Case of anomalous cardiac murmur, concurring with fatal cerebral disease / by W.T. Gairdner.

  • Gairdner W. T. (William Tennant), Sir, 1824-1907.
Date:
[1889?]
Catalogue details

Licence: Public Domain Mark

Credit: Case of anomalous cardiac murmur, concurring with fatal cerebral disease / by W.T. Gairdner. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    normal position, and tlie current of blood thus established from the auricle thrusts them hack again so as to give rise to “ a blubbering mur- mur.” The murmur is not, therefore, one of mitral stenosis, inasmuch as the opening is not diseased in any way; but it is, nevertheless, one arising out of mechanical conditions closely allied to mitral stenosis, and as regards their momentary physical and acoustic result, identical with it. Dr. Flint is himself most careful to point out that the theory as now given is in no degree opposed to the current theory of the murmur of mitral stenosis, which still remains intact as the explanation of all but a very few cases. Indeed, the supporters of the current theory have every reason to regard Dr. Flint’s view, should it be iinally established, as a crowning proof that the murmur in question, qua the mitral orifice at least, is a direct, and not a regurgitant, murmur. But can Dr. Flint’s view be regarded as established on the basis of the evidence hitherto produced? It is difficult, I admit, to withstand the force of conviction implied in the statements made in his last article on the subject, and reproduced in Dr. Bramwell’s paper already referred to. But knowing as I do the numerous fallacies which beset the obser- vation of such murmurs, and which dictated the cautious wording of the reports in detail in the case above recorded, I feel bound to add that I am still unconvinced. Indeed, I have at present occasional oppor- tunities of seeing a case which very deafly illustrates these difficulties, and which is in some respects the convei’se of Dr. Byrom Bramwell’s case. The patient is a laboring man who has been in the hospitals both of Edinburgh and Glasgow. In the Royal Infirmar}'- of Edinburgh he was most cai’efully examined, and held to be a case of aortic disease (obstruction and regurgitation). The opinion I formed of the case, on the other hand, was that it is mainly one of mitral stenosis; though not excluding the possibility, or probability, of aortic disease also. The details on which the Edinburgh opinion was founded were placed in my hands, and it is impossible not to feel that the case is one which might possibly corroborate Dr. Flint, although in the meantime I adhere to the diagnosis above expressed. Dr. Byrom Bramwell lately saw this case with me, and, I believe, agrees with me in general terms about it. Were there to be found no mitral obstruction in this case, it would go far to carry Dr. Flint’s conclusion.^ Dr. Bramwell has placed on record a difficulty in the way of adopting Dr. Flint’s theory, which is the very great fre(piency of free aortic re- gurgitation as compared with the rare occurrence of it in connection with the auriculo-systolic murmur. He quotes Dr. Guiteras, of Charleston, S. C., as having stated, in recording a case of this kind, that he believes 1 Careful diagrams of the murmurs in this case, as heard by several ears on different occasions, have been preserved, but in the absence of further evidence as to the facts it does not seem necessary to reproduce them here.