The relative importance of valvular and muscular lesions in diseases of the heart / Solomon Solis-Cohen.

  • Solis-Cohen, Solomon, 1857-1948.
Date:
[1901]
Catalogue details

Licence: In copyright

Credit: The relative importance of valvular and muscular lesions in diseases of the heart / Solomon Solis-Cohen. 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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    nized, and is significant in diagnosis. Duplication of the first or second sound may be developed. Gallop rhythm is never an early sign, but its evidence of muscle-weakness is always clear, whether in uncompli- cated myopathy or in failure of compensation in cases of valvular lesion. Intermittence, even to asystole, is also significant, yet one may watch and wait for three or four minutes before he notes the dropping of a single beat, either with the finger at the wrist or with the ear over the apex, and then several beats may be dropped in a minute, sometimes as many as one beat in every four or five. Sometimes the patient himself has a sensation of stoppage of the heart, and his may or may not be accompanied with an actual intermission. It may take place frequently or but rarely. In one of my cases it was said to occur but once a day. With the patient quiet, whether recumbent or seated, or even standing, there may be neither intermittence nor irregularity; yet slight exertion, or even change of position, induce both. Among the symptoms on which I am acustomed to lay stress in the diagnosis of myopathy is undue readiness to change in the frequency or character of the pulse on slight change in the position, activity, or emotion of the patient. The volume, tension and strength of the pulse vary greatly in different cases or in the same case from day to day, and are, of course, affected by the presence or absence of concomitant disease of the arte- ries, the latter being usually present. They vary much, also, under medication, more, perhaps, than in uncom- plicated valvular disease. Murmurs are sometimes pres- ent, constantly or inconstantly, due not so much to sclerotic changes in the valves—although these doubt- less occur at times in connection with the sclerotic changes in the parenchyma of the heart—as to relative insufficiency. For complete closure of the cardiac orifices the valves alcne do not suffice. The musculature, not only of the auricular and ventricular walls, but also the papillary muscles, must act perfectly, in order to secure complete occlusion of an orifice in systole. Failure to accom- plish this gives rise to adventitious sounds. Sometimes these are so marked that the incorrect diagnosis of val- vular lesion is difficult to avoid.