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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    it impossible to compress the cases so much as is desirable ; because though, in this paper, only certain points in these cases are discussed, it appears necessary to give an accurate and detailed account of the facts, that they may be available in reference to other questions than those involved in the present inquiry. I ought to mention that I was prevented being present at the dissections of the two succeeding cases (V. and VL) ; but, in both, the hearts were preserved for my inspection. 3ase V.—Aneurism of the left Ventricle, true and sacculated ; Dilatation of the Heart; Hypertrophy ; Fibrous Transformation of the Muscular Suo- stance ; Death by Apnoea. Margaret Sheriff, set. 30, married, was admitted into hospital on the 20th November 1847. She was labouring under most urgent dyspnoea and extreme general dropsy. Her lips were livid ; the pulse was small and feeble ; the ab- lomen was swelled and tender ; urine scanty, density 1-015, albuminous. She vore a tracheotomy tube. History.—She stated that troublesome symptoms had arisen within a year ; mt she could not give a distinct account of their progress. Tracheotomy had >een performed many years previously. In the preceding January she was in hospital under the care of Dr George 5aterson, to whom I am indebted for an account of the symptoms and physical iigns which then existed. At that time she suffered chiefly from dyspnoea, cough, and occasional pal- )itation. Urine was copious, of density 1-015, and free of albumen ; pulse vas 84, small and weak. She stated that, with the exception of slight catarrhal symptoms, which she scribed to the state of the trachea, she had had good health till the preceding November (1846), when, in consequence, as she supposed, of exposure to the veather, aggravation of her chest symptoms, with pain, occurred. Slight swell- ng of the limbs occasionally existed, and scanty urine. The account of the >hysical signs, as then observed, will be incorporated with the statement of hose noticed by myself in November. She remained only five days in hospi- al, and was dismissed by her own desire. From that time she was subject to an often recurring dropsy, which yielded o ordinary diuretics. She was under the care of Dr Thomas Keith, who says hat the urine was free of albumen ; but he did not examine it within three nonths of her admission ; and about that period the dropsy yielded less readily, md latterly resisted the diuretics. Physical Signs.—These were ascertained with difficulty, from her distressed md exhausted state, and from the intensity of general bronchitis. They dif- fered from those observed in January, only in the force of the heart’s impulse, vhicli had become much less ; for it was now feeble compared with its extent, md with the extent of the praecordial space dull on percussion. The follow- ng was the state of the signs as observed in January, and corroborated in November :— The praecordial space dull on percussion was extended. The impulse of the leart was diffused, originally of good strength, but it became feeble compared vith the extent of the praecordial space. The radial pulse was small. A mur- nur accompanied the first sound, and was most distinct at the apex. The usual igns of general bronchitis existed ; these latterly were intense. . Progress.—Gradual and progressive exhaustion followed, without any rnate- ial change in the symptoms, and she died on the 26th. Post-mortem Examination.—Dropsy was general. The larynx, trachea, and ungs, presented no appearance which -was unusual under the circumstances. The heart was enlarged ; it had an irregularly globular form, with two cir-