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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![and accompanied by a feeble thrill. Cardiac dulness was in- creased in all directions, and in the mitral area there was a loud, harsh systolic murmur transmitted to the back. All the sounds, especially the pidmonic second, were sharj^ly accentuated, and over the base of the heart was a triple murmur that by its rhythm and other characters was plainly a pericardial friction-rub. Excepting retraction of their anterior margins the lungs were negative. Her temperature and urine were normal. The diagno- sis was mitral insufficiency of rheumatic origin, and acute peri- carditis, probably plastic, and also rheumatic. Patient was sent home to bed and a blister was applied to the pra^cordium. At first, after rest in bed, local applications and salicylate of soda, the j^atient's condition improved, and she was allowed to get up at the end of ten days. In a few days, however, she again took to her bed, and from this time forward her symp- toms steadily grew worse. Cough became very troublesome, with difficult mucous or muco-sanguineous expectoration, and there were anorexia and constipation. The pulse always remained at 120, and as it failed to be slowed by digitalis, the drug was discontin- ued. June 2d there was a sudden attack of acute rheumatism in the left hand and wrist with substernal pain, and temperature rose to 102° F. Salicylate of soda gave prompt relief to pain, and as the urine was scanty and acid, the salicylate was discontinued for the bicarbonate of potash, which was administered until the urine became alkaline. June 6th, at 2 a. m., there was a sudden exacer- bation of substernal jDain and distress. A pericardial friction- sound now developed over the body of the right ventricle, chiefly below and to the left of the ensiform ap2:)endix. There was great epigastric tenderness and interscapular pain. The anterior mar- gin of the left lung became somewhat more retracted, and the apex- beat now moved nearer to the left anterior axillary line. The patient complained much of pain across the front of the chest, along the lines of the diaphragm, from the right inframamillary to the left infra-axillary region. She complained bitterly of pain in the ])it of the stomach, and suffered with nausea and vomiting. June 8th found ])atient much distressed for breath and unable to retain food. Epigastric pain diminished, but condition of the heart very much as before. Fever was 102° F. at 8 r. m. Stimu- lants and food in small amounts were ordered. At 11 i*. m. there](https://iiif.wellcomecollection.org/image/b21229533_0078.jp2/full/800%2C/0/default.jpg)
