Some considerations in regard to acute obstructive diseases of the lungs / by Andrew H. Smith.

  • Smith, Andrew H. (Andrew Heermance), 1837-1910.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Some considerations in regard to acute obstructive diseases of the lungs / by Andrew H. Smith. 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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    OBSTRUCTIVE DISEASES OF THE LUNGS.* Whenever there is obstruction of the pulmonary circulation, the labor of the right heart is necessarily increased. In pro- portion to its inability to overcome the obstruction, there will be an accumulation of blood in the venous system. Excess of blood in the veins implies deficiency in the arteries, and hence this class of affections is characterized by an unequal division of the blood between the venous circulation and the arterial. This condition has extremely important consequences, especially in acute pulmonary affections. In these we study the pulse with the greatest solicitude to judge how the heart, as we say, is supporting the struggle. But the arterial pulse gives no indication of the immediate peril, for it is not the left heart that is bearing the brunt of the battle. The pulse tells its story only at second-hand. It may be small and weak, but it is chiefly because the left heart does not receive enough blood from the lungs to fill its chambers and to distend the arteries. The trouble is not in lack of propelling power so much as in deficiency of blood to be propelled. But if, instead of feeling the radiai pulse, we could lay our finger upon the pulmonary artery, we should obtain informa- tion vastly more to the point. We should then be able to ap- preciate the degree of pulmonary obstruction by the fulness of the vessel, and to rate the power of the right ventricle by the force of the arterial beat. And in the relation of these two factors one to the other is involved the issue of the case. In- creasing obstruction with decreasing right-heart power means death ; decreasing obstruction with sustained right-heart power gives promise of recovery. It is a question with which the left heart, and therefore the radial pulse, has almost nothing to do. For the peril is not from general exhaustion, as for ex- ample in fever, nor from failure of the heart as a whole, as in some cases of infection, put specifically from tiring out of the the Section on Internal Medicine, of the Tenth International Medical Congress, August 6, 1890.