The diseases of the heart and the aorta / by William Stokes.

  • Stokes, William, 1804-1878.
Date:
1854
Catalogue details

Licence: Public Domain Mark

Credit: The diseases of the heart and the aorta / by William Stokes. Source: Wellcome Collection.

    158/722 (page 134)
    The various effects of organic disease on the function, struc- ture, and form of the valves, is described in every work on pa- thological anatomy. In a practical point of view, it would be sufficient to recognise contraction or dilatation of the orifices, both of which conditions are attended by a permanently open state. This permanent patency is in some cases produced at an early pe- riod of the disease, while in others the valves may be so roughened by cartilaginous and ossific growths as to cause a murmur during the exit of the blood, while they yet remain competent to close the orifice. To this consideration we shall return, as it is one of those which may be indicated as opposed to over-refinement in diagnosis. Valvular murmur is so much more frequently developed at the left than at the right side of the heart, that it is still a question whether we are in any case in a position to declare the existence of disease of the tricuspid or the pulmonary valves. If the relative position of the heart were always the same; if we had to deal only with cases of valvular disease, uncomplicated with change in the figure or volume of the heart; and lastly, if the rule were certain that the loudest sounds were to be found at the exact situation of the disease which produced them, it would be nearly as easy a matter to diagnosticate valvular disease at the right as at the left side of the heart. But when we know that the investigator can seldom meet a case so circumstanced, and then reflect on the o-reater frequency of diseases of the left side, it becomes plain that the cautious physician ought not commit himself hastily in a diagnosis of disease of the valves on the right side, much less de- clare its exact nature. For it appears certain that we must be guided in our treat- ment of valvular disease less by the condition of the valves, than by that of the muscular portions of the heart. The practical phy- sician, having satisfied himself that a valvular disease exists, will not devote too much time in ascertaining its exact nature; but he will examine into the vital and mechanical state of the heart's cavities. He will ascertain the amount of vigour of the heart, whether its force is above or below the natural standard; whether it is liable to excitement from slight causes; and whether irregula- rity of action or the opposite is its ordinary state. He will endeavour