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.

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    rythm of the heart’s action. It matters not whether the endocardial murmur he musical, grating, or soft and blowing, with the exception already indicated in contraction of the mitral orifice, in which the characteristic murmur appears to have a harsh grating character— (see Cases X. and XI., pages 28-31). In illustration of this point, I shall only refer to two cases which have been brought under my notice; in both, incompetence of the aortic valves was attended by a murmur so loud and shrill that it was audible at a distance of seve¬ ral inches from the surface. But the nature or seat of the disease in these cases was determined solely by the position and ry thm of the murmur, which existed, as in all such cases, at the base of the heart, with the second sound. The musical character or loudness of the murmur was connected with the intensity of the vibration, caused by the regurgitant current, which was accompanied in both cases by a vibrating fremitus—a sign not usually observed in aortic incom¬ petence. The various changes which the pulse undergoes are more inti¬ mately related to changes of the muscular substance, than to valvu¬ lar lesions. There are conditions of the pulse which depend only upon valvular disease; but these may be limited to two—the small pulse of mitral or aortic contraction, and the quick diastolic pulse of aortic regurgitation. The visible pulse is not always an abnormal condition ; but, even in its higher degrees, it has no relation to valvular disease. Irregu¬ larity has been regarded as significant of mitral incompetence; but it frequently exists in cases where there is no valvular disease; and it occurs with mitral incompetence, in such circumstances as lead me to believe that it arises only in consequence of superadded dilatation. Want of synchronism of the arterial pulse with the heart-beat has a doubtful connection with valvular disease; it does not occur, except in conjunction with more or less dilatation; and I have met with it altogether apart from valvular disease. Delay of the radial pulse has been stated to depend upon incom¬ petence of the aortic valves; I do not think such is the fact. The radial pulse is naturally more or less posterior to the heart’s impulse; and the interval may vary within the limits of health; besides, from the very nature of the thing, it is difficult or impossible to affirm in a particular case that the degree of delay is abnormal. From my own observations, I am satisfied that an appreciable increase in the delay of the arterial pulse is very rare; and it does not arise in such a proportion of cases of aortic incompetence as to indicate any relation between them. MURRAY AND GIBB, PRINTERS, EDINBURGH.