Volume 2

The practice of medicine / by Thomas Hawkes Tanner.

  • Tanner, Thomas Hawkes, 1824-1871.
Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: The practice of medicine / by Thomas Hawkes Tanner. Source: Wellcome Collection.

    29/690 (page 19)
    together. Pulmonary systolic and diastolic murmurs are infinitely rare. Dr. Walshe has never observed acute obstructive mitral murmur, nor acute regurgitant tricuspid murmur. Disease of the semilunar valves uf the aorta is not uncommon. Supposing that the aflPected valves diminish the aortic orifice during systole (or contraction) so as to prevent the blood from freely flowing out of the ventricle, a systolic bellovrs-murmur will result. This can be best heard at the base of the heart at the second right intercostal space close to the sternum, along the course of the thoracic aorta up towards the right clavicle, and even in the carotids; the murmur diminishing as the stethoscope is moved towards the apex of the heart. If the valves close imperfectly, permitting reflux of blood from the aorta, the murmur will be diastolic, will accompany the dilatation of the ventricle, and will be heard at the second right space and obliquely downwards and to the left along the course of the refluent blood, sometimes being heard very distinctly over the lower end of the sternum, sometimes more loudly in the direc- tion of the apex. The short, second sound of the heart will also be muffled and indistinct, and will be inaudible in the neck. Sometimes we have both these conditions of the aortic valves in the same case—aortic obstruction and regurgitation together; a double bruit or bellows-murmur being then pro- duced. The pulse of aortic disease is regular. In obstruction it is small and prolonged, giving a sphygmographic trace of small amplitude, sloping ascent, round top, and unbroken gradual fall. In the regurgitant form it is often peculiar, being gene- ; rally sudden and sharp, and without any prolonged swell of the I artery; Dr. Hope calls it a jerking pulse. It has also been called a collapsing pulse, from the sudden emptying of the vessel, and a . hammering or even sledge-hammer pulse, from the forcible sensa- tion communicated to the finger; while pulsation is usually distinctly visible in all the large arteries and in the radial at the j wrist, becoming more conspicuous in the latter situation when the ' arm is raised, when also it is commonly audible. The sphygmo- ! graphic traces of such a pulse are said to show certain peculiarities. There is a great amplitude of trace. The line of ascent is vertical. The curve usually presents a pointed summit. This vertical line of ascension and pointed summit are not peculiar, however, to : aortic regurgitation; similar appearances being produced in : functional disturbance from aneeraia. But when the valvular ( incompetency is so great that there is free regurgitation, the i descending line of the curve shows a sudden fall with an absence i of dicrotism ; the aortic notch being more or less suppressed, since , the closure of the aortic valves which produces it is imperfect. . The mitral valve which guards the left auriculo-ventricular i orifice, may become thickened or ossified and its tendinous cords i shortened; the eff'ect of which is to prevent its closing the auricular c 2