Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . ur and established the ex-istence of mitral regurgita-tion. The aortic systolic bruitand loss of the aortic secondsound, together with the sys-tolic thrill, gave evidence ofstiffness, and perhaps steno-sis of the aortic valves. The absence of a rheumatic history, thepatients age, the late development of symptoms, the moderatearteriosclerosis, and lastly, the heart findings, all seemed to war-rant the opinion that the valvular changes were du
Diseases of the heart and arterial system : designed to be a practical presentation of the subject for the use of students and practitioners of medicine . ur and established the ex-istence of mitral regurgita-tion. The aortic systolic bruitand loss of the aortic secondsound, together with the sys-tolic thrill, gave evidence ofstiffness, and perhaps steno-sis of the aortic valves. The absence of a rheumatic history, thepatients age, the late development of symptoms, the moderatearteriosclerosis, and lastly, the heart findings, all seemed to war-rant the opinion that the valvular changes were due to scleroticendocarditis. The condition of the kidneys was not ascertainedat that time, as the son had not examined the urine, but inasmuchas there was nocturnal micturition, renal cirrhosis was thoughtprobable, and it was advised to have the urine collected for twenty-four hours and examined. In this case I believe the cause lay in the strain to which thevalves of the left heart had been subjected for many years in con-sequence of the abnormal blood-pressure brought about by his ex-cessive consumption of food and alcoholic liquids without suffi-. Fig. 33.—Eelative Dulness, Case ofChronic Endocarditis (p. 201). 24 DISEASES OF THE HEART cient physical exercise. How much, if any, influence can be attrib-uted to tobacco and waste products I cannot say. The influence of strain has long been recognised in the produc-tion of the sclerotic changes now being considered. High blood-pressure, lasting for years, is a cause of valvular as well as ofvascular strain, but inasmuch as the individuals in whom such in-jurious blood-pressure is observed generally lead inactive lives,dine well, and often suffer from indigestion and constipation, it islikely that the products of defective metabolism circulating in theblood act as chemical irritants, and play a not unimportant part inthe development of sclerotic changes. Disease of the aortic valves is frequently observed in menwho pursue labori
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