Notes upon the physical examination of the respiratory and circulatory systems / by John Wyllie.

Date:
[1900]
Catalogue details

Licence: In copyright

Credit: Notes upon the physical examination of the respiratory and circulatory systems / by John Wyllie. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    which diminishes the functional powder of the heart will lead to a lowering of the Arterial and a raising of the Venous pressure. Among the symptoms of such cardiac debility there will accordingly be found some, such as faintn^e^Sj which are refer- able to the Arterial defect, and others, such as dropsy, which are due to the Venous excess. The following is a brief note of the various conditions, functional and organic, which may thus cause disturbance and debility of the Heart’s action. I. Nervous or Functional Disorders of the Heart. Both Heart and Blood-vessels are under the control of the Nervous System, the Heart being acted upon through the nerves, both by centres which accelerate, and by centres which inhibit or control, its movements. * A similar control is exercised on the Blood-vessels by the Vaso-motor system of nerves. Nervous derangements of various sorts tell upon the Heart in a great variety of ways. They may cause the action to be too rapid or too slow ; or to be tumultuous and irregular as in palpitation ; or they may so debilitate the Heart’s muscular substance as to lead to the establishment of a tendency to progressive dilatation, with increasing, and possibly dangerous, debility. In the great majority of cases such Nervous derange- ments produce Disturbances of the Heart, like violent Palpitation, which are more alarming than really dangerous ; but in a few cases, as in Exophthalmic Goitre, the Cardiac Debility resulting from Nervous causes may be a source of great danger, and even a cause of death. The cause of such Nervous derangements may be found primarily in the great Nerve Centres, as in cases of emotional or hysterical disturbance ; or they may be found in some Peripheral part, such as the Stomach or Reproductive Organs, where irritation may tell upon the Heart reflexly through the Nerve Centres ; or, lastly, the condition may be a Hsemic one, in the first instance, such as Anaemia, or Toxaemia from Tobacco, Tea, or Alcohol. Such conditions of abnormality in the blood cause a deranged nutrition of the Nerve Centres which tells secondarily upon the action of the Heart. The physical signs of this class of cases are usually those indicative of deranged rate and rhythm. They do not, as a rule, include alteration of Percussion note, or the development of Bruits, yet in many cases Bruits are developed—the Bruits ot Debility—and, when Anaemia is the primary condition, the whole six of these Bruits may sometimes be detected on examination of the Neck and Praecordia. Apart from Anaemia, also, mere Nervous Debility, such as occurs in Exophthalmic Goitre, may lead to such dilatation of the Heart’s chambers as to enlarge the area of cardiac dulness, and bring about the establishment of Bruits of Disparity of size” at the Mitral or Tricuspid Orifice. II. Mechanical Interference with the Heart’s Action from without. The effects of Pressure upon the heart from without are well seen in some cases of Pleurisy with Effusion on the left _side of the chest. Here the Heart is often injuriously pressed upon, so that symptoms of Arterial type, such as weak or irregular pulse, faintness, and Cardiac dyspnoea, may appear ; and, in rarer cases, symptoms of Venous type also, such as dropsy and cyanosis. This class of case as a rule yields no Cardiac Bruit on Auscultation, but Inspection may show the Pleart to be pushed, and the Apex to be displaced, more or less towards the Right side. Another example of pressure from without is found in Pericarditis with gffusion, which gives rise to symptoms similar to the above. Among its physical Signs are to be reckoned especially the marked extension of the Cardiac Dulness, the muffling of the Heart Sounds, and the obscuring of the Apex Beat, which is often displaced somewhat upwards. Acute Pericarditis without Effusion does not cause mechanical compression of