A practical treatise on the management of diseases of the heart, and of aortic aneurism, with especial reference to the treatment of those diseases in India / by Norman Chevers.

Date:
1851
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on the management of diseases of the heart, and of aortic aneurism, with especial reference to the treatment of those diseases in India / by Norman Chevers. 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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    exist with tuberculosis. Cyanosis affords a complete protection against it, &c.* Many oi' tlio ciises of cyanosis adduced in the earlier portions of tliia memoir wholly negative the opinion of Rokitansky, and prove tliat, on the contrary, tlic subjects of congenital malformation of the heart arc rather excessively prone to suffer from tuberculosis at all ages, but especially where hfe is somewhat unusually prolonged.f Hccmorrhages from tlie nose, mucous membrane of the bowels, and lungs, are liable to occur at all periods of the lives of cyanosed patients, but are most frequent towards tlie close of existence, when con- gestion is greatest, and tlie obstruction to the circulation resulting from the advance of structural impairment of the organs is at its height. The lighter forms of htemor- rliage are usually followed by temporary rehef; but hcemoptysis, as it involves an extremely severe .lesion, and almost in- variably resvdts m these cases either from tubercular or pneumonic degeneration of lung-substance, from bronchitis, or from * As quoted by Dr. Stille, Philadelphia Med. Examiner, April 1849, and Ranking-'s Retrospect, vol. X., from Hundbuch der Putb. Aiiat. Ud. ii. p. 510. t See Dr. Ramsbolham's case of obliteration of the pulmonary artery: death at the as;e of six- teen years from tubercular disease. Dr. Shear- man, imperforate pulmonary orifice in a girl, a;tat. 8 years. Lungs found very full of grey tubercle. Dr. C/ieever, marked contraction of the pulmonary orifice in a boy aged 134 years; cyanosis from the first months of infancy. Tu- bercles were found pretty generally diffused through the substance of the lungs. M. Schuler, cyanosis: death at seven weeks; scrofulous de- generation of the mesenteric glands. Mr. Hous- ton, contraction of the pulmonary artery, with cyanosis ; death from phthisis and bronchitis at the age of 3 vears. M. CuilM, cyanosis from birth ; death at 11 years and 7 months. Lungs condensed, and in an advanced state of phthisi- cal degeneration. M. Lexis, extremely contracted state of the pulmonary artery in a girl 5g years of age. The pulmonary tissue contained a few tubercles. Mr. Nappir, contracted pulmonary artery, with cyanosis, in a child aged 5 years and 10 months. Lungs tubercular. Messrs. Aran and Bennett: a female, ffitat. 20. Great con- traction of the pulmonary artery ; very aggra- vated cyanosis; great consolidation of the lungs by tubercles; death from hip-disease and ery- sipelas consequent upon caries of one of the ribs. Case occurring at Guy's Hospital: lad, a;tat. 16; contraction of the pulmonary artery ; cyanosis. The right lung contained miliary tubercles; the left was engorged with blood, and contained at its apex a tubercular excavation, apparently of long standing. Dunglison: a female, ajtat. 21; congenital contraction of the pulmonary artery, with cyanosis. Both lungs studded throughout with crude and miliary tubercles, none of which were softened. Dr. Craigie: a man, a;tat. 44; pulmonary valves contracted so as to form a ring, which could only admit the point of the little finger. Uoth lun^s contained tubercles, and were much consolidated: the apex of the left was occupied by a large tuburcular cavity. Mr. Le Gros Clarke: case of a man, ittat. 19; great contraction of the pulmonary orifice; cyanosis. The lungs presented tubercles at different parts. some new and serious impediment to the pulmonary circulation having its seat in tlie pleuraj, left heart, or systemic vessela, must always be viewed with the utmost ap]irelicnsion. Hepatic, splenitf, gastric, and enteritic congestions, may be regarded almost as the ueecssury and pliysiological attendants upon congenital cardiac obstruction, and are constantly liable to be determined into states of more or less active disease. A foul tongue, offensive breath, imperfect digestion, a general tendency to defective nutrition, bad or capricious appetite, a faidty bUiary secretion, witli constipated or irregular bowels, are the almost inseparable concomitants of the state under investiga- tion ; and hence the danger attendant upon diarrhoeal and dysenteric attacks in these patients. Whenever the urine is found to be albu- minous in a case of acute csocardial or endocardial disease, the prognosis is bad, as here it rarely fails to hapjoen that* the kidneys are the seat of fixed organic lesion, of which the cardiac mischief is not the cause, but the result. Possibly, though uot very probably, patients tints affected may recover for a time, but, as far as I have observed, they most frequently smk under the immediate attack, or only survive it for a very brief pei-iod, during which the abate- ment of symptoms is extremely partial. This arises from the fact that, m acute cardiac and arterial diseases of renal origin, the lesions are generally of the most exten- sive and the gravest character. In all forms of chronic heart-disease where the urine is albmninous, when the patient is first seen the prognosis is mvariably bad, esjDeciaUy where the dm-ation of the renal affection is not known ; and so long as this symptom resists juchciously-employed treatment, the patient's condition must be regarded as very critical. The sudden appearance of albtuuen in the urine of an individual suffering from organic heart-disease, is al- ways a most discoiu-aging symptom ; but the practitioner should not on that account neglect to employ systematic endeavom's to relieve its cause, as it may depend upon Uttle more than excessive congestion of the kidneys, which may, not improbably, be removed, when the bulk of the ciroulatmg fluid, or of any ascitic effusion which may be present, has become diminished, or when the renal functions have become Lightened by moderate excitation of the cutaneous and intestinal axjtions. The secretion of scanty and high-coloured urine, as evidencing renal congestion, is a frequent characteristic of cyanosis; true Bright's disease is, I believe, only noticed in these cases as a vei^ rare and accidental complication. The subjects of cyanosis