On a systolic murmur in the pulmonary artery, and its application to the diagnosis of functional and organic murmurs / by Edward Latham Ormerod.

  • Ormerod, Edward Latham, 1819-1873.
Date:
[1846]
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Licence: Public Domain Mark

Credit: On a systolic murmur in the pulmonary artery, and its application to the diagnosis of functional and organic murmurs / by Edward Latham Ormerod. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Insisting on the fact of the pulmonary valves being generally free from disease, murmurs referred to this situation must be ex- plained on some other supposition than that of structural change. On the exact mode of production of this vibration there is no space here to speculate. The peculiar theory which any one may advocate is a step anterior to that with which we would commence, namely, the audible effect of these causes, whatever they may be assumed to be. We may suppose the ventricle to be contracting with unusual force, with unusual rapidity, to be temporarily, (for the variable nature of the murmur will not let us suppose it perma- nently), dilated, or affected in any way so as to throw the blood into greater vibration ; or the blood itself may, by its tenuity, be more susceptible of vibration. There may be any cause but per- manent structural change in action. But before applying these conclusions to the other orifices of the heart, we must again refer to the table of cases, for we can apply them safely only under certain restrictions. It has been already noticed that the murmurs did not begin at the same time at all the situations at which it was eventually audible. In the majority the murmur began at the same time in more than one situation, and so far this is favourable. For if a murmur arises in any part of the heart except at the pulmonary orifice during acute rheuma- tism, and subsequently a murmur appears at this latter situation, we must look on that case in a less favourable point of view than what we would on a case in which they were all developed si- multaneously ; and this will be the more necessary, if, in addition to the attenuating effects of rheumatism on the blood, (which re- duces its solids in the same way, though not to so great an extent, on the average as does chlorosis,)* venesection,-f* which produces analogous effects on this fluid, have been employed. With this restriction we may apply what has been said of the pulmonary orifice, to the other orifices of the heart. It is possible that the murmurs heard in other parts of the cardiac region may have their origin in the same or similar functional disturbances in which it probable, nay, almost certain, that the murmurs of the pulmonary artery take theirs. On this question, or recurring to the words of our second inference, what grounds there are for pre- suming that a murmur co-existent with one in, but referred to any other situation than, the pulmonary artery, may ultimately disap- pear, the above tables may throw some light. It is true that of the first sixteen cases only seven had all the * Simon, Medizinischen Cliemie, ii. 175,208. Healthy standard, - Rheumatic blood, average, Chlorotic do. do. t Hope, op.cit. p. 100 and p. 100. M. Hall, Med. stq. G. O. Rees, Med. Gazi vol. xxxv. p. 849. Solids. Fluid. 210 790 194 805 172 827 (Jhir. Trans, xvii. p. 270, et