Memoir on the influence of hypertrophy and dilatation on diseases of the heart : and on some points in their diagnosis and treatment / by A. Halliday Douglas.

  • Douglas, Andrew Halliday, 1819-1908.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: Memoir on the influence of hypertrophy and dilatation on diseases of the heart : and on some points in their diagnosis and treatment / by A. Halliday Douglas. 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.

    22/54 (page 18)
    the heart; but they show that transformation had taken place in that part of the heart where the true aneurism or partial dilatation existed, and that that transformation was antecedent to the formation of the true aneurism, because it existed in parts where dilatation had not as yet occurred ; and in regard to the sacculated aneurisms, the saccules which existed in both cases indicate that they may occur without any so peculiar and complete transformation of the tissues as appeared to precede the true aneurisms. If these inferences from the facts of the cases are admitted, it may be stated, in general terms, that the occurrence of true aneurism is determined in a great mea- sure by the transformed state of the tissues; and that the sacculated aneurisms, though they may be preceded by a similar transformation of the tissues, appear to have other causes, and may arise where no adequate transformation exists. These sacculated aneurisms, how- ever, probably tend to induce absorption of the tissues in a greater degree than the true aneurisms do—causing the thin fibro-membran- ous sac walls. It has been already shown, that the effects of these aneurisms are very much in proportion to the degree in which they cause increased capacity of tlie heart; now, the small size of many of these sacculated aneurisms, even when very prominent, will probably render their duration so much longer than that of the true aneurisms, as to give time for more advanced changes in the tissues involved in their formation. The fibro-cartilaginous state of the parts in the vicinity of these sacs is a further evidence of this. Ulceration has been supposed to determine, in some degree, the seat and development of sacculated aneurisms ; but there is a want of facts substantiating this; and in neither of the preceding cases was there any good reason to believe that ulceration of the endocardium had existed. Several of the rudimentary saccules were still at a stage of their formation, in which the effects of ulceration would have been apparent if it had ever existed. Their surface, however, was continuous with the endocardium ; and in some of them the margins of the orifice were formed by muscular bundles,•! it tie altered, and having no appearance of ulceration. In the interior of the aneurismal sac, in the case Stewart (VI.), there was a patch which, from the sloughy state of its surface, and from its sharp, abrupt edges, with dis- coloration, almost justified the opinion that it was an ulcer, but this was doubtful. The loss of substance was not apparent; but this por- tion of the sac had an additional depression, as it were, of a com- mencing dilatation. The only inference which these facts admit of is, that the sacculated aneurism occurs without antecedent ulcera- tion. Pericardial adhesion existed in both these cases. It was very li- mited in the case Stewart (VI.); and it was seated at the posterior surface of the heart. In the case Sheriff (V.) it existed anteriorly, and was extensive. I am disposed to think that undue importance has been attached to adhesion of the pericardium, from the supposition that it tends