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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![i-li_vtlnn ami accent, Avliich, as it sccnis to me, exjilains the divcrsit}' of opinion expressed bv different writers. Potain's explanation of the i)henomenon is that it is dne to an increase in the elastic resistance of the ventricnlar wall over its muscular tonicity, in conseipience of which the inrush of blood from the auricle causes it to generate a sound of tension. Sewall, on the other hand, attributes it to the contraction of the papillary muscles taking place prematurely—i. e., during diastole. What- ever be its mode of production, this rhythm is an evidence of abnormal blood-pressure within the ventricle, and hence of dan- gerous tension of its wall. Its occurrence is most' commonly ob- served over the left ventricle in cases of chronic nephritis, par- ticularly the interstitial variety, and when thus observed it is to be regarded as an evil prognostic omen. It indicates a giving way of the ventricle, which is no longer able to cope successfully with the resistance in the arterial system. I agree fully with those who look upon it as a sign of the end being not far distant in cases of chronic nephritis, since I have never know^n an individual to recover in whom this rhythm was detected. In the spring of 15)00 I had under treatment a com- paratively young man, with stiffened arteries and interstitial nephritis, who presented this phenomenon at different times in its most typical form. Several times, under the influence of nitro- glycerin and cathartics, his gallop-rhythm disappeared entirely, becoming replaced by tw'o heart-sounds of normal rhythm. Yet so soon as pulse-tension was increased, either through lessened vigour of this medication or the administration of digitalis, the ominous disturbance of rhythm rea])peared. This ])atient suc- cumbed after about two months. This interesting canter-rhythm is never heard at the base of the heart, but always over one or the other ventricle, and conse- quently in either the mitral or tricuspid area. It may be of tran- sient duration, yet is often persistent. It may be heard in hyper- tro])liy alone or coud)incd with dilatation, it may occur in dilata- tion alone, in acute infectious diseases, such as typhoid fever and di])htheria, croupous pneumonia, scarlatinp, acute articular rheu- matism, and acute miliary tuberculosis (Fraentzel), all of which lead to myocarditis or to simple weakness of the heart-walls. And lastly, it niay be hcai'd in jxTiiicions anirniia, Icncn'iiiia, and grav<>](https://iiif.wellcomecollection.org/image/b21229533_0044.jp2/full/800%2C/0/default.jpg)
