The Lettsomian lectures on diseases and disorders of the heart and arteries in middle and advanced life / by J. Mitchell Bruce.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929.
Date:
1902
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Licence: In copyright

Credit: The Lettsomian lectures on diseases and disorders of the heart and arteries in middle and advanced life / by J. Mitchell Bruce. Source: Wellcome Collection.

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

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    9 PTREARES ANn DTSOT^PET^R OF THE HEAT^T AKT) distinguished position in the community, ought to retire from public life because he has occasional attacks of prfficordial oppres- sion and a systolic murmur at the base of his heart. What, again, is he to do for the stout, free-living man, just passing the meridian of life, who consults him for weakness and depression, whose heart is large and feeble, and the urine saccharine and slightly albuminous 1 There is not one of my audience who has not met with such cases as these many times in his practice, and a variety of other cases of cardiac disorder and disease after 40, Avhere the importance of the individuals, the value of their lives, and the gravity of their com- plaints and their prospects have exercised him very anxiously. What is the prognosis in cases of this order 1 What can be done for them in the way of treatment 1 These are the questions which we would desire to answer usefully. The answer, it seems to me, can be given only after an analysis and study of a considerable number of instances of the kind, in respect of their origin, their clinical characters and course, and the result. This is the method of inquiry which I propose to follow. It will be a study of cardio- vascular disease in older subjects from the clinical point of view, and it will be approached not only from the ordinary clinical side as it is approached in hospitals, that is, by an investigation of symp- toms and signs, but also and especially in the light of that particular order of knowledge which the family practitioner has learned to appreciate and has so intimate an opportunity to acquire correctly —a knowledge of the origin or causes of the different affections, which it is always difficult, and often impossible, for the hospital physician to ascertain. For the same reason, although, to be complete, a study of the diseases of the circulation at and after middle life should include an account of the post-mortem characters found in fatal cases, and whilst the basis of the account I submit to you will be essentially pathological, I shall not attempt to describe the pathological anatomy and histology of this group of lesions of the heart and arteries. This part of the subject has been remarkably advanced during the last few years; and even if I had the time and the necessary knowledge to deal with it now, I should have nothing original in it to lay before you. Indeed, if I may venture to say so, our attention lately has been too much confined to the pathological states of the heart and arteries and too little directed to the causes Avhich produce them. Arterial sclerosis is now an ordinary diagnosis in every-day practice, as if it were sufficient for