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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    murmur may be heard in this direction where there is none in the aorta, as occurred in cases 2 (3 ), 4 (30), 5 (19), 7 ( 3), 11 OD, 12 (27). Moreover, a during murmur in the aorta may be accompanied by a musical murmur in the direction of the pul¬ monary entry, as in case 18 (28), not to mention other slighter differences in character, as in cases 17 ( 2), 19 (40), and the varying degrees of intensity so frequently noticed in the tables as occurring in the two situations. The conclusion is briefly this,—that murmurs which rise and fall in intensity, quite irrespective of each other, which are of dif¬ ferent characters, and may exist mutually independent of each other in their appropriate situations, cannot be referable to the same cause ; and this the more evidently, as there is a cause in operation in each situation notoriously capable of producing these murmurs in one as much as in the other. We refer one set to the aorta, the other, on the same grounds, to the pulmonary artery. Not to overload the present subject by considering difficulties which can never arise, we may omit all mention of murmurs at the apex, and notice only murmurs in the innominata veins to show that “ a loud continuous hum heard in the jugulars, and pro¬ longed beneath the clavicles in the direction of the innominata veins,” could, were it even otherwise than extremely rare, give rise to no error in diagnosis. On this foundation we would rest the assertion that a murmur heard loudest in the situation so often alluded to is to be referred to the pulmonary artery. It remains to investigate the nature of the cases in which this murmur is generally audible. For this purpose the results of the auscultation of thirty-two cases have been registered in a tabular form. In all of these, at one time or other, a murmur wras plainly distinguishable in the pulmonary artery. They were for the most part recent cases, in which, putting aside all question as to the original cause of the affection, the physical examination could give no certain informa¬ tion as to the existence of any organic lesion of the heart. For the prognosis, then, in one point of view, they are unexceptionable, at the same time that the simplicity of the cases renders the diag¬ nosis less exposed to errors of observation. Had a record been preserved of all the cases examined in the collection of these clear¬ ly distinguishable murmurs in the pulmonary artery, some more satisfactory information might have been furnished as to the pro¬ portion of cases in which a murmur is audible in this situation.* * Ot’ 27 consecutive cases of chlorosis and its kindred maladies, 8 had murmurs at the apex, oo j 15 in the aorta. |. I 1 9 in the pulmonary artery, f 19 out of 21, in the jugular veins. St is necessary to add, that not more than 3 or 4 of these cases were used for the formation of the tables accompanying this essay.