Prognosis in chronic valvular disease of the heart : an address delivered before the North London Medico-Chirurgical Society / by J. Mitchell Bruce.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929.
Date:
1902
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Licence: In copyright

Credit: Prognosis in chronic valvular disease of the heart : an address delivered before the North London Medico-Chirurgical Society / by J. Mitchell Bruce. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    in the keen and active school-boy, whose principal thought is of cricket, football, and cycling. A week ago I was consulted by a young gentleman of nineteen, about to go up to Cambridge, on the subject of the exercise that he might safely take during the winter term. Seven years ago he had acute rheumatism with mitral endocarditis, characterized by a systolic murmur at the apex. He made an excellent recovery; and, indeed, in the course of eighteen months the murmur disappeared. But two years ago an unfortunate event happened. After a football match he was seized with palpitation, which lasted for two hours. Ever since, palpitation has returned as often as he exerts himself, by run- ning or boxing, and therewith a pricking pain under the left breast; whilst hot rooms bring on a feeling of precordial oppression and inability to take a deep breath. I found the heart enlarged on both sides, that is, dilatation with hypertrophy of both ventricles. There was no murmur, as the patient’s doctor had told me, and therefore, strictly speaking, the case was not one of actual valvular disease with failure of compensation under physical stress. But it was even more instructive than that in connection with our present sub- ject. It was an instance of repaired valvular disease in which the muscular walls were strained by physical exertion. The practical bearing of these prognostic considerations is obvious, as well as the importance of regarding every case of heart disease in a youth from this point of view. The parents dwell so anxiously upon the heart and the effects on it of exercise or exertion as to be oblivious to everything else. Our chief concern as practitioners is centred in the prevention of rheumatism which is lying in wait for him, and may haunt him throughout all these years; and our advice is mainly directed to the prevention of rheumatism and to the immediate and thorough treatment of it should it appear in any of its forms or phases however mild. Here, let me say by way of parenthesis, we appreciate one of the principal uses of correct prognosis, of prog- nosis practised on rational lines. I have called it an expression of opinion, a prophecy, but it is a forecast which, like a weather-fore- cast or a stonn-warning, carries with it a patent suggestion of meas- ures for prevention. In the youth with a valvular lesion of rheu- matic origin, prognostic knowledge, if correctly employed, means successful prevention by control of the diet, by attention to the stomach and bowels, by close and continuous outlook for the appear- ance of any one of those aberrant phenomena or phases of rheu-