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
Catalogue details

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.

    53/215 (page 259)
    ® lit is in cases of this kind that copious bleedings are often of the greatest service. ^ ' means of them we have seen a patient who appeared to be in the last gasp iLually restored to life. The extremities had already lost their heat ; the eyes rre dead, the face livid, the respiration accompanied with a rale, the pulse oegular, intermittent and scarcely perceptible ; in a few hours the patient was iiing in a state of asphyxia ; but scarcely did the blood commence to flow through large opening in the vein, when the suffocation lessened, the skin lost its livid Idour, the extremities again became warm, and the pulse rallied, &c. The cause tthe asphyxia in this case being known, it may be readily understood how the i lden abstraction of a great quantity of blood may be attended w’ith such bene- li. al results. This is a proof, among many others, that the indication of bleeding, ddiseases, must be often derived less from the nature of the symptoms which esent themselves, than from the knowledge of the lesion on w'hich these symp- ms depend. IThe dyspnoea often precedes for a long time all the other general signs of diseases tthe heart; this particularly happens, when it is connected with hypertrophy of : ventricle, with dilatation or diminution of its cavity, any obstacle whatever to ;; free passage of the blood existing at the aortic orifice. In the case, on the nntrary, where the disease exists primarily in the right cavities of the heart, traces lidropsy are observed to appear before the respiration has become perceptibly bbarrassed. rrhe dyspnoea depending on a simple affection of the left ventricle, may first iinifest itself only at intervals ; it is observed every time, for instance, that a Biital emotion accelerates momentarily the beats of the heart, or after violent unusual bodily exercise ; afterwards it returns more frequently and without an : preciable cause ; at a later period, in fine, it becomes continued : there then ssts permanent embarrassment in the pulmonary circulation ; consecutively to <s habitual Impediment to the course of the blood, the right cavities of the heart « uy be dilated, their parietes may become thickened ; and thus it may be easily nceived how the disease of the heart, at first limited to the left ventricle, may :tend to all the parts of the organ. lln persons of advanced age, there may be hypertrophy of the left ventricle, with isater or less obstruction at the aortic valves, without the breathing undergoing, a long time, a perceptible embarrassment. (The affection of the heart is i.aerwise announced in this case, either by the impulsion, which is perceived in I s precordial region, or by the intermissions and great irregularity of the pulse.) iue preservation of the freedom of breathing in old people depends probably, t,;, on the diminution of the entire mass of blood ; 2nd, on the less rapidity of ej circulation. However, w'hether it is that the hypertrophy of the heart con- . ues to increase, or its contraction becomes less energetic, there comes a period, aen the breathing commences to be no longer performed with so much freedom ; esc old people soon become asthmatic, then the lower extremities begin to be ililtrated. Sometimes at the moment w’hen this infiltration manifests itself, the spnoea sensibly lessens : is it because the quantity of liquid left by the blood in j cellular tissue so far diminishes the quantity of that which must pass through lung ? But this sort of amendment in one of the most dangerous symptoms is tt temporary. The difficulty of breathing and the dropsy then increase in a larly equal proportion, and death soon takes place. We have already discussed J important question, as to how far it was rational, in cases of this kind, always I have recourse to a debilitating treatment. Abstracting from all theoretical planation, it is certain that in more than one old person placed in the circum- j,j inces above described, w'e have seen the dyspnoea become less, and the dropsy ^appear, at the same time that strong stimulating applications were made the skin, and either tonics, such as quinquina and wine, or different diuretic mulants, such as the preparations of squill, were given internally. K