ÆSCULAPIAN SOCIETY

1898 The Lancet  
Cases. A MEETING of this society was held on Oct. 21st, the President, Dr. JAMES F. GOODHART, being in the chair. Dr. ROBERT MAGUIRE showed a case of Congenital Affection of the Heart in which he thought the lesion was imperfection of the septum ventriculorum. This was so far the most common of the congenital defects of the heart causing symptoms, that all others might for clinical purposes be ignored. Even in the absence of cyanosis the condition of the heart could be diagnosed by the physical
more » ... sed by the physical signs and especially by the character of the systolic murmur which was always present and which, Dr. Maguire asserted, was always heard best along the line of the interventricular septum, diminishing rapidly in intensity when this line was left, even though the murmur could still be heard in every part i of the chest. Dr. Maguire stated that imperfection of the septum might be due to two causes: (1) intra-uterine endocarditis affecting the pulmonary orifice and so preventing, by increased tension in the right ventricle, the due formation of the septum; or (2) deficient developmental energy during the formation of the septum, without any cardiac disease. These two conditions, he asserted, could be diagnosed clinically, for while in the second condition there was present merely the murmur he had described, in the first there was also observed a continuation of the murmur to the left along the line of the pulmonary artery. The occasional absence of cyanosis in such cases was due to the fact that the tension in the left ventricle might be sufficient to prevent access of venous blood to its own cavity, admixture taking place only in the right ventricle, where it was of no consequence. When, however, by reason of bronchitis or some similar respiratory trouble, the tension in the right ventricle was increased, venous blood passed through the septal opening on to the left ventricle and caused cyanosis. It was wonderful how great a deficiency of the septum was compatible with life. In one case which he had observed for some eight years, and in which cyanosis often disappeared for considerable periods, he had found at the necropsy practically only one ventricle, the septum being represented by a small semilunar ridge near the apex of the heart. Dr. MAGUIRE also showed a case of Congenital Heart Disease and made remarks on the varieties of such malformations. Dr. Gow expressed surprise at the statement that the disease was so rare, He inquired whether the unilateral clubbing observed in cases of one-sided chest lesions, such as collapse of the lung from old empyema, was of the same nature as the cases exhibited. Dr. LESLIE THORNE, referring to Dr. Maguire's remarks on congenital heart disease, asked him if he would kindly explain his reason for diagnosing previous intra-uterine inflammation in cases where the systolic murmur was conducted along the line extending from the second left costal cartilage upwards and outwards towards the left clavicular region, and congenital malformation where the murmur was not so conducted. Dr. A. P. LUFF showed a case of Great Enlargement of the Spleen due to Hyperplasia and Fibrosis. The patient, a woman, aged fifty-three years, was first admitted into St. Mary's Hospital in June, 1896, when the spleen reached on the left side to the left anterior superior spine of the ilium and on the right side 1 in. to the right of the umbilicus. Since then it had gradually enlarged until at the present time it reached from 2 to 3 in. to the right of the umbilicus and downwards to the brim of the pelvis. For the past two and a half years the red blood corpuscles had averaged from 2,700,000 to 3,540,000 per hsemic unit while the proportion of white corpuscles to red had throughout been normal. There was no history of ague, malaria, of syphilis. The liver and lymphatic glands generally_were normal. The PRESIDENT alluded to the acute arthritis which sometimes complicates phthisis and is usually regarded as rheumatic. He asked whether the first conditions in Pulmonary Osteo-arthropathy might not be due to similar but chronic forms of arthritis. He drew attention to the analogy between acromegaly and pulmonary osteo-arthropathy and asked whether changes in the pituitary body had been found in the latter affection. Dr. LEONARD GUTHRIE showed, for Dr. JAMES TAYLOR, a boy, aged seven and a half years, suffering from the congenital form of Myopathy. His parents were then healthy. The patient was the youngest of four, of whom the eldest was alive, aged twelve and a half years. The others died shortly after birth. The patient was a full-term child. He could not walk until he was five years of age and could never walk more than a few steps. His legs had not become thinner lately but his arms had wasted. He could never use a knife and fork. He was mentally bright. There was no facial affection. The special senses and sensation, the heart, the lungs, and the sphincters were normal. Movements of the head and neck were normal. There was no local enlargement of the muscles of the arm, but all were small. The middle and lower parts of the trapezii were wasted. The upper parts were normal. -The supra-and infra-spinous fossæ were flattened on both sides. There was complete atrophy of both pectorales majores except a few of the lowest fibres. on the left side. The serrati magni were small on both sides. The latissimi seemed absent on both sides. The diaphragm and intercostals seemed normal, the abdominal muscles werefair, and the spinal muscles were weak. The legs were very weak. He could carry out all movements as he lay in bed, but very feebly. He could only walk a few steps. The muscles of the leg were all very small and the knee-jerks. were absent. Mr. STANSFIELD COLLIER showed a man, aged seventythree years, who after recovering from prostatectomy was suddenly seized with Pain in the Left Eye accompanied by proptosis. The symptoms subsided but again returned, and at the present time there was considerable protrusion of the left eyeball, together with the presence of a firm, tender swelling in the left temporal region. The fundus oculi was normal. His mental condition had recently deteriorated, but otherwise there were no definite cerebral symptoms. Mr. Collier believed that the swelling in the temporal region was malignant and that the sudden onset of symptoms was occasioned by hæmorrhage into a new growth.-The PRESIDENT agreed that a new growth probably existed in Mr. Collier's patient. He alluded to the case of a public speaker who was suddenly attacked by pain in the head with marked proptosis whilst in the act of addressing a meeting. A loud bruit was audible all over the skull and he (the President) believed that an arterio-venous aneurysm had formed in the neighbourhood of the cavernous sinus. Mr. COLLIER also showed a young girl suffering from Con-
doi:10.1016/s0140-6736(01)82794-x fatcat:ttzwwkzaufaj3nma5uk7t5tbdi