The People's Common Sense Medical Adviser in Plain English / or, Medicine Simplified, 54th ed., One Million, Six Hundred / and Fifty Thousand

by Ray Vaughn Pierce

We herewith give a cut, Fig. 1, of Pond's instrument, and two tracings made by it. The first is a healthy tracing, and the second indicates enlargement, technically called hypertrophy, of the heart

Pericarditis, or inflammation of the membranous sac which surrounds the heart, may be either acute or chronic. The symptoms in acute pericarditis are made up from co-existing affections, and are frequently associated with articular rheumatism, Bright's disease of the kidneys, or pleuritis The intensity of the pain varies in different individuals. The action of the heart is increased, the pulse is quick, and vomiting sometimes takes place. When this disease is developed in the course of rheumatism, it is known as rheumatic pericarditis, and is almost always associated with endocarditis. In some cases acute pericarditis is very distressing, in others it is mild. The fatality is not due so much to the disease itself, as to co-existing affections. When it does not prove fatal, it sometimes becomes chronic.

In chronic pericarditis, pain is seldom present. The heart is generally more or less enlarged, its sounds are feeble, the first being weaker than the second.

Endocarditis, or inflammation of the membrane lining the cavities of the heart, is one of the most frequent forms of heart disease. It is almost invariably associated with acute rheumatism, or some of the eruptive fevers, as small-pox, scarlet fever, etc., and is due to the irritation of the unhealthy blood passing through the heart. The disease is generally attended with little or no pain, and, consequently, if the attending physician be not on the alert, it will escape his observation. When associated with acute rheumatism, the disease is only in rare instances directly fatal, but in the great majority of cases it leaves permanent organic changes, which sooner or later develop into valvular affections, and these may eventually destroy life. When the disease occurs, however, as the result of pyæmia (blood-poisoning produced by the absorption of decomposing pus or "matter") or of diphtheria, or when it is associated with any other septic conditions, it constitutes a very grave element. Collections of matter formed on the membrane lining the heart and covering its valves, are liable to be detached and carried by the circulation to the brain, spleen, or liver, where they plug up some artery, and thus cause death of the parts which it supplies with blood.

Chronic endocarditis generally occurs in rheumatic subjects, unassociated with any acute disease, It may exist without any marked symptoms, except, perhaps, a sense of oppression and uneasiness in the chest, with palpitation. It produces a thickening and hardening of the membrane lining the heart, and generally causes a retraction, adhesion, and degeneration of some of the valves of the heart, thus bringing on valvular disease.

Valvular Lesions are, as we have seen, very frequently the result of endocarditis. They are of two kinds. First, those which prevent the valves from flapping back close to the walls of the ventricles, or arteries, thus diminishing, to a greater or lesser extent, the size of the valvular orifices, and offering an obstruction to the free flow of blood through them; and which consist of a thickening and retraction, or adhesion of the valves, chalky deposits, morbid growths, etc. Secondly, those which prevent complete closure of the valves, and thus permit a return of the blood into the cavity from which it has just been expelled. These latter consist of retractions, perforations, and partial detachments of the valves, chalky deposits around the base of the valves and in them, and rupture of the chordæ tendineæ.

These two forms of lesions are usually co-existent, one generally being more extensive than the other. Thus, the regurgitation may be slight, and the obstruction great, or vice versa. The symptoms and disturbance of the circulation are altogether dependent upon the location and form of the lesion, or lesions. Each valvular lesion has its characteristic sound, or murmur, which is heard at a particular period in the cycle of the heart's action, and it is, as before stated, from these sounds, from tracings of the pulse, and from the many other indications, that we arrive at a diagnosis. Thus, in obstruction of the orifice at the junction of the aorta with the left ventricle, one of the most frequent of valvular lesions, a murmur, generally harsh in character, is heard with the first sound of the heart, with greatest intensity directly over the normal position or the aortic semilunar valves. This is conveyed along the large arteries, and may be heard, less distinctly, over the carotids. In the sphygmographic tracing, the line of ascent is less abrupt than in the normal tracing (Fig. 2), and not nearly so high, and it is rounded at the top. In aortic regurgitation, the line of ascent is similar to that of the healthy tracing, but the line of descent is very sudden. The left side of the heart is almost invariably the primary seat of these affections, but in the latter stages of their course, the right side also is liable to become involved, and, as a consequence, there then exists great disturbance of the venous circulation, with a damming back of the blood in the veins, and passive congestion of the liver, kidneys and brain, followed by dropsy, albumen in the urine, etc.

Hypertrophy of the Heart consists of a thickening of the muscular walls of this organ. It may be confined to one portion of the heart, or it may affect the entire organ. The affection has been divided into the following three forms: Simple hypertrophy, in which there is an increase in the thickness of the walls of the heart, without any augmentation in the capacity of the cavities, and which is usually the result of chronic Bright's disease, or great intemperance; eccentric hypertrophy, in which there is an increase in the thickness of the walls of the heart, together with increase in the capacity of the cavities, and which is generally the result of some valvular lesion; and concentric hypertrophy, in which there is an increase in the thickness of the walls of the heart, with a decrease in the capacity of the cavities. Valvular lesions, obstructions in the large arteries, or, in fact, any thing which calls upon the heart to constantly perform an undue amount of labor must, necessarily, produce hypertrophy of its muscular walls, just as the undue amount of labor which the blacksmith's arm is called upon to perform produces hypertrophy of its muscles. With this condition, the pulse is hard and incompressible, and the line of ascent in the sphygmographic tracing (Fig. 3) is higher than in health.