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.

    81/336 (page 69)
    is a far more important feature in reference to tlie eligibility of a given life than an attenuated or impoverished condition of the blood, which may disappear spontaneously or be removed by remedial treatment. Yet the stethoscopic symptoms of both conditions are essentially the same, and as persons proposing themselves for life assurance are seldom or never in a state of visible ill-health, it is very difficult to obtain much assistance from the collateral features and symptoms of the case. In many instances in the male subject, when no disease of the heart could be detected, I have met with a harsh, grating, or blowing murmur over the arch of the aorta, the innomiuata, or the carotid arteries. Now, in the female subject such a murmur might probably be attributable to anaemia or chlorosis, or loss of blood; but in the male cases just alluded to I have generally regarded it as indicating a degenerated con- dition of the large arteries proceeding from the heart. Still I have been by no means certain as to the exact significance of this murmur in all cases, more especially as I have frequently heard it in the case of young men, otherwise apparently in good health, and who continue in good health, and it is just probable that it may be due to accidental pressure on one of the arteries, or to comparatively unimportant and remediable conditions of the blood. The best plan to pursue in such, cases is to defer the proposal for assurance for a few months or years, and, if the murmur should disappear, its nature will then be pretty obvious. Drawing up the diagnostic distinctions between organic and functional murmurs of the heart in a tabular form, the result would be somewhat as follows:— Orf/anic Murmurs. 1. Although often single, are frequently double. 2. Are sometimes prolonged into the large arteries proceeding from the heart, but are never heard in the jugular veins. 3. Are often associated with hypertrophy of the heart, and consequently with increased force of the heart's action, and with a strong thrill felt by the hand. Functional Murmurs. 1. Are always single. 2. Are almost always pro- longed into the large arteries proceeding from the heart, and are often heard in the jugular veins. 3. Are often associated with undue excitement and irritability of the heart, but not with in- creased impulse or strong thrill.