On two heart cases which presented a rare form of irregularity : from Dr. G.W. Balfour's "Clinique" / by Charles S. Roy.

Date:
1878
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Licence: Public Domain Mark

Credit: On two heart cases which presented a rare form of irregularity : from Dr. G.W. Balfour's "Clinique" / by Charles S. Roy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    Case II.—Euphemia Lawson, get. 40, widow, in service as cook. Admitted 9th February 1876 to Ward XIII., complaining of short- ness of breath, pain in the left side, and swelling of the legs. Patient has been twice under Dr Balfour for dilatation of the heart due to u heart-strain.” The case is of much interest from the remarkably complete disappearance, under treatment, of the local signs and general symptoms from which the patient suffered. A report of her case is given by Dr Balfour in his recent work.1 The circumstances of the patient obliged her to return to service, and again, for the third time, her heart gave way from work too hard for her powTers. Never had rheumatism, and enjoyed good health up till eleven years ago, when, while at Woolwich, she had a severe attack of ague. Status Prcesens.—Expression anxious. Muscles soft. Consider- able emaciation. Pulse small and weak, with occasional irregularity. Has often palpitation and pain in cardiac region. External jugulars dilated and pulsating. Venous valves incompetent. The “ Angulus Ludovici” exaggerated to an unusual extent. Diffuse, firm, apex-beat in fifth and sixth intercostal spaces, 3f inches to left of midsternum. Transverse deep heart-dulness extends at fourth rib from 1^ inches to the right to 4 inches to the left of the middle line. Upper margin of dulness, in the left parasternal line, at the third costal cartilage. A systolic murmur with part of a first sound audible over whole cardiac area, with its maximum intensity at the apex. The murmur heard on the tricuspid area has an easily distinguishable difference in character. Pulmonary second sound much accentuated. Percussion over the lungs gives a normal note everywhere. Expectorates a large quantity of sero- mucous fluid. Liver-dulness 4f inches. Treatment.— 14 Ammon, carb. 5j. Inf. digitalis §vi. s. Sig. A tablespoonful thrice daily. The patient was two and a half months in the Infirmary, and, as before, I prefer to summarize my notes. Her ailments were mostly due to repeated embolisms, both in the pulmonary and systemic arteries. The history of the case records that she suffered from a perfect 11 shower ” of such plugs. The pulmonary embolisms were in two cases the cause of localized pleuritis, which at one time raised the temperature to 103°. The clots in the systemic arteries chiefly lodged in the spleen and kidney, but a few days before her death the brachial artery was occluded at its lower end by an embolus. The temperature and the quantity of urine varied incessantly from such causes. It was about a month after her admission that the same form of irregularity which was present in 1 Clinical Lectures on Diseases of the Heart. By G. W. Balfour, M.D., etc. London : 1876, p. 173.