Memoir on the influence of hypertrophy and dilatation on diseases of the heart : and on some points in their diagnosis and treatment / by A. Halliday Douglas.

  • Douglas, 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 / by A. Halliday Douglas. 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.

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    anatomical evidence. The form of the chest, the vertical extent of praecordial dull percussion, and the long duration of her symptoms, render it probable that a considerable increase of muscular substance had occurred; but these signs are not inconsistent with an extreme degree of dilatation, to which the apparent extent or bulk of the heart was probably in a great measure due, and the effects of which were otherwise so manifest. This very disproportionate dilatation satisfactorily explains all the phenomena of the case, as well as the total inefficacy of treatment. The hopelessness of such cases is in exact proportion to the dilata- tion, or enfeebled power of the heart. Depletion can be of service i only in so far as it disburdens the embarrassed heart of the excess of blood which it struggles to propel; and the instant it causes any impairment of the power of the already enfeebled heart, the era-1 barrassment of its action, and the consequent obstruction to the I circulation, is increased. I am disposed to disapprove of the cuppings I practised in this case ;—it is rarely necessaiy to take blood in this I way. When it is desired to remove any quantity of blood, a vein should be opened; but in the majority of cases, when the heart’s I action is embarrassed, four or six leeches will have the effect of allaying the tumult of its action, and give immediate relief. It is not necessary to multiply cases of this description. Those already narrated will serve to exemplify the direct and powerful inn fluence of dilatation, even when hypertrophy exists ; and in a large! proportion of cases all the later and fatal effects of diseased heart! will be found, as in the preceding cases, to depend upon dilatation. | The rarity of fatal cases in which the hypertrophied heart is aa yet little dilated, depends upon the well-known difference between the effects of hypertrophy and dilatation. The former acts tempo! rarily, and causes local effects upon some distant organ, which usualra has been weakened by pre-existing disease—e. y., rupture of the ar-l teries or substance of the brain, and consequent apoplexy. The latten causes more permanent effects on the entire system, through the im- peded circulation. SECTION n. ANEURISM OF TI1E HEART. Aneurisms of the heart, especially certain forms of the lesion, illus trate veiy remarkably the influence of dilatation in causing th leading features, and the ultimate evils, of cardiac diseases. Th application of the term aneurism is here restricted to a dilatatio; which is partial, and more or less intimately connected with a dege nerated or transformed state of the walls of the heart. I have foun