even hi their most extreme and most characteristic de- velopment. The dilFerenccs it hidicates are but differences in degi'ec. The stnic- turc of the morbid products in both forms alike is that of an hnperfectly fibrous, more or less distmctly laminated mass. Tlu'ough this mass ai'c scattered numerous small granular bodies and granules, with a varia- ble quantity of oil glob ides; the whole being cleared, but not entirely removed from sight, by acetic acid. I do not tliink tbnt anything could be predicated more ]Darticularly of the intunate nature of the growths characterizing either of these forms ; and I believe that tliis description is equally applicable to them both. At first sight it might appear that tliis negative evidence of the microscope on so important a point is sufficient to set aside aU other distinctions. Not so. For the microscope also tells us generally that the fibrinous traces of old uiflannnation, after a certain period, cease to present any characters distinctive of the known circimi- stances mider which the inflammation took place. We have no particidar reason, there- fore, to expect to find any such distinctive characters in the particular case imder consi- deration. The distinction, however, between the two forms rests on a safer foimdation, in their observed pathological tendencies, than in these ambiguous differences of their microscopic structure. Pathologically these two forms of valvu- lar disease are distinguished, asah'eady no- ticed, by the characters wliich the principle predominating m then- development has iin])rcssed upon them. In the one fonn there is an oi-iginal tendency to grow rapid- ly,* and still, while growing, to degenerate and decay. In the other there is a definite period of growth, on the detennination of * See on tliis point Dalrymple on the Rapid Oi sranization of Lvmpl) in Caclicxia, Med.-Cliir. Tiiiiis., vol. xxiii. p. 205. Dr. Uenn.tt, On Cancerous and Cancroid Growths, p. 1G4, snys (ril)iin] is more connected vvitli tlic dccnyinj,' than with the formative stage of hfe. wliieh the morbid products contract and consolidale tlieiiiHclvcs. In (lie one tlio morbid product inclines to be (for it u only a quest ion of degree) soft, britile, and gi-anular; in the of lier it is ratlier firm, elastic, and of a fibrous structure. Such is the most general exjjression of the results of ordinary observation in this matter. In 8|)caking of an original disposition, and ascribing to morbid products living powers in so large a measure indejiendeiit of tlio surrounding ijarts, I am presuming your acceptance of the doctrmes whicli these tenns involve. I need scarcely occujiy your time with any detailed expositions of these doctrines. Tliey have been made familiar to you by Mr. Paget.* And in then- appli- cation to the matter under consideration I gladly acknowledge the extent of our obli- gations to Dr. C. J. B. Williamst for his labom-s in this department of general, as before m that of cardiac pathology. With these in your hands details from me would be superfluous. J It is necessary here only briefly to re- capitulate, before applying them, the two general piinciples relatmg to the present subject, on which our attention must be fixed. These are:—First, that there are from the first essential differences in the products of the same disease according to the constitution of the patient. And, secondly, that such constitutional pecuhari- ties imprint on the morbid products certain tendencies, which take effect after the mor- bid products have entered upon a con- dition of comparatively independent exis- tence. Valvular Lesions resulting from Simple or Rheumatic Inflammaiion. The process which gives rise to the ordi- nary form of valvxdar disease has received the name of endocarditis. It is known better in connection with acute rheuma- tism, than as of ap]3arently spontaneous origin. Yet, as the identity of the disease under both chcum stances has been estab- hshed, in the foUowmg remai'ks, as already by anticipation, the valvular lesions with which we are famdiar as the effects of acute rheumatism will bo considered as resulting from smiplo or rheumatic inflam- mation indifferently. It has been lu-ged that the changes which acute rheumatism induces in the valves are not due to inflanmiation at all, but merely * Lectares, Med. Gaz., 1847-49-50. Also Si- mon's Lectures on General Patholosy, Lect. VI., Lancet; and Ur. A. Clarke, Med. Gaz., xlii., p. 416. t Principles of Aledicine, 2d edit, chaps. 3 and 4. % See also a very practical exposition of tlic surKical application of these principles^ Hnin- phry's Lectures, Prov. Med. and Surg. Journ. Lecture V.
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