Neurosal affections of the heart in children / by W.H. Day.

  • Day, William Henry, 1830-1907.
Date:
[1878]
Catalogue details

Licence: Public Domain Mark

Credit: Neurosal affections of the heart in children / by W.H. Day. 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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    minute, and the next minute 90 or 100 heats. It may he met with, as Dr. Eichardson observes, in acute cerebral disease in children; and he looks upon it as a fatal sign when there are other symptoms pointing to acute hydrocephalus. In a boy two years of age, who came under my care some years ago, with sub- acute meningitis and effusion, this fluctuation was observed in the pulse. The complaint was attended with hemiplegia and involuntary action of the sphincters, but no elevation of tem- perature. The patient made a slow but good recovery. 3. Intermittency, or that form of irregularity in which certain beats of the pulse are lost, “ it is as though the pulse were clipped out for the moment, the intermittency of stroke occurring during the whole interval of a normal stroke, or in extreme cases cover- ing the time of two, three, or even a greater number of natural pulsations.” Now this intermittency is attributed by Dr. Eichardson to failure of action of the left ventricle, which continues in diastole for two or more strokes of the systole of its auricle, and then relieves itself by a prolonged effort. There is an absence of the first or systolic cardiac sound, a weak second sound, and loss of the pulse. Then comes the returning first sound heavy and strong, because the ventricle has now to contract with greater force to overcome the additional blood in its cavity. This is immediately succeeded by the two quick second sounds (doub- ling) from closure of the aortic and pulmonary semilunar valves, and then there is a return of the pulse-wave. The outcome of this irregularity and intermittency of the pulse amounts to this—that it is essentially functional and neurosal; that intermittency is not necessarily connected with organic change, and that in my experience, as in cases I have related, intermission of the pulse in the most advanced valvular disease of the heart and other structural changes is rarely noticed. In organic valvular change it is most frequent in mitral regurgitation. The irregular action of the heart which sometimes takes place in chorea and in allied nervous affections is doubtless similar in nature to the irritable condition of the bladder in weakly children —the “ stammering bladder,”1 as Sir James Paget happily terms 1 “ On Stammering with other Organs than those of Speech.”—Clinical Lectures and Essays, by Sir James Paget, Bart., 1875, p. 77.