On the pathology and treatment of valvular disease of the heart and its secondary affections : being the Gulstonian lectures, delivered at the Royal College of Physicians in February 1851 / by Edward Latham Ormerod.

  • Ormerod, Edward Latham, 1819-1873.
Date:
1851
Catalogue details

Licence: Public Domain Mark

Credit: On the pathology and treatment of valvular disease of the heart and its secondary affections : being the Gulstonian lectures, delivered at the Royal College of Physicians in February 1851 / by Edward Latham Ormerod. 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.

    7/62 (page 7)
    active, especially (to anticipate thus much) rheumatism and the effects of want or in- temperance, it were to be expected tliat the simple difference of age would show a great difference in the results of disease, accord- ing to the predominant action of any one cause diu-ing the particular period. These results are set out in the preceding table. This table shows clearly the preponde- rance of affections of the mitral valve diu-ing the earlier periods. The same ap- pears from Dr. Barclay's table. He takes 34-35 as the point of division, and finds— Lesions. ^ Cases. Mitral. Aortic. Before 34 18 17 15 After 34 61 25 37 agreeing sufficiently with the above re- sults.* What the proportion of diseased to healthy valves at each of these ages may be, I have no means of determining. Of about five hundred dissections, valvular disease of some kind and degree or other was found in one hundred and eighty one cases. But this is probably above the average. For some of these patients were watched for a very long time to obtain an inspection of the heart after their death, and the pains which I myself took, and the assistance I have derived from friends in extending my experience, has been greater in this than in any other form of disease. The results accordingly are disproportion- ate, and unfitted for exact numerical com- parison. Of the conditions above enumerated there are four which have been found to precede, or coexist with, valvular disease, sufficiently often to allow one to think that the occurrence was more than a mere coin- cidence, and to give some means for tracing the nature of the connection, namely, rheu- matism, congenital malformation, want and intemperance, and renal disease. In the annexed table, the two series of cases fatal by valvular disease (a), and of cases pre- senting evidence of valvular disease after death {$), have been kept distinct under their several conditions.f * It is scarcely necessary to do more than in- dicate one circumstance which limits the appli- cation of these tables, namely, that the death of the patient does not commonly occur within ex- actly the same period as the causation of the dis- ease. Many valves, for instance, injured by rheumatism may not come under the hands of the anatomist till extreme old age ; years after the infliction of the injury, t Two cases, namely, one of mitral and aortic No.ofjSeat cases Cause. Rheumatism Congenital mal- formation. Want and in- temperance. Renal disease. ( old. (_ rent, Total. a Total. a .Total. a Total. 21 9 12 42 6 35 41 12 30 42 of the Lesion. 4 22 26 The inference is plain that rheumatism and renal disease coincide with affection of the am-iculo-ventriculai rather than of the sigmoid valves of either side; but of both valves of the left side rather than of either of those of the right. That congenital and one of pulmonary valvular lesion, have been entered under both rheumatism and cong-enital malformation. Some cases entered under renal disease have been also set down under rheuma- tism, and others under want and intemperance. My results difter a little from those of Dr. Barclay. He finds rheumatism (op. cit. p. 190) a cause of valvular disease in 15 out of 79 cases, or 189 per cent. In the cases analysed above, it was found in at least 42 out of 181, or in 23*2 per cent. The lesions in my 42 cases (O,) and in 50 (B,) which Dr. Barclay has analysed, were thus dis- tributed— B. O. In — 4 the mitral, aortic, and tricuspid valves were affected. — 2 mitral and tricuspid. 41 19 mitral and aortic. 5 13 mitral only 4 3 aortic only — 1 pulmonary only. 50 42 From which it would appear that there is not always in acute rheumatism so strong a tendency to affection of both sets of valves on the left side of the heart as occurred in Dr. Barclay's cases. Speaking now of the results of rheumatism as disclosed by dissection at all ages.