A manual of the diseases of the heart : their pathology, diagnosis, prognosis and treatment / by Robert Hunter Semple.

  • Semple, R. H. (Robert Hunter)
Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: A manual of the diseases of the heart : their pathology, diagnosis, prognosis and treatment / by Robert Hunter Semple. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

    74/336 (page 62)
    ceases entirely if fluid effusion exists in such quantity as to dis- tend the pericardial sac. It may reappear when absorption begins and the fluid effusion diminishes in quantity, and when con- sequently the opposed surfaces of the serous membrane are again brought into juxtaposition with one another and with the false membranes which the inflammation has developed; and, when the false membranes have become hard and of a cartilaginous con- sistence, the sound may become loud and scraping. The friction- sound will cease quickly if extensive adhesions are rapidly formed, because in that case the surfaces are glued together and cannot move on one another, or the sound will last longer if the adhesions are formed more slowly. The friction-sound will quickly disappear when a large effusion of serous fluid takes place rapidly in the pericardium, constituting dropsy of that membrane, and its dis- appearance will therefore be, in that case, the reverse of a favourable indication ; it will be, in fact, one of the worst signs that can present itself. The pericardial friction-sound, therefore, although a most valuable diagnostic sign when it is present, is necessarily temporary, and can exist only where there is a comparatively small quantity of effused lymph on the anterior surface of the heart in the cavity of the pericardium. When there is adhesion of the adjacent surfaces of the membrane, or when there is dropsy of the pericardium, the friction murmur will alike disappear, but its disappearance is a far more dangerous indication in the latter case than in the former. It should be observed, in justice to the merits of British medical science, that the friction-sounds of pericarditis were first distinctly described, and their true significance in diagnosis was pointed out, by Dr Stokes, of Dublin, who also originally classified them in three divisions—namely, the slight friction-sound, the rasping sound, and the new leather sound. It is to be regretted that in this, as in many other respects, the claims of British stethoscopists have been unduly disregarded by some continental writers on Auscultation, for although M. Collin had previously described the hridt de cuir nevf, or new leather sound, it was reserved for the British physician to indicate with exactness the pathological significance of this and other allied sounds in cardiac disease. 2. Endocardial Murmurs—Bellows, Rasp, Sawing Sounds, Sfc.— These sounds are of various kinds, being sometimes soft and blow- ing, constituting the true bellows sound; sometimes rough, like that