Narrative of a case in which malformation of the pulmonary valves gave rise to remarkable cardiac sounds / [J. Warburton Begbie].

  • James Warburton Begbie
Date:
1882
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Licence: Public Domain Mark

Credit: Narrative of a case in which malformation of the pulmonary valves gave rise to remarkable cardiac sounds / [J. Warburton Begbie]. Source: Wellcome Collection.

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    precediug Friday, when in a state of intoxication—to habits of which he had only lately become abandoned—he had fallen down a stair and had been brought to the surgical hospital, where, upon examination an extensive fracture at the base of the skull was detected. He died the same evening in a state of complete insensibility. It was in the performance of the post-mortem examination to determine the precise nature of the injury of the head, that the opportunity occurred for obser- ving the state of the heart. This interesting case may be almost left without any com- ments, on one or two points only I am tempted to make a few remarks : 1. The physical signs seemed to me from the very first exam- ination to indicate a lesion of the pulmonary valves, one which offered some obstruction to the flow of the blood outwards from the ventricle, and at the same time permitted the reflux of blood backwards to a limited extent. The obstruction I argued could not be very great, as there existed no evidence of hyper- trophy of the right ventricle, nor any signs of imperfect supply of blood to the lungs. The loudness of the systolic murmur seemed to bear out the doctrine of Dr. Hope, that pulmonary murmurs, from the greater nearness of the pulmonary artery to the surface of the chest, are likely to be louder than aortic murmurs. Equally strong indications of the pulmonary oi’igin of the murmurs, as the precise situation in which they were most clearly heard, were the want of propagation in the aortic and large vessels, or along the sternum, and the absence of any peculiarity in the superficial pulses. The incompetency of the pulmonary valves I considered to be only to a limited extent, from the faint character of the diastolic murmur and the absence of any marked pulmonary symptoms. 2. The history of the patient’s case, the fact very specially, that throughout life his breathing had been slightly affected; that he had never suffered from rheumatism, and his appearance, with the shortened right arm, made it not improbable that the cardiac lesion whatever it might be was of foetal origin. 3. Lastly, the absence of any other form of valvular disease, in this case, may reasonably be considered as having materially simplified the diagnosis, though its interest cannot be considered as on that account in auy degree diminished.
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