On insufficiency of the aortic valves in connexion with sudden death : with notes historical and critical / by John Cockle.

  • Cockle, John, 1814-1901.
Date:
1861
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Licence: Public Domain Mark

Credit: On insufficiency of the aortic valves in connexion with sudden death : with notes historical and critical / by John Cockle. 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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    Insufficiency, the double murmur was particularly noticed, butwitliout allusion to its site,or explanation given of its cause. So far from this. Dr. Hodgkin remarks, “ The contractions of the ventricles were marked by strong impulse, and a constant hruit de scie, which presented this peculiarity, that it was double, attending the systole as well as diastole, but not exciting the idea of being at all connected with the auricles. Yet, by a singular coincidence, at the end of this paper, when again adverting to this case. Dr. Hodgkin seems to have divined the physical cause of the double murmur he heard, for he writes, It would still appear, that, in the majority of instances there is no bruit de scie accompanying retroversion of the valves. The peculiar character of this sound in the case of Dr. Cox is well worthy of attention, as connected with some of the appearances noticed in the inspection. It was repeatedly observed to offer a double or spondaic character, the one part marking the systole, and the other the diastole of the ventricle. The spots of partial thickening on the interior, both of the ventricle and of the aorta, and which had evidently been occasioned by the con- tact of the elongated and much retroverted valve, suffici- ently prove that the blood on the left side had been sub- jected to two motions, the one progressive and the other retrograde, in both of which it might easily give rise to some sound as it passed the elongated valve.” Dr. Hodgkin states that in these cases the force of the pulse does not correspond to the heart’s beat. The violent beating of the carotids, and the thrill of the pulse are, also, recorded. The distinction, too, between the generally undisturbed rhythm of the pulse in Aortic compared with Mitral valve diseases, is expressly stated. Dr. Hodgkin appears to have been taught by his ex- perience that in this particular class of cases, “ depletion seems rather to aggravate than to relieve the distress of the patient.” These Memoirs contain the germs of our present knowledge with regard to both physical signs and treatment. Indeed, had Dr. Hodgkin but traced the physical signs with the same success that he did their anatomical cause, the next acute observer had been completely anticipated. From this date until the year 183^, no additional observa- tions were recorded illustrating the Pathology of Insufficieiicy of the Aortic Valves. Throughout the entire historic period of the disease, isolated cases only had occurred, and these so * Edin. Med. and Surg. Journal.