The Science of Therapeutics - Classical Homeopathy Online

Full text of "The Science of Therapeutics: According to the Principles of Homeopath...Page 332 of 653this compensation is sufficient, the patients are not in any verygreat danger. But if an increase of dyspnoea, a stasis in the pereral circulation, or oedema show that the compensation is incomplete, an approaching termination of the patient's suiFerings maybe safely prognosticated. The prognosis is still worse if valvulainsufficiency becomes associated with stenosis of the left auricuventrieular orifice, as is most frequently the case. Before speakof the treatment, let us dwell a little further on the stenosis oleft auriculo-ventricular orifice.b. Stenosis of the Left Auriculo-ventricular Orifice. ,jA constriction of this orifice interferes with the passage of theblood from the auricle into the ventricle, so that a portion of tblood remains behind in the auricle.This result is superinduced by the following anatomical changes:The valves are thickened, especially at their insertion or base,their segments or lappets are more or less completely soldered together or variously distorted in shape, or the chordae tendinese890 Diseases of the Heart.lie contracted, shrunk and deprived of their elasticity, so thatvalves are drawn down into the ventricle, and their segmentsassume a funnel-shaped appearance. In this way, an ostium naturally large may be reduced to the condition of a mere slit or to tdiameter of a goose-quill or pea.The consequences of stenosis are the same as those of insufficiency of the mitral valves : Imperfect emptying of the left auristasis of the blood in the pulmonary vessels, overcrowding of theright ventricle followed by eccentric hypertrophy as a means ofcompensation, which may increase to such an extent that the tricuspid valve becomes insufficient to close the right auriculoular orifice. The left ventricle receives a smaller supply of blohence, the flow of blood through the arteries becomes less activethe pulse grows very small and feeble. In the course of time thecapacity of the ventricle becomes reduced and its walls becomeatrophied. These changes do not 1;p,ke place if the stenosis is aciated with conditions in the aortic system inviting increased extions on the part of the left ventricle. Even in more remote orgathe stenosis results in the same phenomena of stasis as are consequent upon valvular insufficiency, and generally more rapidly andmore extensively.This lesion is characterized by the following physical signs:Cardiac dulness very extensive in breadth, owing to the oftenextraordinary distention of the right ventricle ; the impulse ofheart is heard over a more extensive area both to the left and tothe right, even as far as the right sternal border, and powerfullshakes the thoracic wall ; the prsecordial region is sometimes arthe flapping of the tricuspid valves is sometimes sensible to thehand; diastolic purring is very commonly perceived at the apex ofthe heart. Auscultation returns a diastolic murmur at the apex ofthe heart, and the first sound is considerably feebler; or if thestenosis is associated with valvular insufficiency, a murmur is hinstead of the sound. The aortic sounds are weaker, the sounds ofhttp://www.archive.org/stream/sciencetherapeu00kafkgoog/sciencetherapeu00kafkgoog_djvu.txt