Diseases of the heart and arterial system : Designed to be a practical presentation of the subject for the use of students and practitioners of medicine.
- Babcock, Robert H. (Robert Hall), 1851-1930
- Date:
- 1910
Licence: Public Domain Mark
Credit: Diseases of the heart and arterial system : Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![reduce its size in the least. The liver has always been greatly engorged, extending for a long time nearly to the crest of the ileum, and requiring the daily use of saline laxatives to relieve the patient from pain and discomfort. For the past year the organ has been gradually diminishing somewhat in size and in- creasing in thinness and hardness. The patient has experienced remarkably little dyspnoea on effort, but is greatly annoyed by the pounding and tumultuous action of the heart, this sensation being specially noticeable in the epigastrium. Of late, she has had a great deal of cough, difficult mucous expectoration, and upon several occasions slight haemoptysis. She has to be extremely careful in her diet, and her urine and menses have become scanty. Another female patient with pronounced mitral insufficiency has pericardial adhesions that bind down the left side and base of the heart, fixing the apex-beat immovably in place, far to the left and downward, but the border of the right heart is apparently free from adhesions. Whereas the left ventricle never varies in size under any conditions, the right heart, as shown by the area of cardiac dulness, becomes dilated with the greatest ease and rapidity. The liver, which is ])ersistently enlarged, fluctuates somewhat in size in accordance with the state of the right heart, but even when at its smallest always extends from 2 to 3 inches below the inferior costal margin, no matter how vigorous may be the onslaughts upon it by means of Epsom salts. This patient's symptoms are not of the digestive organs, but are those of short- ness of breath and a rapid pounding action of the heart and gen- eral weakness. The urine remains fairly abundant, and the menses are too profuse and protracted. She is always promptly benefited by absolute rest in bed, a milk diet, cathartics, and digi- talis, although this last-named agent never materially slows the heart. The most interesting class of cases are tliose whose clinical fea- tures closely resemble a case of atrophic cirrhosis of the liver. These cases, usually of chronic fibrous mediastinopericarditis, generally pursue a latent course for many years, and often, even after symptoms have set in, are not recognised as adherent peri- cardium until they come to autopsy. Not only is there a chronic engorgement of the liver, l)iit there is a perihepatitis with increase](https://iiif.wellcomecollection.org/image/b21229533_0130.jp2/full/800%2C/0/default.jpg)
