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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    With respect to Insufficiency of the Aortic Valves, the first clearly described case that 1 have met with is by one of the greatest masters of Cardiac Pathology of the seventeenth century—Paimond Yieussens. In his introductory remarks to this case, Yieussens observes : “ I am aware that some anatomists have found the trunk of the aorta ossified, both in men and animals; hut I have never either read or heard of changes of struc- ture of the sigmoid valves of this vessel.* * I have, never- theless, once found these valves ossified, as is shown from the following observations :—A man, set. thirty, of melan- cholic temperament, subject for a long period to attacks of epilepsy, was seized, in the course of the year 1695, with so violent a paroxysm, as to cause alarm lest some vessel should rupture in the brain. However, on being brought to the hospital the attack so soon abated, that, if not quite conva- lescent, he Avas, at all events, out of immediate danger. Nevertheless, on my visit to the hospital, I examined the case. His expression was dull; face, pale and bloated; already full of the blood it receives from the cavce, the auricle, consequently, dilates, and occasionally equals in size an infant’s head. In many autopsies, the right cavities of the heart have been found greatly dilated, without those of the left side in any way participating. On the other hand, there are very few recorded examples in which these last-named cavities were enlarged, without the right side being more or less implicated. This difference generally depends upon the situation of the obstacle to the circulation. Should it be situate in the pulmonary semilunar valves, for instance, or in the trunk itself of the pulmonary artery, dilatation of the right ventricle ensues, in consequence of the impediment offered to the onward passage of the blood. But the left auricle and ventricle, contract, rather than dilate. But,if the impediment to the circulation is situate at either the mouth or other portion of the aorta, or branches of this vessel, more or less distant, then the left ventricle becomes dilated by the blood thus impeded in its exit; the left auricle becomes full and distended; the pulmonary veins cannot empty themselves of the blood sent by the pulmonary artei-y; they, conse- quently, the right ventricle as well as the right auricle, and perhaps, also, the caval veins, undergo successive dilatation. Generally the walls of dilated hearts are softened, although at the same time often thickened, not merely with respect to their cellular tissue, but as to their actual sarcous element. See Yieussens, Traite du Coeur, ch. 16, 1715, for a similar chain of reason- ing. Also Treviranus, Biologie. Band iv, p. 231. * It is singular that the same remark should have been made by Lancisi, the great cotemporary of Yieussens. He does not appear, however, to have had any insight into the pathology of aortic insufBcieucy. 'I'he following pas- sage is from his work, “ De Subitaniis Mortibus,” Ed. 1706, p. 100, s. vii.: “ Igitur, ad posterioris animadversioncm transeuntes, ingenue fatemur, hoc sarcomatum vitium in tot observatis cadaveribus nunquaiu alias nobis fuisse compertum, hoc adhuc ex aliorum lectione cognitum ; utcumque viderimus hujusmodi valvulas cartilagineas, osseas, exesas, phlogosi afifectas, aut cum sanguiferis varicosis.” It is, however, quite certain that diseases of the valves had been described by several authors before either Yieussens or Lancisi. Yide Morgagni, Letter 23, a. 10.