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.

    34/54 (page 30)
    Fyffe, I do not see any explanation of the coma, except the hypei*- trophy of the right ventricle; and other cases present a corroboration of this apparent connection. The effect of tlie blood-letting in this case proves its suitableness; and, in the cases of renal disease above referred to, I have met with even more decided benefit from bleeding. The blood-letting must ordinarily be pushed with greater freedom than the generally feeble state of the patient, or the diseased state of the heart itself, might appear, at first sight, to admit of. Apart from the unfavourable, and, as it may be termed, the acci- dental effects of hypertrophy of the right ventricle already referred to, the present case, and the contrast of its progress with that of the one (IX.) preceding, indicates that, while the dilatation of the one aggravated or developed the evils arising from the valvular disease, the hypertrophy in this case had the effect of counterbalancing the obstructive effects of the contracted orifice. The facts on which this statement is founded, are, the greater length of time during which the patient endured, and frequently recovered from paroxysms of cardiac distress, and the completeness of the respite she enjoyed during these intervals; while, in case IX., the symptoms once fairly developed, the progress was almost uninterrupted and unfavourable. Again, but for the counterbalancing influence of the hypertrophy in this case, the obstruction of the circulation ought to have been greater than in case IX. (Forrester), because the supposed obstruct- ing cause, the contraction of the mitral orifice, was very much greater. Accordingly, we see a very different anatomical state of the lungs in these two cases. Pulmonary apoplexy has been sup- posed to be intimately connected with contraction of the mitral orifice, like obstructed circulation generally; but we find, in the case in which the contraction was greatest, neither hemorrhagic conden- sation of the lung, post-mortem, nor, according to the statement of the patient, had she ever had haemoptysis; while, in case IX., both conditions existed—the dilatation being greater, though the valvular obstruction must have been less. The heart in Fyffe’s case was virtually free of dilatation; for, though the right ventricle was increased in capacity, the hyper- trophy was much greater in proportion. The effect of this hyper- trophy of the right side was to give the heart nearly the same glob- ular form as occurs in dilatation, but its general bulk was less; and the tricuspid valve and pulmonary artery were in a morbid state rarely met with in the right side of the heart. Such cases as the present are apt to create confusion, in refer- ence to the signs of hypertrophy and dilatation. Our notions of the physical signs of hypertrophy are gathered from a very different class of cases, in which the left ventricle is chiefly involved. In such cases the effects of the hypertrophy and the physical signs arc more mani- fest, because of the greater amount and degree of the hypertrophy, its more direct influence on the systemic circulation, and, its situa- tion being more anterior, when the left ventricle is affected, the car-