A practical analysis of seventy cases of inflammatory, functional, and structural disease of the heart : with observations on the treatment and prevention / by S. Scott Alison, M.D.

  • Alison, Somerville Scott, 1813-1877.
Date:
1851
Catalogue details

Licence: Public Domain Mark

Credit: A practical analysis of seventy cases of inflammatory, functional, and structural disease of the heart : with observations on the treatment and prevention / by S. Scott Alison, M.D. Source: Wellcome Collection.

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

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    instances, this has arisen from inattention to obvious evidence; in others, from the absence of some of the more common indications, such as palpitation, pain or oppression, particularly in the region of the heart, or from the impulse and sounds of the heart being in some mea- sui-e obscured by effusion in the lung or pleura, or by emphysema. In some examples, it is not unlikely that it arose from a current but fal- lacious idea that there must necessarily be heard, in organic disease, abnormal bruits and marked alteration of the sounds of the heart; and that when these are not made out, symptoms alone, such as palpitation, blue face, dyspnoea, dilated veins, etc., are to go for little or nothing. One gentleman (No. 39 in the general table) had the sounds and im- pulse of heart so masked by emphysema and oedema of the lungs, together with much flatus in the stomach, that his disease, great as it was, was not made out by two of the oldest physicians in town, who had attended within a short time of his death. The feeling of the patient in respect to the stomach being the chief seat of disorder, may likewise be operative in leading to this error. A patient (No. 37 in the general table) spoke so confidently of his disease being merely wind in the stomach, that I felt it my duty to inform him that it was much more serious; but he apparently treated my information on this point as unworthy of consideration. The anaemic venous murmur in the neck, which had been dis- tinctly heard in case No. 36, before the jugular veins became greatly dilated, and the seat of regurgitation, on the occurrence of these con- ditions was no longer heard, although the blood continued fully as much diluted. This cessation was probably due to the subtraction of one of the necessary conditions for the production of the sound; viz., a certain amount of rapidity of current. Diagnosis. The diagnosis in advanced organic disease is, for the most part, sufficiently easy; though, as we have seen, even great alter- ation may be marked by emphysema, oedema, or flatus. A careful examination of the impulse and the sounds, of the patient's narrative, and of his general condition, Avill leave little room for doubt. But it is otherwise in the commencement of those examples of disease, un- proclaimed by valvular murmur, or by recent acute inflammation, and