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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![initml valve—to tuko tlio coiniuoiiost case —Ims to be fluppovtod I)y tlio delieiito pul- mouiii-y oapillarios, witli only timt amount ol rclii^r wliicii tlio inerc^ase ol' capacity of tlio auricle supplicrt. It is life boiif,'h't by cliseaae, by sheer Ibrco—a make-Bliift, not a remedy. Nor yet, vvlieu the heart itself sustains the increased pressure, as in the ease of sigmoid obstruction, does hyper- trophy consist with ])erfect health ; for the power of adaptation to dillerent cir- cumstances, wherein animal mechanism surpasses artificial (ronlrivanccs, is here most sorely impaired. The power of the hyportrophied heart is indeed most accu- rately calculated to the mean daily require- ments of the body ; yet, though the ad- justment bo correct, and the heart's action safe for all ordinary purposes, the impulse of an hypertrophied heart under excite- ment cannot be regarded without appre- hension. Take, for instance, such a ease of aortic obstruction where the impedi- ment is exactly counterbalanced by the increased power of tlie heart. It is obvious that the more the arteries are distended on the further side of the obstruction, tlie more forcibly wUl the shock o( the heart's contraction be transmitted past the ob- struction to distant. parts. The most trivial cause, impeding for a moment the flow of blood through the jugular veins, may readily induce sueh a condition of the arteries leading from the heart to the brain : the more readily, the sligliter the obstruction—that is to say, generally, the earlier in the disease. And wlien the eifect of the organic obstruction at the sigmoid orifice has been tlius neutrahsed, a few fuU, forcible eonti'actions of the left ventricle may place such a patient in the most imminent danger of extravasation of blood into the substance of the brain. It is our duty as physicians to prevent, as far as may be, what we cannot ciu-e. This rule must never be absent from oiu* minds, but must enter into all the minutise of the treatment of valvular disease of the heart. By enjoining rest and prudence we may delay the advance of dilatation and hypertrophy; but we cannot reason- ably attempt their cure, except by remov- ing their cause, which to a great extent is imjiraeticable. It is worse than idle to cup and leech, and use antimony and mer- cury, to try to cure them, or the disease of the valves on which they depend, except so far as their existence is conncclcd with a condition of jiarts or a general condition indicating the employment of sueh reme- dies. Sueh treatment cannot remove them; and, if it could, we must needs bring them back again, or the patient woidd die. The rational indications of treatment in many such cases are satisfied rather by the use of quinine and h-on* tlian by antiphlo- gistic means. For serious as are the secon- dary effects of increase in the strength and (iapaeity of the ventricles on other organs, tlie direct effects of weakness of the heart are much more to be ajiprehended. It is a very imperfect view of the effects of valvu- lar disease on the heart itself which sees only a progressive hicrease of its sli-zinglh or capacity, and docs not look forward to that period when its powers of adaptation fail, and, mstead of rising to meet, the heart sinks beneath its bm-den. The data are as jet wanting from whicii to investigate this most important prac- tical question,—under what circmnstances, namely, this state of things occurs. On the more obvious explanations, which th« effects of the original size of the coronary trunks m hmiting the supply of blood, or which the deteriorated quality of the iui- perf'ectly aerated blood suggest, there is as yet room for little beyond conjecture, how- ever probable. Only let us keep clear ol one fallacy. Fatty degeneration of the heart is apparently the natm'al termination of liypertrophy of that organ where the hypertrophy has depended on a temporarj' cause. But such is essentially not the case in valvular disease. The cause of the hypertrophy is rather progressively in- creasing than temporary. These two forms of disease of the heart—fatty degeneration and valvular disease—have httle in com- mon : their couicidence is but rare, and the mode of then connection in these rare cases quite inexpUcable. But there will be occasion to refer to this hereafter. The failure of the heart's action marks a distinct period; and, whether it be the rhythm or the power that fails, the influence that should chrect, or the substance that should sustain the action—whether it supervene in the same gradual way as the hypertrophy, or in a- moment fatally, it is a matter of the deepest interest. It is the last alternative awaiting those who have avoided or strug- gled tlu'ough those complications of other organs which first demand oiu* attention. III. However great be the value of ob- servations of the effect of valvular disease in inducing hypertropliy and dilatation oi the heart, as a measure of the virtual amount of that disease, yet, as a ride, the duration of Ufe under such circumstances depends more on the degree to which the various organs can assist or tolerate the impeded cu'cidation, or the heart can ac- commodate itself to its altered circiun- * See on this subject Dr. S. Alison on the Vsc of Iron in Organic AlTections of the Heart; anil a most excellent practical paper by Pr. Law, Dublin Medical Journal, vol. xvii. p. 192-](https://iiif.wellcomecollection.org/image/b22305609_0046.jp2/full/800%2C/0/default.jpg)
