Case of anomalous cardiac murmur, concurring with fatal cerebral disease / by W.T. Gairdner.
- Gairdner W. T. (William Tennant), Sir, 1824-1907.
- Date:
- [1889?]
Licence: Public Domain Mark
Credit: Case of anomalous cardiac murmur, concurring with fatal cerebral disease / by W.T. Gairdner. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![]^ut as it happens to be the very first instance in which facts bearing at all in the direction of the late Dr. Austin Flint’s now well-known thesis in respect to the pre-systolic murmur have occurred to me, and as Dr. Byrom J^ramwell has recently contributed to this Joukn.'VL for March, 1888, another exceptional case presumably of the same or similar order, I regard it as simply a matter of duty to avoid the implication that any important observation, apparently opposed to the current theory ot mitral stenosis and its murmur, will be on this account suppres.sed. At the same time it is surely not unbecoming to emphasize the fact, that Dr. Bramwell’s case, observed in October, 1886, and the present one, are actually, I believe, the only contributions hitherto from the Euro- pean side of the Atlantic to the theory in question, viz., that a charac- teristic pre-systolic murmur, such as in most cases accompanies mitral stenosis, may be produced without disease of the mitral orifice, when there is present exceedingly free regurgitation through the aortic valves. Dr. Bramwell’s case, though very striking and up to a certain point convincing as to its clinical features, is deficient, considered as evidence, from the want of a post-mortem examination. The present case, on the other hand, is one in which the clinical evidence fails to come up to the standard of precision, while the post-mortem results are such as, with better and more secure clinical data, might be accepted as conclusive. The two cases taken together show that the apparent corroborations of Dr. Flint’s theory are probably few and far between. This is not by any means a legitimate reason for setting aside the theory or the facts adduced in support of it. But it is a reason for suspense of judgment until the multiplication of unquestionable facts in the experience of competent observers has allowed of the que.stion being looked at all round, as it were, instead of merely as one involving the authority, high as it is, of one distinguished man. As the matter stands at present. Dr. Flint’s first case was observed in May, 1860, and his second in February, 1861. There is then a long pause, and no other case appears to have occurred to him for more than twenty years. Another case, however, in America is alluded to in a footnote in the posthumous edition of Dr. Flint’s Principles and Practice of Medicine; and yet another recent case is quoted by Dr. Bramwell from the Transactions of the Association of American Physicians. These are, so far as known to me at present, all the materials available in print for the consideration of this subject. Dr. Flint’s theory, reduced to its simplest possible expression, is that when the ventricle is j)rematurely filled, and over-filled, during the diastole, owing to free regurgitation through the aortic valves, the mitral curtains are floated up, mechanically, so as to lie athwart the auriculo- ventricular opening, and to close it; and that the auricular■eoirt.^Hotioit; coming later in sequence, surprises (so to speak) the valves in this ab-](https://iiif.wellcomecollection.org/image/b21695945_0006.jp2/full/800%2C/0/default.jpg)
