On defective closure of the tricuspid foramen as a frequent cause of dropsy / by Peyton Blakiston.

  • Blakiston, Peyton, 1801-1878.
Date:
[1841]
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Licence: Public Domain Mark

Credit: On defective closure of the tricuspid foramen as a frequent cause of dropsy / by Peyton Blakiston. 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.

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    Tlie phenomena observed in these two cases may, in some measure, tend to explain why such extensive obstruc- tion to the circulation may exist at the origin of the aorta without greatly af- fecting the general health. The heart's action was fluttering, and was accom- panied by a very prolonged rasp sound, thus indicating the continued action of the ventricle, whereby the blood was at length squeezed through the con- tracted foramen, and explaining the cause of the thready vibratory motion which replaces the pulse in such cases. Andral relates a case* of extreme nar- rowing of the aortic orifice by ossific deposit, and states it as certain that many aged persons are similarly af- fected without being attacked by dysp- ncEa or dropsy. He attempts to account for the absence of such effects by the fact of the slowness of the circulation in aged persons ; but it appears to me that the explanation given, based on the observation of Cases XI. and XIII., is more satisfactory. Since, therefore, serous infiltration does not seem to depend on the degi-ee of obstruction to the circulation existing at the left side of the heart, it is pro- bable that there is some other obstacle more direct in its action and more con- stantly present. Dr. Hope, who 1,akes this view, considei-s hypertrophy and dilatation of the heart to be the cause of obstruction. He remarks, So long as the heart remains free from dilata- tion, hypertrophy, or softening, the valvular disease, according to my ob- servation, is not in general productive of great inconvenience. This opinion is founded on the following grounds :— I have seen individuals, who were af- fected in an. eminent degree with dis- ease of the valves of the aorta, main- tain for years a very tolerable state of health so long as there was no hyper- trophy or dilatation of the heart: but, in proportion as these supervened, the symptoms of valvular obstruction be- came more and more developed, and eventuallv assumed their most aggra- vated form. I have reason to beheve that in these cases the symptoms were attributable in a great measure to hy- pertrophy or dilatation, because I have seen a greater valvular contraction pro- duce less severe symptoms when the hypertrophy or dilatation was less con- * Clinique MtSdicale, Brussels, 1834, vol. i. p. siderable. I have not only seen nume- rous cases of a mechanical obstacle unattended with ])assive congestions, dropsy, &c. but I have seen a still greater number of instances in which all the phenomena of an obstructed circulation were occasioned by dilata- tion alone, as no other obstaclecapable of accounting for them could be de- tected in the course of circulation. And again, I have repeatedly witnessed cases in which a well-marked, if not a considerable obstacle—as a contracted valve, a regurgitation, or a dilatation, or aneurism of the aorta—had subsisted for a long period, even for years, with- out producing any material symptoin of an obstructed circulation; but the moment that dilatation of the heart supervened the symptoms made their appearance in an aggravated form. Fully agreeing with Dr. Hope as to the frequency of hypertrophy and dila- tation of the heart in cardiac dropsy, more especially dilatation, I do not think that they can be considered as the direct causes of it. Every day (says Bouillaud) we find otherwise skilful phy- sicians attributing to dilatation of the heart a number of evil efiects, which in fact are only accidentally joined with it, such as passive congestion and the sense of suffocation which generally accompa- nies it. Active hypertrophy of the left ventricle may so increase its power that too much blood may possibly be thrown into the capillaries, thereby giving rise to congestion and serous infiltration; and concentric hypertro- phy, whereby a diminution of the capacity of any one cavity of the heart takes place, must create a certain obstruction to the circula- tion ; and yet numerous cases could be adduced in which each of these mor- bid states of the heart existed without having given rise to dropsy. If the heart be generally dilated, and at the same time attenuated, it may be considered that it has not sufficient power to carry on the circulation pro- perly so that congestion may super- vene ; but this is only one particular case. On the other hand, when there is general hvpertrophy and dilatation of the heart', so that the proportion be- tween all the cavities is preserved, no cause of obstruction can be recognised; and yet such cases are very commonly accompanied by dropsy. Andral, al-