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
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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![3« which the masses have aUiiiuod their present irref)[iil(ir iluyelopmeut, point to tlieir posbi- blo origin in some cases by rupture of ehordiv tendineic. It is to these growths tliat tlie names of combs, wattles, caiiiillowers, and so on, liave been iipphed, as descriptive of their external form, and sullloieiitly expressive of tlie dillercnee which subsists in that respect between tliem and tlie beading so characteristic of tlie results of rheumatic endocarditis. But otiior processes than the mere addi- tion of new matter on tlie exterior are gene- rally rcquireil to produce these appearances. The ellcct of simple growth is merely to form long processes or fdaments. It is to the other processes, which advance simul- taneously with growth, namely, earthy or atheromatous degeneration, laceration, and perforation, of these, and of the parts in their immediate neighbourhood, that the singularity ot their form, and the grave extent of the lesion, are mainly owing.* A more minute inquu-y into the nature of these morbid changes gave the following results. As before, the most satisfactory single observations, rather than the general inferences, are detailed. In one case the growth is described as soft and leathery. It sprang rather from the interior than fi'om the surface of the valve, and the endocardium stopped ab- ruptly at its root. It was possible to dis- tinguish in the mass numerous small gra- nules and some fat. This growth had given origin to a similar one on the corresponding edge of the other flap of the mitral valve. Another case of the same kind displayed soft growths, over which the endocardium was not continued, but was thickened in their hnraediate neighbourhood. The growths had a granular, not a fibrous texture ; they were insoluble in ether and acetic acid, but soluble in liq. potassaj. Throughout the soft mass were scattered cubic cryst als, with striated facets, soluble, w ith eJfervescenee, in hydrocliloric acid. These crystals were accumulated chiefly on the surface of the diseased parts. The same granular textm-e was observed in the ends of some ruptu'cd chordse tendineoe wuich were fovuid in this case. The above may be taken as fair instances 0 this second form of disease in its most characteristic di'velopincnt. But I think that, whatever genei'al rules might be laid down, it woidd be impossible to tell, fi-om the microscopic examination only, except at particular peiiods and under very fa- vom-able circumstances, what was originally 1 he cause of the disease of tlie valves. At * See Watsnn's Lectures. vr.| ii.. p. 286, for a description of two cases of this kind least, after some pains spent in the inquiry, 1 am sure that T cannot certainly do so. Tlicrc is one very important distiiictiou between growths of this kind, and thosu whicli result from rheumatic endocarditis; namely, the minute distance wliich sepa- rates tlie points where we may Ihid seve- rally, the growth a<lvancing, the traces of its degeneration, and a hcaltiiy state of the valve from w]h(;h it lias sprung. All these may be seen within the space of three or four Unes. This fact quite falls in with the result of general observation elsewhere noticed ; namely, that the products of disease bear the stamp of their origin upon them m their tendency to undergo certain ulterior changes, and to decay nearly in projiortion to tlie rapidity of their growth. But it illustrates another very important point; for it lias been shown, when on the subject of the first form of disease, of how serious a nature were the changes impli- cating the structure of the valve, and creeping back mto its substance. Such changes are in this form almost entirely wanting. The substance of the valve is affected to no further extent than the exist- ence of tlie growths would seem sufficient to explain. Even to this extent the difie- rent tissues are not matted together: thougli they are thickened, they appear even looser than natural. On the one side they shade rapidly off into the healthy structm-e of the valve ; on the other, the change mto the morbid growth is still more abrupt. The affection of the endocardium especially would seem to be quite secondary, for it commonly terminates abruptly at the edge of the growth, just as the skm does some- times at the edge of a mahgnant tumor springing from a different subjacent tissue; and for the reason that this fonn is not primarily and essentially a disease of the endocardiimi. The large size to which such masses may attain in patients scarcely arrived at man- hood, or even at puberty, is very chai'acte- ristic of this form of growth. In one pa- tient, aged 21 years, one of these growths fi-om the aortic valves measured Ig inches in length. With these large masses obstructing the onward flow of blood, and with such ex- treme disease of the valves, it is at first sight almost inconceivable how the circu- lation can be maintained. But theu* form and consistence in some degree explain this; at least, as far as concerns the sig- moid orifices, where it is most commonly that they attain to such a size. For the elongated masses or tails floating loose in the onward stream would not obstruct the circulation so much as, from their size,might he imagined ; and, during the diiistole, there can be littledoubtthat valves.growths,](https://iiif.wellcomecollection.org/image/b22305609_0038.jp2/full/800%2C/0/default.jpg)
