Volume 6

A system of medicine / by many writers ; edited by Thomas Clifford Allbutt.

Date:
1896-1899
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / by many writers ; edited by Thomas Clifford Allbutt. Source: Wellcome Collection.

    19/974
    EIGHT-SIDED VALVULAK DISEASES Diseases of the Pulmonary Valves Pulmonary incompetence.—This is the rarest of the valvular lesions of the heart, only 17 cases having been noted in the post-mortem room at Guy's Hospital out of 11,000 examinations during a period of twenty- three years. One of the eai^liest papers on the subject was by Whitley (1857), who reported three cases. Blattmann (1887) collected 14, Barie (1891) 35, and Gerhardt (1892) 6 new cases; all of which were confirmed by necropsy. To this we have been able to add 41, of which 29 are un- published cases from the records at Guy's Hospital.^ The total number is therefore 99, besides some 30 published clinical cases which were not verified after death. Etiology.—These cases may be divided into five important groups : A, Ulcerative endocarditis, 57 cases; B, Dilated pulmonary arteiy, 12 cases; C, Aortic aneurysm pressing on the pulmonary valves, 14 cases ; D, Abnormahty in the number of valves, 13 cases; E, Pulmonary , stenosis, 14 cases; F, Unclassified, 5 cases. A. Infective endoeapditis.—This is by far the most frequent cause of ■ the incompetence, being present in 57 cases. The age distribution is as follows 0-10 years 11-20 „ 21-30 31-40 „ 2 cases 12 „ 15 „ 11 .. 41-50 years 51-60 „ 61-70 ,, 4 cases 4 „ 1 „ Etiology.—There are several associated conditions which are of especial importance in connection with infective endocarditis of the pulmonarv \ valve. ^ ' No obvious cause . . .19 cases Patent ventricular septum . 10 ,, Congenita] pulmonary stenosis 8 ,, '. Patent ductus arteriosus . . 3 ,, Gonorrlicea Puerperal fever Pyaemia . Pneumonia 8 cases 4 ., 1 I am inclebte.1 to my friend, Dr. Alfred Salter, for the great troul,le he has taken in ■•examuimg or me the records at Guy's Hospital, and for his collation of the notes on the cases of pulmonary and tricuspid lesions.