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.

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    respectively, pulmonary oedema or effusion into the Peri- cardium, and it requires but a small quantity of such effusion to exhaust the already weakened heart. In the incipient stage of aortic valvular disease, the most important question that Therapeutics can ask of Pathology, is that which regards the causation of the affection. If this is the direct result of Rheumatic fever, those agents are of course indicated which experience has invested with a specific action over the rheumatic poison, and, subsequently the long continued use of moderate counterirritation, with the internal use of iodide of potassium, alone or in combina- tion, with a view to the absorption of the exudation matter. Simultaneously with these means, the avoidance of the ordi- nary causes of cardiac excitement is to be sedulously cared for. It is certain that valvular disease of the aorta, occurring as stated, is amenable to treatment and occasionally so far modified as to leave no signs of either general or local disorder. On the other hand, when Atheroma is probably causative of the affection, treatment is, for the most part, abortive. It is ever to be remembered that, in this incipient stage, the phenomena of cardiac excitement are, for the most part, but the reflex of the obstructed blood current. So that here we treat the valve disease, qua valve/ while, in the later stages, with permanent valvular obstruction, it is to the chambers of the heart that our remedial measures are to be addressed. In the second, or confirmed stage of Insuffi- ciency of the aortic valves, the one most frequently pre- sented to our notice, and characterized by so many striking and familiar phenomena, medical treatment is, strictly speak- ing, absolutely contraindicated. This stage may, and often does, endure for years with but little appreciable encroach- ment on the vital powers, unless any of the accidents of the affection, induced by some excess, should suddenly super- vene. Our care should simply be to enforce, so far as is practicable, the avoidance of all the mental and physical influences likely to embarrass the heart’s action. Attention to diet is of extreme importance. There is no cause of car- diac suffering, or even death, more common than improper diet, in the Organic diseases of the heart. The restricted use of fluids is important, to prevent the plethora ad molern ; since we have seen that, in many cases of advanced disease, all the great eliminating organs are congested and inade- quate to the extra stress, so that the vessels are kept pre- ternaturally full.