Levi Brown, a cabinet-maker, forty-eight years of age, complained in
February, 1809, of great difficulty of breathing, and an indescribable
sensation in the chest, which he said was sometimes very distressing,
and at other times quitted him entirely. Being a man of an active
mind, he had read some medical books, whence he got an idea, that he
was hypochondriac.
On examining his pulse, it was found to be occasionally intermittent,
contracted, and vibrating. He had some years previously been attacked
with copious haemorrhages from the stomach or lungs, which have
occasionally recurred, though they have lately been less frequent.
Eight years since he suffered from an inflammation of the lungs; and
about two or three years ago he first experienced a beating in the
chest, and pain in the region of the heart, which increased till
within six or eight months, since which the beating has been
stationary, and the pain has much increased. In the course of the last
summer, dyspnoea, on using exercise, and especially ascending any
eminence, commenced. This has greatly increased, so as to render it
almost impossible for him to go up stairs. His countenance is turgid,
and uniformly suffused with blood; his eyes are bright and animated;
his lips livid. The pulsation of the heart cannot be felt on the left
side, and is barely perceptible on the right side of the sternum, and
in the epigastric region. When he is distressed with fits of dyspnoea,
he feels something as if rising to the upper part of the thorax, and
the heart then seems to him to be beating through the ribs. I have not
witnessed any of these paroxysms. The inferior extremities and abdomen
have been swelled about three weeks. When in bed, he has his head and
shoulders elevated, and, upon the attack of his paroxysms, sits up and
inclines his head forward; but he keeps from the bed as much as
possible. In his sleep he is apt to start up, suddenly, in distress,
especially when he first slumbers. His dreams are often frightful,
and, when awake, he is affected with reveries, during which, though
conscious of being awake, strange illusions present themselves. At
intervals he seems slightly delirious. He has a violent cough, with
very copious expectoration of thick mucus. He often suffers from
severe head-ache, and the least exercise produces dizziness.
This man has a very robust frame of body, and has been accustomed to a
free use of ardent spirits, and of opium, of which he now takes about
twelve grains in a day. His appearance is such, that, on a slight
survey, one would not suppose him diseased, but, on observing him with
a little attention, a shortness and labour of respiration are
perceived, with some interruption in speaking, and a frequent catching
of the breath, or sighing.
April. Since writing the above account, the dropsical collections were
absorbed, and the palpitations and other symptoms moderated, so that
he considered himself nearly well, and attended to his usual business.
Within a few days, however, the symptoms have returned with more
violence. The dyspnoea is at times very distressing; the pulse more
irregular and intermittent; the palpitations are more constant. His
sufferings from lying in bed are so increased, that in the most
comfortable nights he passes, he sits up once in an hour or two. The
appetite is keen. The legs begin to swell again.
Some organic disease of the heart exists in this case. The
indistinctness of the palpitations, the want of hardness in the pulse,
and the slow progress of the disease, indicate a loss of power in the
heart, the effect of the distention and thinness of its parietes. The
irregularity of the pulse affords some reason to suspect disorder of
the aortal valves, which is not yet very considerable.
ENUMERATION _of the principal morbid changes, observed in the organization
of the heart, in the preceding cases_.
Enlargement of the volume of the heart, or aneurism.[12]
Increase of the capacity, or aneurism of the right auricle, } with
of the right ventricle,} thickened,
of the left auricle } or thin,
of the left ventricle, } parietes.
of the aorta, with thickening of
its coats.
Fleshlike[13] thickening of the mitral valves.
of the aortal valves.
of the aorta.
Cartilaginous thickening of the internal membrane of the heart, and
generally of its valves.
Ossification of the parietes of the heart.
mitral valves.
aortal valves.
aorta.
coronary arteries.
[Footnote 12: Morgagni uses this term, which he borrows from
Ambrose Pare, to express dilatation of the cavities of the
heart. It seems to be as applicable to the dilatation of the
heart, as to that of an artery. I have therefore adopted it
in this enumeration.]
[Footnote 13: The term fleshlike is employed to express that
roughness of the valves, which somewhat resembles flesh in
its appearance, but which is very different from the
thickening of the parietes of the heart.]
ENUMERATION _of the principal morbid appearances, observed in these
cases of disease of the heart, which may be considered secondary_.