Royal Infirmary cliniques.

  • James, Alexander, 1850-1932.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Royal Infirmary cliniques. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    The displacement of the heart to the right which this patient presents is more than one usually sees, and merits a few remarks. I have seen it occurring to a similar extent in four cases—three males and one female. In two of the males the disease of the lung which had brought it about had been arrested years before I had seen them, and coming before me for other ailments, the condition of the heart had been recognised accidentally. The evidence of old lung mischief was easily made out in the shape of impaired percussion note and weak respiratory murmur at the right apex, and indications of shrinking in this locality. In three of the male cases (including the patient whose case we are now considering) there was a distinct history of strain. The mode of displacement of the heart in this and other such cases I believe to be as follows:—With the base of the heart as the fixed point and centre of a circle, the long axis of the heart, like the radius, has described an arc to the right, whilst at the same time the organ has rotated on its long axis so as to bring the left ventricle more anterior. No doubt the entire organ and the mediastinum are dragged over to some extent en hloc, but I believe that this tilting of the apex to the right and the rotation are the chief causes; and it is to be remembered, too, that the dragging up of the liver may now be assisting in this displacement. With such a displacement one might suppose that some twisting or kinking of the large vessels would certainly occur and cause bruits, but such bruits have not markedly been present in the examples of this condition which I have seen. A question which you may ask here is, How long has this displacement existed ? We cannot say definitely. We know that it has been so for the last two years at least; we may suppose that it has been so for a much longer time. In one of the other cases, in which I found a very similar displace- ment, the mischief in the right upper lobe had existed for two years.