On a systolic murmur in the pulmonary artery, and its application to the diagnosis of functional and organic murmurs / [Edward Latham Ormerod].

  • Ormerod, Edward Latham, 1819-1873.
Date:
[1846]
Catalogue details

Licence: Public Domain Mark

Credit: On a systolic murmur in the pulmonary artery, and its application to the diagnosis of functional and organic murmurs / [Edward Latham Ormerod]. Source: Wellcome Collection.

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    deuce, it cannot be said bow much of the murmur in the epigas¬ trium was referable to regurgitation through the tricuspid orifice ; for although this valve was palpably diseased in the last case only, in all the right auricle was dilated. Insisting on what these cases had in common, a correct diagnosis was made in each instance by a different observer. In the absence of all other information on the subject, the results of the observation of these cases would not much aid the diagnosis, but they are very valuable, as showing that the diagnosis can be made by insisting on a small portion even of the evidence which recent cases afford. This evidence is of a character to preclude the possibility of a murmur heard loud¬ est in the direction of, being seated elsewhere than in, the pul¬ monary artery, while the facts elicited by observation of actual disease of the pulmonary valves add, so far as they go, their po¬ sitive to the masses of negative testimony. The next case throws some light on the further direction of the current of blood producing a murmur in the course of the pulmo¬ nary artery. G. H., aged 22,* a tall delicate looking young man, under treatment for an abdominal affection, presented on ausculta¬ tion a distinct diastolic murmur, musical in the course of the pul¬ monary artery, then soft and blowing as it crossed obliquely from the left to the right side of the sternum, and finally lost in the re¬ gion of the right ventricle. This case proves that the current of blood which produces a murmur in the line described runs in the direction of the right ventricle. A systolic murmur, which only commences at the pulmonary orifice, cannot supply this link of evidence. In the absence of any dissection, for the case did not terminate unfavourably, it is impossible to say that there was not here some abnormal position of parts. The experience of any auscultator will inform him, without needlessly lengthening this essay by quoting such cases, how far the situation here pointed out differed from that where murmurs referable to the aortic or auriculo-ventricular valves are usually audible; and as far as a systolic murmur is con¬ cerned, that this may be heard in the course of the pulmonary ar¬ tery where no deviation from the normal position exists, was shown by the dissection of a patient who sunk after amputation, in whom there had been a murmur audible in that situation for some days before his death. There are no grounds, then, for presuming, without positive evidence, that murmurs in this situation are referable to the aorta in an altered position ; and as far as aus¬ cultation can show' the aorta and all the heart to be normally si¬ tuated, the evidence is conclusive that they are so. For a murmur may be heard in the aorta in numerous cases, loud and distinct in all its details, where no murmur is audible in the direction of the pulmonary artery at all. Conversely, a * See the parallel case of Edmond Rogers. Hope on the Heart, 3d ed. p. 599.