A case of traumatic endocarditis / A. Herzfeld.

  • Herzfeld, Alfred Abraham.
Date:
1906
Catalogue details

Licence: In copyright

Credit: A case of traumatic endocarditis / A. Herzfeld. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    5/10 (page 3)
    lower intercostal spaces were drawn in. The heart impulse was easily visible, its pulsation can be seen extending from the right border of the sternum to the anterior axillary line. The apex beat was most distinct in the sixth intercostal space be- tween anterior and middle axillary line. There was a distinct pulsation in the epigastric region. The heart dullness extended from the third rib above to the apex beat below and from the anterior axillary line to the right border of the sternum. Over the apex a loud blowing systolic murmur could be heard, which was transmitted to the left. Over the aorta a loud systolic and diastolic murmur could be made out. A systolic murmur was also heard in the carotid, sub-clavian, axillary, brachial and femoral arteries and a distinct murmur on either side of the vertebral column extending from the lower end of the scapula to the first lumbar vertebrae. The carotids pulsated visibly. The pulsation of the capillaries could be seen under the finger nails (Quincke’s capillary pulse). The second pul- monary sound was accentuated. Nothing abnormal wras found over the tricuspid valve. There was no venous pulse. A systolic thrill could be felt over the entire heart area, particu- larly over the left ventricle. Pulse was 120 and of a low ten- sion. The blood pressure, according to tonometer of Gaertner, was 70-80 mm. The liver was distinctly palpable about two fingers’ breadth below the free border of the ribs. The spleen could also be palpated under the free costal margin. The urine of a specific gravity of 1018 showed a slight trace of albumin, but no casts. No edema or ascites was noticed. Eye- sight was apparently normal. Patient complained of frequent attacks of dyspnea, palpitation of the heart and extreme weakness. Further Treatment.—On April 20, 1905, I was called to see the patient. His heart’s action was identical with that ob- served right after the original injury. A very severe dyspnea was present, pulse 160 to 170, heart’s action very rapid and tumultuous. He told me that another boy hit him and he had to run away from him. I again ordered the cold applications to heart and gave him internally two to three drops pure tincture of opium every two to three hours. The cardiac in- sufficiency was very marked and the whole left side of the thorax seemed to pulsate. The insufficiency of the heart be- came more apparent from day to day. Face and extremities were cold and cyanotic. Digitalis and hypodermic injections of strychnin finally had no more influence on the heart’s action and on May 2 patient died. On account of religious scruples the autopsy was not permitted. LITERATURE AND DISCUSSION. This interesting case induced me to look up the lit- erature of similar cases in order to compare them with mine and to study their mechanism and the changes pro- duced in the anatomy of the heart.