Volume 2

The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan.

  • Andral, G. (Gabriel), 1797-1876.
Date:
1836
Catalogue details

Licence: Public Domain Mark

Credit: The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    41/215 (page 247)
    i iikl often, also, when the left side is aftected. Thus, then, as a general principle, i imiust not be concluded from the pulse retaining its ])hysiological character, that e3 heart is exempt from change. ! The lesions of the pulse, in cases of diseases of the heart, ma}’ regard its 1 rythm, its strength, or its frequency. i lit has been said that the irregularity of the pulse indicated the existence of an- iS'Stacle at the aortic orifice of the left ventricle. Observation is far from always < rrifying this assertion : on the one hand, in individuals whose pulse had jjre- i tinted during life the greatest irregularities with respect to the strength of the a laats, and their mode of succession, the autopsy showed the existence of no a isstacle at the auriculo-ventricular or arterial orifice on the left side of the heart; 1 Kid, on the other hand, we have more than once observed a very regular pulse in i -<«es where, after death, we found at the ventriculo-aortic orifice ossifications, li or other obstacles. We have ascertained this irregularity of the i ildse without any obstacle to which it could be referred, with the existence of j ee following lesions :— list. Simple hypertrophy of the left ventricle, with diminution of its cavitj'. t2nd. Hypertrophy of this same ventricle, with dilatation of its cavity. 13rd. Hypertrophy of the two ventricles, with or without dilatation of their cavities. •)4th. Simple increase in the size of the right cavities, the left side of the heart iiiig intact. ’When the irregularity of the pulse is not |)roduced by an obstacle to the free (J sscharge of the blood into the aorta, it is scarcely apparent, except when the jsease of the heart becomes exasperated, when, under the influence of causes oore or less appreciable, the dyspnoea becomes more considerable, and dropsy is voduced or increased. On the cessation of this exasperation the pulsations of loe artery resume their regularity. llf, on the contrary, there exists an obstacle, the pulse oftentimes becomes egular, long before any other sign of heart disease manifests itself; this happens iiincipally in aged persons. In such cases it is not till several years after the idse has begun to present striking irregularities, either in the strength or in the itervals of the beats, that the respiration begins to be embarrassed, the first Mces of serous congestion appear, &c. It is very probable that in cases of li'is kind the cause of the irregularity of the pulse resides in ossifications of the rrtic orifice, which may exist for a long time without disturbing the pulmonary rcculation, and consequently without producing dyspnoea; but this irregularity the pulse should not cause the less dread of the future development of other nmptoms of diseases of the heart. iSometimes it happens that every time the arterial beats are counted, they are uund to be very regular; but then they may present another species of irregu- ririty, which it is important to know. If we count at different periods of the nme day, and even only at the interval of some minutes, w'e find the greatest ir.riations in their frequency. Thus, for instance, in an individual aftected with qpertrophy of the two ventricles, with dilatation of their cavities, in whom the ^JWfifices of the heart w'ere free, but whose aorta was traversed with numerous '.jjkt.tches, we counted one day one hundred and twenty one arterial pulsations in flt'e minute ; three or four minutes after we found but sixty, and a little after jjhty-three. On the following day we counted in the space of some minutes idrty-seven, fifty, forty-two, fifty, then ninety-six pulsations. In another patient liao laboured under great dyspnoea, and was delirious, the pulse when first tried j' iv.ve but thirty pulsations in a minute, a little after having given sixty-eight. At other times it is only from one day to another, that, without any known luse, without increase or diminution in the other symjitoms of disease of the ; j isart, the pulse presents the greatest irregularities in its frequency. Here is a liriking instance of it.