Lancet-Clinic Volume 112, No. 14 (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1914 Excerpt: ...left auricle in withstanding the back pressure of the mitral lesion. Whereas in the case of an aortic valve lesion the wall of the left ventricle really has to bear the brunt of the abnormal blood flow. Consequently if stenosis intensifies the dilating effect of the regurgitation on the wall of the left ventricle, there is nothing back of it but the left auricle to help out the ventricle, and when the mitral valve once yields to the dilating force expended on the ventricle, the result is disastrous. Consequently I should regard a combined aortic ob struction and insufficiency as offering a grave prognosis. Two or more lesions at different orifices are of very grave prognosis and would not warrant insurance even as a defective risk. In determining the prognosis of any valve lesion something more is required than a mere examination of the heart and general circulatory system. Inquiry should be made into the occurrence or not of rheumatic symptoms, for if these are experienced there is somewhere a focus of infections, and this seriously influences prognosis. The prognosis is further affected by focal infections through the possibility of their leading to septic endocarditis, this being particularly true as regards the faucial tonsils and hence recurring attacks of tonsillitis. The man of seventy-two mentioned above has died recently of septic endocarditis, orginating probably in acute tonsillitis. So-called grippe attacks as well as mouth diseases that belong to the province of dentistry also come under the category of focal infections which predispose to malignant endocarditis. In estimating the prognosis of chronic heart disease one must likewise take into consideration the occupation and habits of the applicant. Vocations entailing but slight physical exert...