On a case of patent ductus arteriosus with aneurism of the pulmonary artery / by James Foulis.

Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: On a case of patent ductus arteriosus with aneurism of the pulmonary artery / by James Foulis. 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.

    6/28 (page 4)
    very loud and blowing with a decided thrill in it, accompanied the systole of the heart, and at the same time a strong heaving im- pulse was communicated to the stethoscope. Just before this murmur ceased a distinct click was heard, and then immediately a second murmur, but of a softer nature and of shorter duration than the first murmur, was heard. On moving the stethoscope to the aortic area, the murmurs were still very distinctly heard, but the cliclc which, as I have said, joined the two murmurs together was heard much more clearly, and I believe indicated the quick and sudden closure of the aortic valve. How the murmurs them- selves were produced I could not at this time venture to say. They were heard also at the apex of the heart, but not nearly so loud as at the spot already stated. The point of maxivium intensity of both murmurs was to the left of the sternum hetiocen tlu second and third ribs. Upon entering into the history of my patient, I learned that about six years previously she had an attack of scarlet fever, but she could not say that her health in any way was worse after the attack. There was no history of rheumatic affection. I advised my patient to give up all unnecessary exertion, and to rest as much as possible, and to continu.e taking the iron and arsenic for another month. At the end of a month I acjain saw her. She was lookintj greatly better. Her face and lips showed that her antemia had quite disappeared. She still had great breathlessness on exertion, and complained much of the noises in her head and chest. On listening over the base of the heart to the left of the sternum, in the second intercostal space, a strong heaving impulse was com- municated to the stethoscope with the systole of the heart, and both murmurs, as already described, were heard with extraordinary clearness—I never heard anything like those murmurs before or since. At the apex of the heart the murmurs were not so loud as at the spot indicated; and in the aortic area, while the click joining the two murmurs was very distinct, the murmurs themselves were but slightly diminished in intensity. Being very much puzzled as to the cause of these murmurs, which, be it borne in mind, were much louder and better marked since the girl's atuBmia had disappeared, I thought it would be interesting to hear what Dr George Balfour had to say as to the cause of the murmurs. After a careful examination he came to the conclusion that the case was one of patent ductus arteriosus, but at the same time confessed that his diagnosis was founded upon hypothetical rather than well-known scientific data. As regards treatment of the case, Dr Balfour advised that she should continue to take iron and arsenic, and should rest as much as possible. From time to time I visited my patient at her own home, as she was unable to come to my house. At this time my friend Dr Wyllie saw her with me. He also kindly took me to see a case