Structural diseases of the heart considered from the point of view of prognosis / by W.H. Broadbent.

  • Broadbent, W. H. (William Henry), Sir, 1835-1907.
Date:
[1891?]
Catalogue details

Licence: Public Domain Mark

Credit: Structural diseases of the heart considered from the point of view of prognosis / by W.H. Broadbent. Source: Wellcome Collection.

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    and the absence or existence of disease of any other import- ^i^L f^'?*^^' especially of the kidneys and liver. The patient's cueertulness, hopefulness, and courage under his sufferings, or his despondency, will make powerfully for or against him, not only as direct influences, but because the state of mind IS often an index of the state of the system. Another inquiry of great prognostic weight will be as to th& patient 8 family history. It is through this that we obtain an Idea of his vital tenacity and of the trustworthiness of hia tissues, and sometimes of the special liabilities of his heart, lliere are few tendencies which run more strongly in families than tliose wlueli are manifested in the heart and vascular system, whether to high arterial tension with the effects on the vessels and heart, which follow from this, or to dilatation and weakness, or to degeneration, and a prognosis, otherwise not unfavourable, might have to be instantly revised on learning that the father and an uncle or two, or a brother, had died at about the patient's acre from heart disease. Finally the response to treatment will speedily afford an indication of the utmost value, and this, the treatment, may be de- scribed at once. In the treatment of advanced symptoms due to dilatation of the heart, we have to deal at the same time with defective propulsive power on the part of the ventricle, and damming^ back of blood in the venous system—the former being the primary and principal difficulty—and the indications are to- relieve the ventricles of work and give them strength, and at the same time to deplete the venous engorgement. This last object must, indeed, be taken first. We must undo the consequences of the original departure from the normal condition backwards and reach causes through effect; the venous stasis and the distension of the right side of the heart being the ultimate effects. Venesection, the most eifeetual means of relieving the right side of the heart, is very rarely applicable in dilatation. It is conceivable that under some pulmonary complications result- ing from chill, the engorgement of the right ventricle and auricle might be such as to make blood-letting the less of two dangers ; but, the initial fault being weakness of one or both ventricles, we cannot trust the heart to adjust itself to a rapid change of any kind, and the right ventricle may not be in a condition to lake advantage of the relief afforded it. Usually, however, the venous engorgement is developed slowly, and the indications for venesection do not arise. The application of six or eight leeches over the liver is safer, and it will usually eflfect all that can be done by direct abstraction of blood. The indication for this local bleeding is enlargement of the liver and, when this is considerable, it rarely fails to afford striking relief. Very frequently, for example, the patient, who has previously been tortured by sleeplessness, will sleep at once and sometimes for a night or two afterwards. The reason for selecting tlie hepatic region for the application of the leeches is simply that pain and tenderness felt there are relieved ; it is not supposed that blood is drawn from the liver, or that the same amount ab- stracted elsewhere would not be equally efficacious, ihe leeches will be followed by a hot poultice, which, besides en- couraging the bleeding, will bring blood to the surface. When the liver is not enlarged, and especially if the right ventricle impulse and sounds are weak, there is no advantage to be gained by leeching.