Volume 2

The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan.

  • Andral, G. (Gabriel), 1797-1876.
Date:
1836
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Licence: Public Domain Mark

Credit: The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    found on examination of the body, traces of inflammation on the inner surface of the cavities of the heart and great vessels. This inflammation was announced, 1st, by greater or less redness of this internal surface ; 2nd, by a well-marked tumefaction of the parts of the internal membrane constituting the different valves of the auriculo-ventricular and arterial orifices ; 3rd, by the facility with which we sometimes removed, in large shreds, this same inner membrane within the cavities of the heart ; 4th, in some cases by a remarkable softening, an extreme friability in the fleshy substance itself, which was very red aud gorged with blood, and which then participated in the inflammation of the internal membrane. Of these different characters of inflammation, the first only can be disputed. We have elsewhere assigned the motives which incline us to consider as inflam- matory a considerable number of red or brown colourings on the interior of the heart and its vessels. We shall only add here, as an additional motive for con- viction on this matter, that on horses who were opened immediately after they were killed, we have found, either on the inner surface of the heart, or in the arteries, or in the veins, the same shades of colouring, as we have referred in man to an inflammatory state ; now, in this case, cadaveric imbibition could not have acted any part. Let us add also, that more than once, in man, we have found the aorta red only around ulcerations, that is, in those parts where a process of inflam- mation could be no longer called in question. Acute inflammation of the inner surface of the heart and vessels appears then to be the cause, to which we may refer, at least in a certain number of cases, the symptoms above mentioned. Now, these symptoms are precisely' those which develop themselves in certain individuals at the commencement of the organic affection of the heart; we are right then in inferring what might be admitted a 2)riori, namely, that uruler the influenee of internal carditis, the fleshy substance, consecutively or simultaneously irritated, may be hypertrophied, just as the mus- cular tunic of the stomach is thickened after a gastritis. But this hypertrophy of. the heart depends not only on the irritation communicated to its fleshy substance by the inflammation of its inner membrane : if this latter inflammation pass to the chronic state, the membrane which is the seat of it becomes thicker, there par- ticularly where it is doubled to constitute the valves of the different orifices of the heart; for it is a sort of law in pathology, that the circumference of the orifices < of communication in the different cavities of the body is struck by chronic irritation ' with more intensity than the other parts of these cavities. In this case may be enumerated the pyloru.s, the point of junction of the ileum and caecum, the neck of the bladder, &c. Not only does this membrane become thickened, but it also. becomes the seat of vegetations, and various degenerescences. The portions of fibrous tissue w'hich it covers are also thickened ; and there, as in every part where it is attacked with inflammation, this tissue evinces a tendency to pass to the cartilaginous or bony state. These different changes have the common effect of contracting the different orifices of the heart, of opposing the free action of the valves, and consequently of impeding the circulation of the blood; thence a greater effort is made by the muscular fasciculi of the heart, and from this excess y of action, a more active nutrition and hypertrophy. ff The inflammation of the inner membrane of the heart may, like every inflam- ff raation, assume from its commencement a chronic course ; then the time it com- I mences is most frequently not aj)preciable by us, and it manifests its existence only by the hypertrophy of the heart to which it gives rise. But the different course of a disease does not change its nature : whether then the different changes of the inner membrane of the heart be preceded in their formation by manifest | symptoms of inflammation, or whether the latter remain latent, it seems to us I that their cause and primary origin should not be considered as different. Thus , tw'o pleuritic effusions are not considered to be of a different nature, because the I one was preceded or accompanied by pain, dyspnoea and fever, w hilst the other was !