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?]
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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![will not be as to the actual size of the heart, but as to the strength remaining in its walls. A greatlv dilated heart whidi is capable of giving a reco.,'nisable apex beat and fair impulse of right or left ventricle is more to be trusted Uian one which has apparently undergone less change in its dimensiotis, but the movements of wliicli can scarcely be felt at all. Ihere IS always a post^ibility that degeneration may enter into the causation of the symptoms. It is better, again, that t''_e sounds should be strong than weak, spaced than approximated, and it is important lhat the second sound of both ventricles should be well marked. Irregularity of action IS, according to my experience, of less consequence than fre- quency, and I liave learnt not to attach serious importance to the regular alternation of a strong and weak beat, so long as there is no great frequency with it. The pulse is of importance chiefly as an indication of the vigour with which the blood is propelled into the arterial system. Dilatation of the heart presupposes high arterial tension at the time of its ]n-oduction, and it is a favourable sign that a certain degree of this tension persists. When we find a short, small, low tension pulse, uidess tnis is the result of treatment, it means that the heait has not sufficient strength to maintain tlie pressure in the arteries. The probability of improvement or of prolonged immunity from ulterior consequences will next depend on the general condition of the patient, on the soundness and nutritional vigour of his tissues and organs, and especially of his blood- vessels ; if he is weak and ansemiC; on the cause and character of the impairment of health—whether it is inhei'ent or acci- dental, wliether, in effect, it is remediable or not. When the state of the heart and of the general health is attrihutable to alcoholic or othpr excesses, including tlie abuse of tobacco, to habits or mode of life or external conditions adverse to health—whether or not the patient is willing and able to re- nounce his self-indulgence, and relinquish his vices, or alter liis ways and surroundings. Considerations of this kind are of the utmost importance, but there is not time to enlarge upon them here. When we come to consider the treatment of cardiac dilata- tion in this stage, the first question to be aslied is. What object may we venture to set before ourselves ? Wliat assur- ance can we give our patients ? Can we ever reduce existing dilatation ? Can we even arrest the tendency to increase, and avert or postpone the evil consequences? To no question can we return a more confident answer. Every day we see dilatation reduced in some degree in favourable cases, and, at the worst, much can be done to prevent the development of its ill efl'ects. It has already been stated that in the acute aggravation of dilatation which gives rise to symptoms, the apex arid extreme limit of dulness maybe seen to return towards the normal position day by day, and the well named curable mitral regurgitation of Dr. George Balfour is a form of dilatation incident to anfemia. The means to be taken are in the first place the removal of any recognised cause in the habits, mode of life, and sur- roundings so far as this is practicable. Next, to improve the general health bv favourable hygienic influences and by suit- able remedies. The amount of exercise to be taken will be a most important question, but no rule can be laid down ap- plicable to all oases. Speaking generally, exercise is good, and whatever amount of walking cau be done without breath-](https://iiif.wellcomecollection.org/image/b20390129_0030.jp2/full/800%2C/0/default.jpg)
