On defective closure of the tricuspid foramen as a frequent cause of dropsy / by Peyton Blakiston.

Date:
[1841]
Catalogue details

Licence: Public Domain Mark

Credit: On defective closure of the tricuspid foramen as a frequent cause of dropsy / by Peyton Blakiston. 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.

    11/16 page 11
    each side of the chest. The first sound of the heart was accompanied by marked bellows sound. In a few days time intense pain at the prsecordial region suddenly made its appearance, with most distressing dyspnoea. Pulse 120, very sharp and hard, with some fulness. Venesection being freely em- ployed, with the administration of digitalis and mercurial frictions, the acute symptoms were removed ; the anasarca and the pulsation of the jugular veins disappeared. The pulse remained very hard and vibratory. In a few weeks venous pulsation of the neck, rapidly followed by anasarca, re- appeared, and he gradually sank. Autopsy.—Much fluid was found in the abdomen and thorax, and four ounces in the pericardium. This membrane was thickened and opaque in patches. The heart was generally hypertrophied, and dilated to more than twice its natural size. The tricuspid valves were a little thicker and larger than usual, but could not nearly close their foramen, which would admit four fingers and the thumb nearly up to the knuckles, and the circumference of which measured nearly seven inches. The mitral valves were thickened, but free to act. The lining membrane of the left auricle was thickened and opaque, studded with several horn-like patches. On one of the aortic valves was a patch of soft, reddish, recently organized false membrane, of the size of a fonrpenny-piece. The lining membrane of the aorta seemed thickened, and puckered unevenly. The other organs were healthy. Case VII.—John Wilson, set. 62, wood-turner: had an inflammatory at- tack of the chest eighteen months ago, since which time he has felt a tightness of the chest; for the last nine months dyspnoea, and lately palpitations. Six weeks ago his legs swelled for a few days; this went off, and returned three weeks since. Dyspnoea was most urgent. The jugular veins were seen to pulsate, chiefly on the right side; but were not turgid. The urine was not coagulable by heat. There was dulness, more extensive than usual, around the region of the heart. The respiratory sound was coarse in places, with slight cooing. The action of the heart was tumultuous, heaving, and irregular. Pulse irregular, but moderate. The sounds of the heart were feeble and obscure, but on the right side of the sternum the first sound was louder, being slightly coarse and prolonged. In two or three days time he began to expectorate dark blood, sometimes in clots. This, with increasing dyspnoea and anarcarsa, continued up to his death, which took place three weeks after my first visit. Autopsy, forty hours after death.—The legs and thighs were anasarcous; a little fluid was found in the abdomen. At the inner edge of the back and lower portion of the upper lobe of the right ung (both of which were otherwise leal thy) was a mass of pulmonary apoplexy, of the size of an orange, with abrupt edges. The heart was immense, and measured fifteen inches around the outside of the base of the ventricles. It was generally hypertrophied and di- lated, firm and red. Within the folds of one of the aortic valves was a patch of semi-osseous matter, which did not prevent the free action of the valves. The circumference of the tricuspid foramen measured full six inches. One valve was large, the other two small. They were roughed by small hard sub- stances, rather less than split mustard- seeds, particularly on their free edges. The coronary vessels were large, but healthy; and the aorta was studded with numerous soft elevations, produced by atheromatous deposit. The other organs of the body were healthy. Remarks on Cases VI. and VII.— In these cases hypertrophy and dilata- tion of the heart seem also to have re- sultedfrom old attacks ofinllammation; but inCase VI. an acute attack of endo- carditis supervened; and this being met with active treatment, the dropsy disappeared for a time. The pulsations of the veins of the neck also ceased; but whether this arose from contraction of the tricuspid foramen when the heart was relieved from the pressure of blood by venesection, whereby regurgitation was prevented; or, which is more likely, by the diminished energy of the heart’s action, produced by digitalis, cannot be positively determined. All the valves were slightly increased in size, yet the tricuspid orifice was so enormously di- lated that they could not nearly close it; hence, in a short time, the old symp- toms reappeared in an aggravated form. I now pass on to cases wherein the dilatation of the heart may in whole,
    digitised image 1
    digitised image 2
    digitised image 3