Studies in cardiac pathology / by George William Norris.

  • Norris, George William, 1875-1965
Date:
1911
Catalogue details

Licence: Public Domain Mark

Credit: Studies in cardiac pathology / by George William Norris. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    Mitral obstruction may be produced experimentally either by introducing a distensible balloon through the auricular appen- dage, or by passing a suture or clamp around the auriculo-ventric- ular ring.^ The immediate result is the lowering of the general arterial pressure and the great elevation of the pressure in the pulmonary arteries, the pulmonary veins, and the left auricle. The pressure in the systemic veins is little if at all elevated, unless there arises an insufficiency of the right ventricle, or with it a relative insufficiency of the tricuspid valve. The essential feature of the process, as indeed of all changes of blood-pressure due to any obstruction of the blood- stream from alterations of the heart, lies in the fact that the amount of blood in actual circulation is diminished, while the rest of the blood stagnates behind the obstruction. In the human being the constrictive process occurs gradually, and thus a better chance for compensation is offered. The fall in the systemic pressure is counterbalanced by an increased arterial constriction, so that arterial tension is maintained at practically a normal level. Clinical Considerations.—Owing to the serious and progressive character of mitral stenosis, and the fact that so manj' cases wreck individual existences early in life. Sir Lauder Brunton suggested some years ago that at some future time this lesion might be treated by surgical means. At present this is, of course, out of the question, but recent experience shows that this is by no means as chimerical a suggestion as it at first appeared to be. The heart is no longer surrounded by an invincible noli me tangere. Bernheim's experiments have shown that it is a good deal easier to convert a mitral obstruction into an insufficiency than to pro- duce the former lesion.^ Wounds of the heart are treated on the same principles as the wounds of other muscles, and with no small degree of success. Of some 160 cases of cardiac wounds surgically treated thus far, 69 were in the right ventricle, with 48 deaths ''69.6 per cent.j; 74 in the left ventricle, with 45 deaths (60.8 ' Mlc.CMuu, :iw\ .VInClurc; 'J'lvuis. Assoc. Am. Phys., ]90(), p. 5. ■' I5r-nilii-i,„: l;,il|..tin .lolms llcpkiiis Ilospiliil, April, HIOO.
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