Cases of Organic Diseases of the Heart E-Book

Warren

• Herausgeber: Science & Technology Publishing
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 68

Veröffentlichungsjahr: 2025

Beschreibung

Cases of Organic Diseases of the Heart by John Collins Warren is a seminal medical text first published in the early 19th century, offering a comprehensive exploration of cardiac pathology as understood in its era. Drawing from his extensive clinical experience, Warren meticulously documents a series of case studies detailing the symptoms, progression, and post-mortem findings of patients suffering from various organic diseases of the heart. The book delves into conditions such as valvular disease, hypertrophy, pericarditis, and other structural abnormalities, providing detailed observations on the physical manifestations and diagnostic challenges associated with each. Warren’s approach is both scientific and compassionate, emphasizing careful observation, thorough patient histories, and the importance of autopsy in understanding the true nature of cardiac ailments. He discusses the limitations of contemporary diagnostic tools and treatments, while also highlighting the advances made in the field. The text is enriched with clinical anecdotes, comparative analyses, and references to the work of other leading physicians of the time, situating Warren’s findings within the broader context of medical knowledge. Intended for physicians, students, and scholars, Cases of Organic Diseases of the Heart serves as both a practical guide and a historical document, reflecting the evolving understanding of heart disease in the pre-modern era. Its detailed case reports and methodical reasoning make it a valuable resource for those interested in the history of medicine, cardiology, and the development of clinical practice.

Leseprobe

CASESOFORGANIC DISEASESOF THE HEART.

WITH DISSECTIONS AND SOME REMARKS INTENDED TO POINT OUT THE DISTINCTIVE SYMPTOMS OF THESE DISEASES.

READ BEFORE THE COUNSELLORS OF THE MASSACHUSETTS MEDICAL SOCIETY.

BY JOHN C. WARREN, M. D.

BOSTON: PRINTED BY THOMAS R. WAIT AND COMPANY. COURT-STREET. 1809.

PLATE I.

Appearance of the valves of the aorta in Case 3d, Article 10.

a a The two valves thickened.b b Bony projections, one of which extends across the cavity of the valve.c The orifices of the coronary arteries.d d Fleshlike thickening of the aorta.

PLATE II.

Is a representation of the fleshlike thickening of the aorta in case 7th. The valves are smaller than usual, and their form is in some degree changed. A round spot, thickened, is seen at a little distance from the seat of the principal disease.

CASES OF ORGANIC DISEASES OF THE HEART,WITH DISSECTIONS.

Morbid changes in the organization of the heart are so frequent, as to have attracted the observation of those, who have devoted any attention to the study of morbid anatomy. Derangements of the primary organ of the circulation cannot exist without producing so great disorder of the functions of that and of other parts, as to be sufficiently conspicuous by external signs; but, as these somewhat resemble the symptoms of different complaints, especially of asthma, phthisis pulmonalis, and water in the thorax, it has happened, that each of these has been sometimes confounded with the former[1]. The object of the following statement of cases is to shew, that, whatever resemblance there may be in the symptoms of the first, when taken separately, to those of the latter diseases, the mode of connection and degree of those symptoms at least is quite dissimilar; and that there are also symptoms, peculiar to organic diseases of the heart, sufficiently characteristic to distinguish them from other complaints.

CASE I.

The symptoms of organic disease of the heart are marked with extraordinary clearness in the following case. The opportunity for observing them was very favourable; and there was every incitement to close observation, which could arise from the important and interesting character of the patient. These advantages will justify an uncommon minuteness in the detail of the case; especially, as the most accurate knowledge of a complaint is obtained from a successive view of its stages.

The late Governour of this commonwealth was endowed with most vigorous powers of mind and body. At the age of sixteen he was attacked with fits of epilepsy, which first arose from a sudden fright, received on awaking from sleep in a field, and beholding a large snake erecting its head over him. As he advanced in life they became more frequent, and were excited by derangement of the functions of the stomach, often by affections of the mind, by dreams, and even by the sight of the reptile which first produced the convulsions.

At the commencement of the American revolution he became deeply engaged in public affairs; and from that time devoted himself to intense application to business, with which the preservation of his health was never allowed to interfere. In the expedition against Rhode Island, an attack of inflammation of the lungs had nearly proved fatal to him.

In the beginning of the year 1807, he suffered severely from the epidemic catarrh; and a remarkable irregularity of the pulse was then perceived to be permanent, though there is some reason to believe, that this irregularity had previously existed, during the fits of epilepsy, and for a few days after them. In the summer, while he was apparently in good health, the circulation in the right arm was suddenly and totally suspended; yet, without loss of motion or sensation. This affection lasted from noon till midnight, when it as suddenly ceased, and the circulation was restored. In the autumn he was again seized with the influenza, which continued about three weeks, leaving a troublesome cough of two or three months’ duration, and a slight occasional difficulty of breathing, which at that time was not thought worth attention. Soon after, in November, he had one or two singular attacks of catarrhal affection of the mucous membrane of the lungs, which commenced with a sense of suffocation, succeeded by cough and an expectoration of cream coloured mucus, to the quantity of a quart in an hour, with coldness of the extremities, lividity of the countenance, and a deathlike moisture over the whole body. These attacks lasted six or eight hours, were relieved by emetics, and disappeared, without leaving a trace behind.

At this time he began to complain of palpitations of the heart; yet, it is probable, that he had been affected with these before, since he was unaccustomed to mention any complaint, which was not sufficiently distressing to require relief. He experienced a difficulty of respiring, as he ascended the stairs, and became remarkably susceptible of colds, from slight changes of clothing, moisture of the feet, or a current of cold air. His sleep was unquiet in the night, and attended with very profuse perspiration; and, in the latter part of the day, a troublesome heaviness occurred. The sanguiferous vessels underwent an extraordinary increase, or, at least, became remarkably evident. The pulsation of the carotid arteries was uncommonly strong; the radial arteries seemed ready to burst from their sheaths; the veins, especially the jugulars, in which there was often a pulsatory motion, were every where turgid with blood. The countenance was high coloured, and commonly exhibited the appearance of great health; but, when he was indisposed from catarrh, this florid red changed to a livid colour; which also, after an attack of epilepsy, was observable for two or three days on the face and hands. This livid hue was often attended, under the latter circumstances, with something like ecchymosis over the face, at first formidable in its aspect, and gradually subsiding, till it had the general appearance of an eruption, which also soon vanished.

These symptoms increased, almost imperceptibly, during the five first months of the year 1808. Much of this time was passed in close application to official duties; and it seemed that a constant and regular occupation of the mind had the effect of obviating the occurrence of any paroxysm of disease, as well of epilepsy, as of difficult respiration; and that a very sudden and disagreeable impression generally produced either one or the other. There were, indeed, independently of such circumstances, some occasional aggravations of those symptoms. Some nights, for example, were passed in sitting up in bed, under a fit of asthma, as it was called; sometimes the mind became uncommonly impatient and irritable; the body gradually emaciated; yet the appetite and digestive functions remained principally unimpaired; and persons around were not sensible of any material alteration in the condition of the patient.

On the approach of warm weather, in June, the violence of the symptoms increased. Paroxysms of dyspnœa occurred more frequently, and were more distressing. They commenced with symptoms of slight febrile affection, such as hot skin, hard, frequent, and more irregular pulse, disordered tongue, loss of appetite, and derangement of the digestive functions. This kind of paroxysm lasted two or three days. Evacuations of blood from the nose and hæmorrhoidal vessels, which before rarely occurred, became frequent; a fulness at the upper and right side of the abdomen was sometimes perceptible, formed apparently by temporary enlargement of the liver; the difficulty in ascending an eminence increased sensibly. In the intervals of these attacks, which were variable, but generally continuing ten or twelve days, the strength was frequently good, and accompanied by a great flow of spirits, and an aptitude, or rather ardour, for business.

Such was the course of this complaint until the latter part of August, when a very severe paroxysm occurred. It commenced, like the former, with febrile symptoms, but those more violent than before. The countenance became high coloured; the dyspnœa excessive, and rendered almost suffocating by a slight movement, or attempt to speak; the pulse hard, very irregular, intermittent, and vibrating; and the digestive functions were suspended. These symptoms soon increased to the highest