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.

    18/456 (page 6)
    number of good observers). On careful observation to-day, however, it does not appear probable that this is the case; but, on the other hand, the extremely loud and all but continuous murmurs heard over the right ventricle seem to Dr. Gairdner much more striking, and also more difficult of interpretation, than what was originally observed and re- ported. At the right of the sternum they are not so over- poweringly loud, and are also more rhythmic, than elsewhere; and over the aortic area V.S. and Y.D. murmurs, very much of the usual character in aortic disease, can still be separately distinguished; but, on the other hand, the loud, almost roaring, hollow murmurs heard midway between the left nipple and the middle line are such as to confuse the ear as to the rhythm, more especially as the sounds (apart from the murmurs) are entirely lost, and what must be presumed to be the Y.S. and V.D. murmurs (see above) are here quite con- tinuous with one another. Various hypotheses have been entertained since this patient’s admission, to account not only for the peculiarities of the murmurs, but also for the obstinacy of the dropsical symptoms, and the evident great predom- inance of the right side of the heart in a case where the murmurs and the pulse seemed to indicate aortic disease; the question was entertained of aneurysm, possibly communi- cating with the right ventricle or pulmonary artery; but, on the other hand, the absence, or slight degree, of cyanosis seemed unfavourable to that view; and nothing in the per- cussion at the base, or the palpation in the jugular fossa corre- sponds with the idea of an aneurysm of the first part of the arch. Now, however, with these extremely complex murmurs heard over the right ventricle, it seems difficult to exclude some lesion of an unusual kind involving the right side of the heart; but, so far as can be observed, the pulmonary artery is not particularly involved in it, and wherever the Y.S. and Y.D. can be separately distinguished, the inference would rather be that they are of aortic origin.” The above note, made sixteen days before the patient’s death (which occurred on May 23rd), and used for direct bedside instruction at a time when the patient was quite in a state