The murmurs of mitral disease / by Edward Mansfield Brockbank.

  • Brockbank, E. M. (Edward Mansfield), 1866-
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The murmurs of mitral disease / by Edward Mansfield Brockbank. Source: Wellcome Collection.

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    More recently (1887) a very important contribution to the discussion was made by Howship Dickinson1 in a paper entitled On the Presystolic Murmur, falsely so called. In this paper, Ormerod's and Barclay's views were supported by very powerful arguments, derived from much clinical experience. It is impossible to do justice to Dickinson's views in a short abstract of his paper, but I may note that one of his strongest reasons for believing that the presystolic is really a ventricular-systolic murmur is the frequently repeated observa- tion, that if a finger be pressed between tbe ribs, particularly in a thin person, and when the heart is not too rapid, and if, at the same time, the double stethoscope be adjusted to the murmur, the beginning of the murmur will be found synchronous with the beginning of the impulse. Dickinson looks upon the short sound which immediately follows the special murmur—up to which the latter runs—as marking the conclusion of ventricular systole. This point as to the exact place in the cardiac rhythm at which the short, abrupt first heart sound occurs, is very important; and as I discuss it fully at a later page, I will only say here, that I believe Dickinson to be in error in placing it at the conclusion of ventricular systole. Dickinson's original papers, On the Presystolic Murmur, falsely so called, appeared in the Lancet, London, in 18872 and 1889,3 and excited considerable correspondence in favour of and against his theories, in which all the authorities on the subject joined; to these pages I beg to refer any reader who wishes for wider references to the literature of this subject than I am giving here. Of recent years a good deal of attention has been paid to the action of the auricle in cases of mitral stenosis. It is stated that in health, instead of ceasing its contraction before that of ventricular systole begins, as used to be thought the case, the auricle may con- tinue to remain contracted after the commencement of the contrac- tion of the ventricular muscle, both auricle and ventricle continu- ing to contract simultaneously until the moment when the sigmoid valves are opened and blood begins to be expelled from the ven- tricle into the aorta. Potain considers that the auricle is in action from the beginning of its systole until the precise moment of closure of the auriculo-ventricular valves—that it is this 1 Occasional Papers on Medical Subjects, 1896, p. 225.