On insufficiency of the aortic valves in connection with sudden death, with notes historical and critical.

  • Cockle, John, 1814-1901.
Date:
1861
Catalogue details

Licence: Public Domain Mark

Credit: On insufficiency of the aortic valves in connection with sudden death, with notes historical and critical. 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.

    28/30 (page 28)
    simple Diastolic Murmur, if at all well marked at, or even a little beyond, tbe left* apex. Such point has before been hinted, at in Traube’s remarks, and I have, on more than one occasion, after death verified its connection with simple Aortic disease. Such a murmur may practically (for the exceptions are so few) be regarded as the physical expression of Aortic Insufficiency, and this, the more certainly, if percussion signs of enlargement of the Right Ventricle and general Venous stasis, are absent. But, with regard to the Semeiotic importance of simple murmur, whether of limited or of wider range, we must be cautious not to allow it to transcend its just value. I would venture the opinion that such murmur indicates the kind, but not the degree of the lesion. This latter condition is measured, as before stated, by the amount of collapse of the vessels. Moderate obstruction at the aortic mouth is to be considered a most important kind of compensation for Aortic Insufficiency. An immobile, or still healthy valve, mingling its proper sound with the murmur, arrests and breaks the refluent stream, and thus directly tends to prevent collapse, as also that worst evil of the disease—Dilatation. It is not, perhaps, saying too much, that the management of these cases is not unfrequently, even now, matter of mere routine. To treat a diseased heart, not only with ordinary success, but even with ordinary safety, it is not enough that the practitioner be thoroughly conversant with the workings of Nature to compensate for injury done to its valvular appa- ratus, or even, when her resources are exhausted, with the simultaneous or successive steps that lead to death. Perhaps the larger and more valuable part of his knowledge is de- rived from the clinical study of the Congestion of the heart, as also of the Congestions and the vicarious action of the other large organs ;—now acting as safety valves by in- creased secretion ; and now again, as a consequence of such Congestion being inadequate to the task of eliminating refuse material, thus giving rise to a chronic asphyxiating process, and eventually entailing degeneration of their proper struc- tures. The laws, too, of the reciprocal influence of the various organs, are of the greatest importance to a right appreciation of the use of remedial agents. It is astonishing in cases of long-standing disease of the valves associated with a weakened heart, how slight a cause will terminate life. Ordinary catarrh, congestion of the coronary veins, may determine,