Volume 2

Glasgow hospital reports / edited for the committee by George S. Middleton [and others].

Date:
1898-1901
Catalogue details

Licence: In copyright

Credit: Glasgow hospital reports / edited for the committee by George S. Middleton [and others]. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    17/456 (page 5)
    “ At the apex, a loud Y.S. murmur is heard ” (first report after admission), “ long and blowing, and a much fainter and shorter V.D. The Y.S. becomes still louder towards the sternum, and reaches maximum intensity just over the tri- cuspid area, where also the Y.D. is very distinct. Both murmurs are audible at the aortic cartilage, the Y.S. being- much less intense here than at the lower division of the sternum, and scarcely at all conducted into the neck, while the Y.D. attains its maximum over the second right cartilage, and is not at all heard over the cervical vessels. No capillary or venous pulse can be demonstrated.” At this time my own conviction, founding on several very careful personal observations, was that there was probably aortic valve-disease, obstructive and regurgitant, but also, 'probably, something more. The pulse was fairly characteristic of aortic regurgitation; but the peculiar distribution of the murmurs, the thrill over the tricuspid area, the epigastric pulsation and enlargement of the liver, the great amount and persistence of the dropsy, all pointed to the implication of the right ventricle to a much greater degree than is usual in aortic disease, even when of some considerable standing. In this way the question of aneurysm, though not a matter of evidence, was distinctly before the mind from the first, and was thus introduced as a speculative diagnosis into the summary above given; and, amid all the changes taking place in the general condition as above indicated, nothing in the physical signs, or the disposition of the murmurs, occurred to suggest any change in the essential lesion, until, perhaps, seven or eight weeks, or more, after admission, when a marked increase in the complexity of the murmurs began to be observed, but without any corresponding, or at least any sudden, change in the symptoms. On 7th May I endeavoured to convey this, admittedly puzzling, change, as follows: “ It has seemed to Professor Gairdner in some of the more recent observations, that there is a change in the quality and even in the rhythm of the murmurs; and this at one observation suggested the possibility of some part of them (at least) being of exocardial origin (the point was, in fact, submitted to a