The bearings of chronic disease of the heart upon pregnancy, parturition, and childbed : with papers on puerperal pluero-pneumonia and eclampsia / by Angus MacDonald.

  • Macdonald Angus, 1836-1886.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: The bearings of chronic disease of the heart upon pregnancy, parturition, and childbed : with papers on puerperal pluero-pneumonia and eclampsia / by Angus MacDonald. 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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    on the part of the heart and lungs, whilst it at the same time strengthened the expulsive power of the uterus. An interesting question is suggested by this case, viz., What effect would the extreme mitral obstruction have upon the condition of matters} would it be beneficial or otherwise in its bearing upon the aortic lesion} To solve this point, we have to consider how danger is specially apt to arise in connection with this lesion, i. Fatty degeneration is apt to occur in the enlarged ventricle in consequence of defec- tive nutrition of the heart, the coronary arteries not being filled sufficiently, because, owing to the incompetency of the aortic valves, there is never a sufficient tension in the blood in the sinuses of Valsalva to thoroughly flush these arteries. 2. Danger is apt to arise from the hydraulic pressure of the column of blood, which regurgitates at each diastole with a force proportional to the perpendicular height of the highest part of the vascular system above the apex of the left ventricle. 3. Danger is apt to arise, also, in consequence of the hypertrophy of the left ventricle leading to mitral incompetency, and thus setting free an hypertrophied ven- tricle to pump with a force, corresponding to its thickness, a stream of blood into the venous radicles of the lungs, and thus to directly oppose the normal action of the right ventricle and induce destructive congestion of the lungs. The extreme mitral obstruction would have no effect upon the first tendency to disaster; but, by diminishing the velocity of regurgitation from the ventricle, it seems to me quite possible that, within certain limits, it may have prevented in some degree the indirect evil effects of the aortic lesion in the third tendency to death mentioned. Upon the question whether it could modify the serious effects of the backward column from the aorta, by limiting the distension of the ventricle before each systole, I really feel unable to venture a positive opinion, although, from the way in which the