Clinical and pathological notes on pericarditis / by W.T. Gairdner.

  • Gairdner, Sir William Tennant, (1824-1907)
Date:
1860
Catalogue details

Licence: Public Domain Mark

Credit: Clinical and pathological notes on pericarditis / by W.T. Gairdner. 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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    movement, and retraction of the parietes at several intercostal spaces. The history was a long and complicated one, even when I first saw the case, but there had been traces of early rheumatism. Ordinarily there was no murmur, or at most a little roughness or reduplication of the sounds; but on various occasions during the course of a long illness I detected transitory murmurs, which appeared to me to be blowing murmurs, both in the region of the apex, and between the apex and sternum, always with the first sound of the heart. What was the real nature of these murmurs ? On this subject I had many doubts during the life of the patient; and, as it happens, these doubts were not resolved by the post-mortem examination. The heart was found somewhat dilated and hyper- trophied ; but I have often seen more, both of dilatation and hyper- trophy, without any murmur. The valves were perfectly free from deformity, and the endocardium had apparently never been the subject of any disease leaving even a trace behind. Nor were there any of thb usual symptoms of regurgitation at the mitral orifice ; no dropsv, no haemoptysis,nor indeed any marked pulmonary symptoms, except such as were accounted for by an old pleuritic attack, which had to a great extent disabled the left lung. Were, then, these murmurs, tliough of well-marked blowing type to my ear, after all exocardial ? The adhesions were universal, and very firm ; but in the case of M. R., formerly related, we have seen that this does not necessarily exclude the possibility of murmur. Against this idea, there- fore, I have only to oppose the strong impression of the ear (yaleat quantum) that the sound was not at all of the rubbing type, but de- cidedly of blowing character. The reader already knows how little I am disposed to place absolute reliance on such an impression ; but in the present instance I incline, on the whole, to think it was correct, and that these transitory murmurs indicated something quite different from the permanent condition of adherent pericardium ; perhaps an occasional slight degree of regurgitation through the auriculo-ventri- cular orifices. Be this as it may, the fact of the occurrence of an apex-murmur in connection with old pericarditis, and without any positive valvular deformity or endocardial disease, is plainly an ex- tremely important one in its bearing upon diagnosis; for such a murmur would be almost certain, unless it possessed very strongly the character of friction, to mislead the ear. into the belief of disease of the mitral valve. I have seen several cases in which this diffi- culty of diagnosis has arisen, and more than one in which, after every care had been employed, the true solution of the murmur remained, after all, doubtful. The following case is valuable, as showing that a murmur, re- garded as endocardial during nearly a whole month of observations by a number of educated ears, may nevertheless have had an exo- cardial origin :— P., set. 45, a widow, noting as a night-nurse in the Royal Infirmary, came nnder my care on the 26tii of February 1853, labouring under febrile oppression,