1911 Archives of Pediatrics & Adolescent Medicine  
From a clinical study of fourteen cases of congenital heart disease Walker1 draws the following conclusions: (1) By a careful examination of the physical signs in patients suffering from congenital morbus cordis, it is probable that, with the accumulation of details, such cases will be divided into clinical groups of distinctive types, and that eventually when such clinical groups have been established and the morbid conditions associated with them described, the diag¬ nosis of one lesion from
more » ... of one lesion from the other, and the prognosis based on it, will be possible. (2) Exclusive of other lesions, such as septal defects, there appear to be at least three clinical groups of pulmonary stenosis: I, a. Cases in which the signs seem to indicate a constriction in the neighborhood of the pulmonary valve; high stenosis. I, 6. Cases in which the signs seem to indicate a constriction and incom¬ plete fusion of the infundibulum with the body of the right ventricle; low stenosis. II. Cases in which there are evidences that the ductus arteriosus is also patent. (3) Patent ductus arteriosus may give rise to a water-hammer pulse and capillary pulsation. (4) In many cases of congenital heart disease, and more espe¬ cially when there is evidence of ductus arteriosus patency, an abnormal zone of basal cardiac dulness is present. (5) There seems to be evidence that where pul¬ monary stenosis is accompanied by patency of the ductus arteriosus the symp¬ tomatology is less severe and life more prolonged. (6) A large percentage of cases of congenital heart disease, associated with pulmonary stenosis, give a definite history or family history of rheumatic infection, or a history of cardiac disease in other members of the family. Goodman2 reports a case of patent ductus arteriosus in a boy aged 14, of good mental development, apparently healthy, exhibiting no subjective symptoms of cardiac disease and showing no cyanosis or clubbing of the fingers. He con¬ siders the following points, in this case, of diagnostic importance, but cautions that too much weight should not be placed on any one sign or symptom: Of the physical signs, emphasis is laid on the bulging of the left side of the chest, visible pulsation in the second left interspace and a systolic thrill in the same area not felt elsewhere. Here is to be heard a loud, rasping, grating systolic murmur, appreciated a short distance from the heart, transmitted to the carotids, better to left than to right, and heard well in the interscapular space at the level of the spine of the scapula, and along the vertebral column; hypertrophy of the right and left ventricles with a "band-like area of dulness" along the left margin of the sternum between the second and fourth ribs; pulsus paradoxus; normal pulse tracing; paralysis of left vocal cord; Röntgen-ray confirmation of Gerhardt's dulness. Goodman has collected from the literature seventy-one cases, practically all the cases reported from 1847 to the present time, and has analyzed them from the point of view of symptoms and physical signs. 3. Von Bokay, Z.: Ueber Transposition der grossen Schlagadern des Herzens,
doi:10.1001/archpedi.1911.04100110065007 fatcat:4xcloh2i2jfjdc5puwe3nugzzm