April. Since writing the above account, the dropsical collections were absorbed, and the palpitations and other symptoms moderated, so that he considered himself nearly well, and attended to his usual business. Within a few days, however, the symptoms have returned with more violence. The dyspnœa is at times very distressing; the pulse more irregular and intermittent; the palpitations are more constant. His sufferings from lying in bed are so increased, that in the most comfortable nights he passes, he sits up once in an hour or two. The appetite is keen. The legs begin to swell again.
Some organic disease of the heart exists in this case. The indistinctness of the palpitations, the want of hardness in the pulse, and the slow progress of the disease, indicate a loss of power in the heart, the effect of the distention and thinness of its parietes. The irregularity of the pulse affords some reason to suspect disorder of the aortal valves, which is not yet very considerable.
ENUMERATION of the principal morbid changes, observed in the organization of the heart, in the preceding cases.
| Enlargement of the volume of the heart, or aneurism.[12] | |
| Increase of the capacity, or aneurism of the right auricle, of the right ventricle, of the left auricle of the left ventricle, of the aorta, with thickening of its coats. | with thickened, or thin, parietes. |
| Fleshlike[13] thickening of the mitral valves. of the aortal valves. of the aorta. | |
| Cartilaginous thickening of the internal membrane of the heart, and generallyof its valves. | |
| Ossification of the parietes of the heart. mitral valves. aortal valves. aorta. coronary arteries. |
ENUMERATION of the principal morbid appearances, observed in these cases of disease of the heart, which may be considered secondary.
- IN THE CAVITY OF THE CRANIUM.
- Inflammation of the meninges.
- Water between the meninges.
- Water in the ventricles.
- IN THE PLEURA AND ITS CAVITY.
- Inflammation and thickening of the pleura.
- Collection of water in its cavity.
- Lungs dark coloured.
- generally very firm, and particularly in some parts.
- loaded with black blood.
- crowded into a narrow space.
- IN THE PERICARDIUM AND ITS CAVITY.
- Inflammation and thickening of its substance.
- Adhesion to the heart and lungs.
- Collection of water in its cavity.
- IN THE CAVITY OF THE ABDOMEN.
- Collection of water.
- Liver very full of fluid blood.
- having its tunic flaccid and inflamed.
- Mesenteric veins full of blood.
- CELLULAR MEMBRANE full of water.
- THE BLOOD every where fluid, except in the cavities of the heart.
REMARKS.
The symptoms, which are most observable, in some or all of the preceding cases, are the following:
The first notice of disorder is commonly from an irregular and tumultuous movement of the heart, which occurs some time before any perceptible derangement of the other functions. This irregularity slowly increases, and arrives at its height before the strength of the patient is much impaired, at least in the cases which I have noticed; and as the vigour of the patient lessens, the force of the palpitations diminishes. These palpitations are often so strong, as to be perceptible to the eye at a considerable distance. They are seldom most distinct in the place where the pulsation of the heart is usually felt. Sometimes they are perceived a little below; often in the epigastric region; and not unfrequently beneath, and on the right side, of the sternum.