Prognosis in chronic valvular disease of the heart : an address delivered before the North London Medico-Chirurgical Society / by J. Mitchell Bruce.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929.
Date:
1902
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Licence: In copyright

Credit: Prognosis in chronic valvular disease of the heart : an address delivered before the North London Medico-Chirurgical Society / by J. Mitchell Bruce. 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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    the kinds of it, and therefore most difficult to employ as elements of prognosis. Let me turn now from the compensated to the failing heart in valvular disease, and inquire how we can turn to prognostic use the clinical facts that characterize it. Our efforts to maintain compen- sation have been in vain. As we stand by the bedside of a child, a young man, a middle-aged or an old man, suffering from diopsy, orthopncea, precordial distress, and the other miseries unhappily so familiar to us in valvular disease with failure, is it not too late to inquire which of the many causes of failure that we have reviewed is at work before us, and from it to estimate the prospect of re- covery ? It is not too late; and I maintain that a correct prognosis is impossible otherwise. Is it rheumatism, or chorea, or physical strain in the lad of seventeen that has changed the healthy-looking youngster of a month ago into this poor sufferer? The question must be deliberately asked and if possible answered. Is it worry, or drink, or exertion, that has broken down cardiac compensation in the same way in this man of thirty-five ? Is it the responsibility and worry of a great business, or the consequent success and self- indulgence ending in disordered metabolism and gout or even Bright’s disease, that is at the bottom of the urgent cardiac symp- toms in the city merchant, who has had an attack of angina in hurrying to business in the morning, although to our knowledge he had had a cardiac murmur without symptoms for the last twenty years ? The correctness of our answer to the anxious inquiries put to us by him and his friends will depend in great part on the trouble we take to ask these questions and to answer them faithfully. But I must stop. You will begin to say by this time that prog- nosis in chronic valvular disease of the heart involves nothing short of universal knowledge. Indeed, this is very near the truth. In chronic cardiac disease, more than in any other disease, there is seen that balance of disease and repair, of disability and compensation, which exists and must be maintained in every damaged individual and every damaged organ if health is to be preserved, and which must be restored if health have been disturbed; and this balance is dependent on every condition and event of life. It is not from a knowledge of etiology and pathology alone that the practitioner is in a position to prognose, but also, and far more in most instances, by that knowledge of man individually and of the world that dis- tinguishes the family practitioner. V .