A case of traumatic endocarditis / A. Herzfeld.

  • Herzfeld, Alfred Abraham.
Date:
1906
Catalogue details

Licence: In copyright

Credit: A case of traumatic endocarditis / A. Herzfeld. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    be clearly made out. It seemed to be a continuous murmur. The region of the chest, bounded by the right border of the sternum, the middle axillary line, the third rib below and the epigastrium below, was pulsating so violently that the heart action was plainly visible at a distance. The heart dullness corresponded with this area of visible pulsations. The apex beat appeared to be between the anterior and middle axillary lines in the seventh intercostal space. On the next day, when saw the patient in consultation with Dr. i. Adler, his gen- eral condition and heart action had not changed. No fluid was found in the pericardium. Patient had partially regained his consciousness, but was still very apathetic and listless. Treatment.—The treatment consisted in the application of the ice bag over the heart and internally five drops of tincture of opium every two to three hours. On the third day one drop of the fluid extract of digitalis every two to three hours was added. As the patient could not stand the pressure of the ice bag we resorted to icy cold water applications. Under this treatment the acute symptoms subsided, and the fourth day after the injury the heart action became more regular; the pulse now was 140, small and easily compressible. A loud blowing systolic murmur could be easily heard over the region of the apex beat, which was transmitted to the left and be- hind. The heart sounds over the aortic, pulmonary and tri- cuspid valves were not quite clear, but no murmur could be heard the digitalis treatment was continued, but the dose was reduced to one drop three times a day. Further Examinations.—On June 28 the boy was allowed to sit up in bed. A careful examination of the heart on that day still revealed the same loud systolic murmur over the mitral valve. The sounds over the other valves were perfectly clear and normal. The digitalis treatment was continued one to two drops a day and when, after an extended absence from the city, I saw the patient again on Oct. 25, 1903, I found his general condition much improved, pulse 120 and his heart smaller. In addition I could now hear a loud diastolic and faint systolic murmur over the aortic valve which were not present at the time when I left the patient in June. I did not see much of the patient during 1904, as he had been taken to the country apparently improved. I saw him again on Jan. 4, 1905, when he showed the signs and symptoms of an in- fluenza. During the attack the heart again became insufficient, and fluid extract of digitalis was again given. The most prominent symptoms during this influenza attack was the very marked dyspnea. Patient improved again and on Feb. 27, 1905, I showed him at a meeting of the Society of German Physicians of New York. At that time he was pale, anemic and poorly nourished. He was restless, easily excited and for a few weeks had showed distinct choreic movements. Nothing abnormal could be discovered in the lungs, but on deep respiration the