Memoir on the influence of hypertrophy and dilatation on diseases of the heart, and on some points in their diagnosis and treatment / [Andrew Halliday Douglas].

  • Douglas, A. Halliday (Andrew Halliday), 1819-1908.
Date:
1850
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Licence: Public Domain Mark

Credit: Memoir on the influence of hypertrophy and dilatation on diseases of the heart, and on some points in their diagnosis and treatment / [Andrew Halliday Douglas]. Source: Wellcome Collection.

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    illustrated in other cases, but in connection with other signs, espe¬ cially the state of the impulse, it is the most invariable and important of the physical signs. It bears a very direct relation to the rounded form of the heart which occurs in dilatation. The displacement of the apex of the heart to the sixth intercostal space is a sign, as to whose value I am not confident. It has been regarded as very absolutely indicative of hypertrophy; and I have not met with it, except in such cases. But it frequently does not occur; and the apex still presents in the fifth space, in many cases of very excessive hypertrophy—even when the hypertrophy is of the left ventricle mainly; but still more certainly where the right ventricle is the seat of the hypertrophy. In the present case, the bulk of the heart was partly due to the hypertrophy, which was general; though it must not be overlooked that the capacity of the cavities was great. The supplemented state of the sigmoid valves is very unusual. 1 do not remember to have met with it in the aortic valves before; it is believed to occur more frequently in the pulmonic valves, though even there it is rare. We have no means of ascertaining whether these valves had at any former time been incompetent—they had not the aspect of having ever been sufficiently deformed for this. The following case was under observation several months. The leading facts only will be reported; without a minute account of its progress and changes :— Case III.—Hypertrophy of the Heart; Dilatation ; Death from Erysipelas. Andrew Ormiston, set. 44, a waggon-driver, was admitted on the 17th Dee. 1845. He was a robust man, of intemperate habits. He had a bloated coun¬ tenance, slight general oedema, and urgent dyspnoea. His sleep was disturbed : and violent paroxysms of angina pectoris occurred. He had little cough, and no expectoration. History.—He stated that these symptoms, with occasional fits of palpitation, had been troublesome only within a fortnight ; they occurred suddenly, and without any definite pain. He had been unable for his work for ten days. Physical Signs.—The heart’s action was tumultuous. The impulse was widely diffused, and not proportionately forcible. The prsecordial space dull on percussion had a horizontal as well as a vertical diameter of five inches. The sounds of the heart were free of murmur. The first was prolonged, but obscure ; and at times reduplicated. The second was increased in loudness, at the base of the heart. The pulse at the wrist was always small, and more or less irregular; it was imperfectly synchronous with the heart's impulse. The left side of the chest was extensively dull on percussion ; with feeble¬ ness of the respiratory signs; and some obscure wheezing and sub-mucous rattle. Progress.—In the progress of the case the symptoms underwent frequent variations. The physical signs continued very much as reported at the time of admission. His great distress resulted from the paroxysms of angina pectoris, with dyspnoea and tumultuous action of the heart ; and during those attacks dropsy was usually considerable, and the urine scanty. Angina frequently existed without dropsy ; but the most marked and continued relief to this, and to other symptoms, resulted when copious diuresis occurred—whether it was spontaneous or the effect of treatment. Up to the last, though dropsy had nearly disappeared, the paroxysms were severe and frequent. On the 28th