On the pathology and treatment of valvular disease of the heart and its secondary affections : being the Gulstonian lectures, delivered at the Royal College of Physicians in February 1851 / by Edward Latham Ormerod.

  • Ormerod, Edward Latham, 1819-1873.
Date:
1851
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Licence: Public Domain Mark

Credit: On the pathology and treatment of valvular disease of the heart and its secondary affections : being the Gulstonian lectures, delivered at the Royal College of Physicians in February 1851 / by Edward Latham Ormerod. 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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    onco. I I'col it 8Q towards all those, —the liiyliost luiiiios in tlio jmst and pi'e- scnt goiieratiou oC ijliysiciana in our own country, or on tlio continent,—wlio have placed the knowledge of thoracic diseases, and especially diseases of the heart, on its present foundation. It is now a quarter of a centuiy, since Andral, writing on diseases of tlie heart,* pronounced our knowledge of them,—such as liis immortal countrymen, Sonac, Corvi- sart, and Laennoc had described them,—to bo almost complete. Since that time this subject has engaged the attention of many of the ablest minds in our profession, espe- cially in this country ; and additions to our information have eonthnially accrued from tiieir inquu'ies. Yet vnll any one say, even now, that our knowledge of the subject is nearly complete ? Indeed, information is wanting on many of its most important points, and tlie solution of one question only opens another inquiry. After all our labour, stUl, the higher the structure grows, the wider does the district yet to be ex- ploited appear from its rising summit. The pouits which at that time appeared to Andral to need further investigation were generally these fom':—First, the whole subject of pericarditis was a complete mys- tery ; next, the causes of valvular disease were very obscure ; thirdly, the effects of valvidar disease, either du'cct, as witnessed in tlie pulse, or indirect, as in the lesions of differentorgans,seemedtorequire a thorough investigation, in order to explain awaymany seeming anomalies ; and lastly, the resvdts of auscultation and percussion appeared, even in the best hands, to lead occasionally to such erroneous conclusions, that it was evident that this most elementaiy part of the whole subject was imperfectly under- stood. I. On each of these points much has been done since Andral first WTOte. The whole subject of pericarditis, of which Louis' elaborate researchesf sei-ved but to sliow the extent of oiu- ignorance, has been mas- tered, and cliicily by the skill of Dr. Watson and Dr. Stokes. J Indeed, difRcidties greater than Andral had conceived have been surmounted as, with our increasing know- ledge, tliey have come into view; for we liavc learned to look in the now fami- liarly imderstood diseases of the pericardimn i'or f ile explanation of symptoms which had been tliouglit to depend on disease of tlie brain. And such is the accuracy with which we can now investigate pericardial affections, that it is scarcely too much to say that the amount of fluid in the peri- * {'liiii(|nc Mf'dicalc, tome iii. 1826. t llcc hciclK's Aiiat. Path., p. 284. i Watson's Luitiircs, lect. Ixi. Jst edit. eardiuni can often bo measm-ed by the expe- rienced ear with an exactness little sliorl - of that of tlie practised eye. And if the ; diagnosis of adhesion of the )ierieardium stii; ' remain unsettled, and an obloquy to auscul- ' tators, is it not because, in trutli, adhesion of the pericardium is of itself uuunportant. * and lias reaUy no symptoms ? c II. In the knowledge of the causes oii valvular disease, also, great advance lias » been made. Dr. Latham* and M. Bouil laud liave satisfactorily traced valvular lesions, in many cases, to acute rheumatism. > A disease which had been, with few excep- > tions, considered all but harmless, save 1' in its present effects, would appear to be, ^ in its remote consequences, almost as great 'j- a scourge to mankind as typhus fever. Perhaps this discovery is the single most important contribution to clinical medicine ci that has been made for many years. More >■ recently. Dr. Barclayf has analyzed this- u subject in an essay, to which there wiU be- frequent occasion hereafter to refer. III. Again, something has been donC' n towards supplying the third class of An- ;■ di'al's desiderata. Dr. BlakistonJ has called attention to the modes in which some ol the secondary affections are produced, trac- ■ a ing them, with whatever measure of sue- t cess, to lesions of particular parts of the heart. And Dr. BmT0ws§ has done for the r; diseases of the brain which arise from the ti heart what, to display valvular disease inn i< all its terrors, it needs some one to do for tl the corresponding class of pulmonary affee- tions which crowd our hospitals on each tr retuni of winter. This field of observation s is still open in all directions. The inquiry; may be long and difficult, but, under the t hands of numerous and able observers, it! t is daily bearing fruit. il IV. But it is in the fourth particular I that the greatest advance has been made ; F and it is in the improvements in the phy- x sical diagnosis that much of the progress- i' in the other particulars turns. Dr. Hope i and Dr. Williams have explamed the mode of production of the first sound of the hearty, and Dr. CarsweU has cleared up * On Diseas s of the Heart, vol. i. p. 101. t Med.-Chir. Trans., xxxi. p. 185. i On Disea.scs of the Clicst, 1848. § On the Cerebral Circulation. ll Objections have been made to the theory of the cause of the lir.st sound of the heart, as now- Kenerally received, as neiiig- too complex. It is a sufficient answer to tliese objections, that any explanation which did not include all the ele- ments would be too limited It does not fall within the scope of tlle!^e remarks to discuss the question plivsiolof^ically, even had 1 anything:- new to add ; but it is worth while to i)oint to two piitliologrical i)henotiienabearinj^ upon it. What share the friction of the blood, or other possd)le causes, niav have in producing the first sound, I have ha(l no means of ascertniiiinir, and cannot say ; but mv experience would leail me to rcftard