Note on a case of congenital malformation of the heart : congenital atresia of conus arteriosus - incomplete septum ventriculorum - aorta, mainly arising from the right ventricle / by Judson S. Bury.

  • Bury, Judson Sykes.
Date:
[1887]
Catalogue details

Licence: Public Domain Mark

Credit: Note on a case of congenital malformation of the heart : congenital atresia of conus arteriosus - incomplete septum ventriculorum - aorta, mainly arising from the right ventricle / by Judson S. Bury. 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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    babies with disoasod hearts ; nor is there proof that the fcetus is subject to rheumatism. Von Hoffmau has suggested that from hsemorrhagio foci in the placenta, patliologioal jjroducts may be introduced through villous absorption into the foetal circulation, and so occasionally induce inflammatory lesions. Whatever the explanation, it is curious and sug- gestive that in a fcetal heart one should see all the lesions—vegetations, thickenings, shrinkage, calcareous degeneration, ifec, of the valves encountered in adult hearts, and known there to be the result of rheu- matic endocarditis. In the foetal heart we invoke some arrest of develop- ment on which an inflammatory lesion has been grafted, but do not think it necessary to find a weak spot as a predisposing cause for the point of selection of endocarditis occurring after birth. In the following case, the heart, belonging in its broad features to one of the commonest types of congenital malformation, presents certain peculiarities, of which one of the most interesting is the complete absence of any trace of recent or of old inflammation. William M., aged 10, was brought to the Clinical Hospital at the beginning of April, 1887. He was fairly grown and of average stature for his age. His nose and cheeks were purplish in colour; his lips, tongue, and the inside of his mouth presented a dark purple congested appearance. The ends of the fingers and toes were livid and much clubbed. There was no oedema, and the urine was free from albumen. On examining the chest there was slight bulging of tlie prtecordial region. The heart's impulse was normally placed; it was a little stronger than natural, but not distinctly heaving; no pulsation was detected at the lower end of the sternum or in the epigastrium; there was no thrill: the cardiac dulness was increased laterally, extending from a finger's breadth to the right of the sternum to the left nipple line. On ausculta- tion, a harsh systolic murmur was heard at the base, of maximum intensity at the second left costal space near the sternum ; it was con- ducted a little better towards the right than towards the left clavicle ; was heard on moving the stethoscope down the sternum, or towards the left apex, but was not heard in the axilla nor behind—the heart sounds being quite clear and pure at the angle of the left scapula and over other parts of the back. The pulse was quite regular and of normal quality. As regards the lungs, the resonance was impaired at the right apex, and the breath sounds there were harsh and prolonged, but not distinctly bronchial. Occasionally some fine moist sounds were audible at the end of a deep inspiration ; elsewhere the lungs seemed to be healthy. On inquiring from the boy's mother, she stated that he was blue when born, and that the midwife who attended her remarked that his heart was wrong. He was born iit the full time—the mother had a good confinement, and was quite well during her pregnancy; did not