CASES OF OBSCURE HEART DISEASE. By S. P. ROY, M.B., M.R.C.S. A FEW caaea m my practice appeared to ine for the time being rather ainguiar, and I passed
March, 1887.]
CASES OF OBSCURE HEART DISEASE
75
and been bringing up much thick phlegm aud with as simply cases of heart disease over them rendered obscure by some cause or other. I great difficulty. Prescribed the following :? R was in a state of doubt about them, when my ( Ammonse Carbonas gr. ii. au to article on drawn Masked was attention Spirit Chloroform Heart Disease' published in the Lancet, October a & m. xv. Spirit iEther Sulph. m. 30th 1886. x. Tincture Scillae 5 ss. A perusal of Dr. Hollis' article, mentioned Syrup Tam Infusion Senega} ad 3 i. above, has, however, considerably cleared up a 2 hours. dose confirmed For the notions rather every hazy my doubts,and I had about them. Stimulating liniment to be rubbed on the chest Allow me to relate briefly a few illustrative and fomentation every 2 hours. I assured the friend of the patient, who came for the medicine, cases:? Case No. 1.?Babu G. C., booking-clerk, of the probable recovery of the patient. He E. I. Ry., get. 40, of intemperate habits, died suddenly that night at 1 a.m. Remarks.?The news was shocking enough, dyspeptic and subject to habitual constipation, sought my medical help on the 30th of January and no less surprising to me in the morning. Jast at about 9 p.m. Found the patient in great Reflecting over the case, I came then to the that the patient had had latent heart conclusion on the left side distinctly breathing dyspnoia, disease, aud it had escaped my notice. I am, asthmatic, a few moist rales could be detected. Abdomen tympanitic. Temperature 98*4 F. however, now confirmed iu the opinion (as the Nothing abnormal could be detected about following case would prove) that genuine orthe heart-sounds. ganic disease of the heart may go ou silently Pulse weak, slow, but regular. The patient working its fatal end, and escaping all the while complained much of excessive weakness and the most careful scrutiny of the auscultator or severe pain on the left side of the chest from the only attracting the attention at a stage too armpit downwards. advanced, when perhaps detection is of no avail. For three or four days, previous to my visit, Case No. II.?Saw S. Gr., a)t. 35, ou the 26th had been under treatment of another medical 1886. April Opium eater, used to drink hard, gentleman for the above complaints. Some dyspeptic for several years, and subject to habiopening pills and a stimulating cough-mixture tual constipation. Had been under the treatI gave him every two hours a were given. ment of three other medical men, previous to my mixture composed of aromatic spirit of ammonia,, visit, for more than a month. Had the usual chloric ether, sulphuric ether and henbane, aud palliatives given him for the dyspepsia, flatulence ordered turpentine fomentation aud poultice to (which latterhadof late become very distressing), the abdomen. aud constipation. Felt a little relieved, and could sleep comFound the patient complaining of excessive paratively better in the night. Found him flatulence, dyspnoea, and palpitation. The diffinext morning much better, though still comculty of breathing would come on each time the plaining of excessive weakness and pain in the patient attempted to lie down on the bed. The abdomen still left side of the chest. I listened to the chest, aud examined the tympanitic; last night's fomentation, &c., only heart carefully, but failed to detect auything temporarily relieved it to a slight extent. more than a palpitating heart beating regularly. Ordered soap and water enema; only a small The usual auscultatory signs of morbus cordis quautity of semi-solid dark, almost tarry offen- were entirely absent. Flatulence and dyspnaja sive fecal matter could be washed out. were the chief complaints, and the former The enema, however, gave some slight relief, urgently called for relief. I tried my best to the distressing flatulence recurring as usual. relieve it, but nothing would do so. He remainThe breathing, however, was getting easier. ed uuder my treatment for about a week, till he seemed tired of all English drugs, and called in February ls?.?Found the patient in the a morning (9-30 A.M.) sitting up on a hhatea kabiraj for a chauge as it were. The learned taking some milk and sooji; still complaining liabiraj pronounced the case heart disease, and of the sense of great prostration and same pain treated it accordingly. in the chest. I listened to the chest, and could A couple of days after, the kabiraj came to detect only a few coarse moist rales and cooing me one morning in a great hurry and pressed rhonchi; no adventitious sounds with the heart We me to examine the chest of the patient. beats,atany rateuothiugindicativeof the impendwent to his place, aud found him in a state of active delirium. On listening to^ the chest, I ing fatal issue of the case could I make out, but the whole, and to my best judgment, I on was surprised to find a loud bruit all over the found the patient much better than before. pericardium; the normal sounds were quite Tem. 98*4. masked by the bruit The patient was spitting I was informed in the evening that he had up blood, and was in severe orthopnoea, aud was a distressing sense of tightness across the chest, evidently sinking. He died the night following. ???
???
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76
THE INDIAN MEDICAL GAZETTE.
[March,
1887.
Remarks.?Now this was clearly a case of had been in the full enjoyment of good health* heart disease, where the ordinary physical signs Digitalis and diffusible stimulants, however, Another re-were absent from the beginning, or at least revived her for the time being. occurred on the 30th of November last, lapse fatal end of the not detectable till the very case. The patient had all the usual symp- and the patient rapidly sank under it on the 1st January. This was a remarkable instance toms of chronic dyspepsia, and the ordinary remedies used to relieve him from time to time, of organic disease of the heart, insidiously a fatal course and suddenly developing and, as a matter of fact, he .had been under working all the of the malady at a stage ordinary or less more medical treatment, continuously, for when detection signs availed little. Excessive dyspepsia for about two or three years. I beg flatulent distension of thevery abdomen I have freto draw attention to one symptom particularly observed in connection with disease of quently the This mean I in this case, dyspnoea. dyspnoea the heart. would come 011 each time the patient attempted It may be a prominent and distressing sympAt first only slight till it culmito lie down. tom urgently calling for relief where neither the nated in the agonising orthopncea so common nor is appreciably faulty. I appetite of disease the This heart. to organic tendency have tried digestion my best, but nothing would relieve to come 011 in the recumbent posture is characteristic of the dyspnoea of heart disease ; it is the this obstinate flatulence of morbus cordis. In A practical lesson to bad cases it would come on at any hour of the precursor of orthopncea. be learnt from cases like these, is to take a more day. The patient is perhaps quiet and combut all of a sudden the serious view of so-called dyspeptic troubles than fortable in the morning, is generally done, and to shape our proguosis whole abdomen begins to distend painfully from below upward and threatens to burst, and accordingly. Case No. 111.?R. H., ast. 35, a zemindar. the sufferer is in intense agony for a couple of Habits temperate. Subject to asthmatic troubles hours or so. Gradually, however, the distension for several years, in other respects fairly healthy. subsides, and the patient is comparatively comI was called in during one of his fits of asthma fortable again. Food or digestion, it appears to has no direct and appreciable connection with (1st June 1886.) On examination, I found be- me, it. The appetite may be good and digestion decided well-marked sides mitral disease asthma, of the heart. Flatulence had of late become a tolerable, yet this symptom may be a most distressing one ; and again it may be quite out of rather troublesome symptom. to the quantity of nourishment taken. On further enquiry, I could make out that the proportion on several hours come It (8 to 10) after may heart affection had escaped the notice of his be a troublesome thing quite early former physician. From the day I detected meals ; may Carminatives or stomachics mitral disease (1st June 1886), the case ran in the morning. or no effect on this ; little have purgatives do to bad and in from about three weeks' worse, relieve it, but are no good in bad time the patient sank rapidly with all the sio-ns temporarily cases, where fits of flatulent distension come on of advanced heart disease markedly What may be the cause of 2 or 3 hours. He died towards the morning of 22ud June 1886. every which resists all treatthis symptom distressing One more case and I have done. It is said to be premonitory to cardiac Case No. IV.? Saw an aged lady of about 80, ment ? But why should it be so ? or ascites. in consultation with Dr. Ghose on the 23rd of dropsy should we account for this excessive generHow Found 1886. the November patient suffering of gas in the digestive tube ? Is it due to from great difficulty of breathing which appear- ation tone of the alimentary mucous memof loss ed to be asthmatic. There were auscultatory brane or to deficient secretion of bile, and conof air into obstructed of the air passage signs of the intestinal contubes; a few moist rales too could be detected. sequent decomposition we know, is a distressing tents? Flatulence, would be the Here too dyspnoea aggravated by and one of grave prognosis in jaundice. the recumbent posture. The character of the symptom, flatulence of morbus cordis owe the the Does pulse, however, was remarkable. We could feel same origin ? well-marked dicrotic pulse of moderate strength, This symptom I have observed always debut irregular as well as intermittent. There was towards the advanced stage, or at any velope thus mitral murmur, marked systolic setting rate towards the fatal end of heart disease. It matters beyond all doubt. most distressing about that becomes stage of been The patient had not particularly ill the disease. None of has survived my patients was of what to attack this first until thought more than a month the full development of this be asthma and fever. Dr. Bose had been treatI am, therefore, inclined to look upon symptom. three or two days previing her for fever for as a symptom of very grave it prognosis in heart ously to my visit. The pulse, he said, all of a disease. sudden changed its character. No member of the family had ever heard the patient complaining of any difficulty of breathing, and, in fact, she
developed.
March, 1887.]
CASES OF OBSCURE HEART DISEASE
75
and been bringing up much thick phlegm aud with as simply cases of heart disease over them rendered obscure by some cause or other. I great difficulty. Prescribed the following :? R was in a state of doubt about them, when my ( Ammonse Carbonas gr. ii. au to article on drawn Masked was attention Spirit Chloroform Heart Disease' published in the Lancet, October a & m. xv. Spirit iEther Sulph. m. 30th 1886. x. Tincture Scillae 5 ss. A perusal of Dr. Hollis' article, mentioned Syrup Tam Infusion Senega} ad 3 i. above, has, however, considerably cleared up a 2 hours. dose confirmed For the notions rather every hazy my doubts,and I had about them. Stimulating liniment to be rubbed on the chest Allow me to relate briefly a few illustrative and fomentation every 2 hours. I assured the friend of the patient, who came for the medicine, cases:? Case No. 1.?Babu G. C., booking-clerk, of the probable recovery of the patient. He E. I. Ry., get. 40, of intemperate habits, died suddenly that night at 1 a.m. Remarks.?The news was shocking enough, dyspeptic and subject to habitual constipation, sought my medical help on the 30th of January and no less surprising to me in the morning. Jast at about 9 p.m. Found the patient in great Reflecting over the case, I came then to the that the patient had had latent heart conclusion on the left side distinctly breathing dyspnoia, disease, aud it had escaped my notice. I am, asthmatic, a few moist rales could be detected. Abdomen tympanitic. Temperature 98*4 F. however, now confirmed iu the opinion (as the Nothing abnormal could be detected about following case would prove) that genuine orthe heart-sounds. ganic disease of the heart may go ou silently Pulse weak, slow, but regular. The patient working its fatal end, and escaping all the while complained much of excessive weakness and the most careful scrutiny of the auscultator or severe pain on the left side of the chest from the only attracting the attention at a stage too armpit downwards. advanced, when perhaps detection is of no avail. For three or four days, previous to my visit, Case No. II.?Saw S. Gr., a)t. 35, ou the 26th had been under treatment of another medical 1886. April Opium eater, used to drink hard, gentleman for the above complaints. Some dyspeptic for several years, and subject to habiopening pills and a stimulating cough-mixture tual constipation. Had been under the treatI gave him every two hours a were given. ment of three other medical men, previous to my mixture composed of aromatic spirit of ammonia,, visit, for more than a month. Had the usual chloric ether, sulphuric ether and henbane, aud palliatives given him for the dyspepsia, flatulence ordered turpentine fomentation aud poultice to (which latterhadof late become very distressing), the abdomen. aud constipation. Felt a little relieved, and could sleep comFound the patient complaining of excessive paratively better in the night. Found him flatulence, dyspnoea, and palpitation. The diffinext morning much better, though still comculty of breathing would come on each time the plaining of excessive weakness and pain in the patient attempted to lie down on the bed. The abdomen still left side of the chest. I listened to the chest, aud examined the tympanitic; last night's fomentation, &c., only heart carefully, but failed to detect auything temporarily relieved it to a slight extent. more than a palpitating heart beating regularly. Ordered soap and water enema; only a small The usual auscultatory signs of morbus cordis quautity of semi-solid dark, almost tarry offen- were entirely absent. Flatulence and dyspnaja sive fecal matter could be washed out. were the chief complaints, and the former The enema, however, gave some slight relief, urgently called for relief. I tried my best to the distressing flatulence recurring as usual. relieve it, but nothing would do so. He remainThe breathing, however, was getting easier. ed uuder my treatment for about a week, till he seemed tired of all English drugs, and called in February ls?.?Found the patient in the a morning (9-30 A.M.) sitting up on a hhatea kabiraj for a chauge as it were. The learned taking some milk and sooji; still complaining liabiraj pronounced the case heart disease, and of the sense of great prostration and same pain treated it accordingly. in the chest. I listened to the chest, and could A couple of days after, the kabiraj came to detect only a few coarse moist rales and cooing me one morning in a great hurry and pressed rhonchi; no adventitious sounds with the heart We me to examine the chest of the patient. beats,atany rateuothiugindicativeof the impendwent to his place, aud found him in a state of active delirium. On listening to^ the chest, I ing fatal issue of the case could I make out, but the whole, and to my best judgment, I on was surprised to find a loud bruit all over the found the patient much better than before. pericardium; the normal sounds were quite Tem. 98*4. masked by the bruit The patient was spitting I was informed in the evening that he had up blood, and was in severe orthopnoea, aud was a distressing sense of tightness across the chest, evidently sinking. He died the night following. ???
???
???
???
76
THE INDIAN MEDICAL GAZETTE.
[March,
1887.
Remarks.?Now this was clearly a case of had been in the full enjoyment of good health* heart disease, where the ordinary physical signs Digitalis and diffusible stimulants, however, Another re-were absent from the beginning, or at least revived her for the time being. occurred on the 30th of November last, lapse fatal end of the not detectable till the very case. The patient had all the usual symp- and the patient rapidly sank under it on the 1st January. This was a remarkable instance toms of chronic dyspepsia, and the ordinary remedies used to relieve him from time to time, of organic disease of the heart, insidiously a fatal course and suddenly developing and, as a matter of fact, he .had been under working all the of the malady at a stage ordinary or less more medical treatment, continuously, for when detection signs availed little. Excessive dyspepsia for about two or three years. I beg flatulent distension of thevery abdomen I have freto draw attention to one symptom particularly observed in connection with disease of quently the This mean I in this case, dyspnoea. dyspnoea the heart. would come 011 each time the patient attempted It may be a prominent and distressing sympAt first only slight till it culmito lie down. tom urgently calling for relief where neither the nated in the agonising orthopncea so common nor is appreciably faulty. I appetite of disease the This heart. to organic tendency have tried digestion my best, but nothing would relieve to come 011 in the recumbent posture is characteristic of the dyspnoea of heart disease ; it is the this obstinate flatulence of morbus cordis. In A practical lesson to bad cases it would come on at any hour of the precursor of orthopncea. be learnt from cases like these, is to take a more day. The patient is perhaps quiet and combut all of a sudden the serious view of so-called dyspeptic troubles than fortable in the morning, is generally done, and to shape our proguosis whole abdomen begins to distend painfully from below upward and threatens to burst, and accordingly. Case No. 111.?R. H., ast. 35, a zemindar. the sufferer is in intense agony for a couple of Habits temperate. Subject to asthmatic troubles hours or so. Gradually, however, the distension for several years, in other respects fairly healthy. subsides, and the patient is comparatively comI was called in during one of his fits of asthma fortable again. Food or digestion, it appears to has no direct and appreciable connection with (1st June 1886.) On examination, I found be- me, it. The appetite may be good and digestion decided well-marked sides mitral disease asthma, of the heart. Flatulence had of late become a tolerable, yet this symptom may be a most distressing one ; and again it may be quite out of rather troublesome symptom. to the quantity of nourishment taken. On further enquiry, I could make out that the proportion on several hours come It (8 to 10) after may heart affection had escaped the notice of his be a troublesome thing quite early former physician. From the day I detected meals ; may Carminatives or stomachics mitral disease (1st June 1886), the case ran in the morning. or no effect on this ; little have purgatives do to bad and in from about three weeks' worse, relieve it, but are no good in bad time the patient sank rapidly with all the sio-ns temporarily cases, where fits of flatulent distension come on of advanced heart disease markedly What may be the cause of 2 or 3 hours. He died towards the morning of 22ud June 1886. every which resists all treatthis symptom distressing One more case and I have done. It is said to be premonitory to cardiac Case No. IV.? Saw an aged lady of about 80, ment ? But why should it be so ? or ascites. in consultation with Dr. Ghose on the 23rd of dropsy should we account for this excessive generHow Found 1886. the November patient suffering of gas in the digestive tube ? Is it due to from great difficulty of breathing which appear- ation tone of the alimentary mucous memof loss ed to be asthmatic. There were auscultatory brane or to deficient secretion of bile, and conof air into obstructed of the air passage signs of the intestinal contubes; a few moist rales too could be detected. sequent decomposition we know, is a distressing tents? Flatulence, would be the Here too dyspnoea aggravated by and one of grave prognosis in jaundice. the recumbent posture. The character of the symptom, flatulence of morbus cordis owe the the Does pulse, however, was remarkable. We could feel same origin ? well-marked dicrotic pulse of moderate strength, This symptom I have observed always debut irregular as well as intermittent. There was towards the advanced stage, or at any velope thus mitral murmur, marked systolic setting rate towards the fatal end of heart disease. It matters beyond all doubt. most distressing about that becomes stage of been The patient had not particularly ill the disease. None of has survived my patients was of what to attack this first until thought more than a month the full development of this be asthma and fever. Dr. Bose had been treatI am, therefore, inclined to look upon symptom. three or two days previing her for fever for as a symptom of very grave it prognosis in heart ously to my visit. The pulse, he said, all of a disease. sudden changed its character. No member of the family had ever heard the patient complaining of any difficulty of breathing, and, in fact, she
developed.
