An inaugural dissertation on the congenital malformations of the heart / by John Paget.

Date:
1831
Catalogue details

Licence: Public Domain Mark

Credit: An inaugural dissertation on the congenital malformations of the heart / by John Paget. 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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    PATHOI.OGICAr. EFFECTS, tlie pulmonary artery, while it occurred only once in the aorta. Disease of the tricuspid valve, is more common than of the mi- tral ; but both are rare. In the cases already quoted, dilatation of the right auricle was observed in eighteen; five times with hy- pertrophy, and twice with atrophy of its parietes. The right ventricle was dilated nine times ; and in four of these it was also hypertrophied. Simple hypertrophy of the walls of this cavity occurred in six others. On the left side, dilatation of the auri- cle was seen eight times ; of the ventricle, four. Hypertrophy of the former, is mentioned in three instances ; of the latter, in two only. It must strike every one that these appearances, as hy- pertrophy, retraction of the orifices by deposition or union of the valves, &c. are so analogous to other independent morbid states of the heart, that there can be little doubt that they must arise from similar causes, and are frequently formed long after birth. They have, however, in other cases been found at so early an age, as to be attributable, only to a morbid action prevailing during the period of foetal developement. To the latter, must we refer many of those instances terminating fatally soon after birth ; to the former, those which show themselves only at a later period. This leads me to one of the most extraordinary circumstan- ces, in the history of the disease under consideration. Many of the subjects of malformation of the heart have lived for six- teen, twenty, or many more years, without betraying any strik- ing symptom of the presence of such affection ; and this has led to a doubt, whether the malformation has existed, previously to the occurrence of the train of symptoms, by which it is usually known. Most of the cases in which such a doubt is admis- sible, will be found to consist of simple communication of the cavities, by perforation of their septa ; and in these instances we think, the causes of this apparent anomaly may be made suf- ficiently obvious. Laennec * conceives that the narrow oblique opening which is often seen between the plates of the valve of the forame?] ovale, though preventing any admixture of the venous and arterial blood, is often the cause of a more serious affection ; since by a violent blow or sudden effort it may easily become dilated, and then • I.aenncc on DisMs> s of the Cliest, &c. Translated by Forbes. 1829. p. C3(l.