Memoir on the influence of hypertrophy and dilatation on diseases of the heart : and on some points in their diagnosis and treatment / by A. Halliday Douglas.

  • Douglas, Andrew Halliday, 1819-1908.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: Memoir on the influence of hypertrophy and dilatation on diseases of the heart : and on some points in their diagnosis and treatment / by A. Halliday Douglas. 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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    Some of these signs, however, I am disposed to think, have a more specific relation to the dilatation than has been usually acknow- ledged. Such conditions as lividity, dropsy, hrrmoptysis, pulmonary con- densation from hemorrhage, and the distended state of the left ventricle, have been very absolutely associated with disease of the heart; but they have not been so pointedly associated with dilata- tion, as this case and many others testify is the fact. No doubt these conditions occur in other cases than mere dilatation ; but even in such cases, a very intimate relation may be traced to dilatation, or to a state of the organ causing the same obstructive effects on the circulation. In the present case, the degree of dilatation was great, and no other lesion existed, unless hypertrophy, to account for the extreme degree of the conditions above referred to; and it will be found that these do not ordinarily exist without more or less dilata- tion. These symptoms in most cases exist late in the attack, and may be regarded as the index of a preponderating and formidable dilatation. The post-mortem distension of the left ventricle in this case may he noticed. In the diseases of the heart I have never met with this, except in cases in which the capacity was increased, and the power of tne organ consequently embarrassed. In such cases death is usually sudden, or rapid as in this man. From the facts stated, and from the physical signs in the case, it is manifest that a very embarrassed and enfeebled state of the heart’s action existed, but these are the very opposite of the conditions which exist when hypertrophy is in excess, which involves augmented power. We are therefore shut up to the conclusion that the em- barrassment of the circulation, and its consequent effects, were due to the dilatation of the heart, notwithstanding co-existing hyper- trophy, or increased muscular substance. It is very difficult to determine what value we shall attach to the statements given by patients of the history of then* diseases. In so far as the statement can be trusted in the present case, it is im- portant to observe that his very old-standing chest symptoms were not of heart disease, but probably of a chronic bronchitis. This state of the lungs, by hindering the freedom of the circulation, was no doubt the primary cause of the cardiac changes which gradually .and insidiously supervened, and only manifested themselves when, from accidental causes, the balance of the circulation was more disturbed; and then, the defective state of the heart incapacitated it for the work of restoring the equilibrium ot the circulation ; and the subsequent rapid progress of the case, with prominent heart symptoms, became remarkable. This rapid progress in the later stages is to be taken in connection with the very dilated state ot the heart. In the treatment of this case we see a well marked instance of the benefit of moderate leeching to the scrobiculus cordis. The ulti- mate! v unfavourable result of the case, with recurrence of all the