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
Catalogue details

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.

    12/54 (page 8)
    April, four months after the cardiac symptoms had become troublesome, erysi¬ pelas of the head occurred, and he died on the 30th. Treatment.—The principal treatment, and that whose effects were most ap¬ parent, consisted in small local and general blood-letting, and the administra¬ tion of diuretics. Up to a late date the application of three or four leeches to the scrobiculus cordis, afforded speedy relief to the anguish of the paroxysms ; and was at times succeeded by copious diuresis. On one occasion, when the urine was nearly suppressed, dropsy was considerable, with dyspnoea, cough, and the signs of general bronchitis ; and a tumultuous state of the heart’s action ; all treatment having proved unavailing, the remedies were omitted, and digitalis given in the form of infusion. Within twenty-four hours, diuresis commenced ; and in a few days the daily quantity averaged 80 oz.,—at the same time the heart’s action was calmed; and the pulse fell to 50, with a rare irregularity, and his distress became altogether less. The quantity of the infusion taken was under 8 oz. in the course of thirty hours. Post-mortem Examination.—I regret this part of my report is very imper¬ fect ; the notes of the post-mortem examination having been mislaid. The following statements are made from memory ; but may be relied on so far as they go The heart was hypertrophied in all its parts : and dilated in both ventricles, —the left most decidedly, the w'alls of which were nearly an inch thick. No lesion of the valves existed. The left pleura contained several quarts of high- coloured serum, with much lymph in loose masses, and in membranous layers on both pleural surfaces. Remarks.—This case contrasts with the others of this series in several particulars. One of the most striking of these is the manner of death, and its immediate cause. In the other cases death resulted more or less directly from the state of the circulation. This man was cut off by erysipelas. It has been asserted that there is a tendency to such a termination in cases of disease of the heart; but I have been quite unable to trace any consistent relation between them. They do not concur more frequently than may be explained by acci¬ dental causes. The physical signs of the dilatation agree only in part with the signs in the other cases. It is important to bear in mind this partial disagreement; it will be observed more or less in every case; and arises from the different degrees of the dilatation and hypertrophy. In this, as in the other cases, the signs of the greatest value were the horizontal extent of dull percussion, and the disproportionate feebleness of the impulse compared with its extent. The smallness and want of synchronism of the radial pulse with the heart’s beat, are valuable signs ; and are closely connected with the dilatation ; though it may be seen, from other cases of this series, not always to occur, even when dilatation is great. The reduplication of one of the heart’s sounds is a sign of which I have been unable to discover any satisfac¬ tory explanation. It usually affects the second sound; and I have been in the custom of attributing it to mere irregularity of mus¬ cular contraction, and consequent want of synchronism in the valvular and tendinous tension on which the heart sounds largelv depend. The muffled state of the first sound demonstrates, that per-