A Report of 392 Cases of Intubation and 139 Cases of Tracheotomy Done at the Boston City Hospital

Abstract

an aortic régurgitation, were made out, and there were also moist râles above the right clavicle.Case X. William M., aged forty, complained that for one week he had experienced cough and pain in the chest.No other symptoms could be elicited.Examination disclosed moist rales in both bases behind, also a double aortic murmur and a systolic murmur at the apex transmitted into the axilla.Case XL F. S., aged fifty-six, paper-hanger, has had a cougli all winter, with little expectoration, and he also suffers from " sour stomach."The heart is irregular in action and the aortic valve is incompe- tent.Case XII.Daniel S., aged seventy-two, complains of being "sore all over" and "choked up in the chest."He coughs all night, with a mucous expectora- tion.Bread and tea are the chief diet.The pulse is irregular, feeble and intermittent.There is a faint systolic murmur at the apex, transmitted towards the axilla.Pulmonary oedema exists at the bases of both lungs.Of these twelve patients, five had disease of both the aortic and mitral valves, four had mitral régurgitation, one had mitral stenosis, one had aortic régurgitation, and one had both stenosis and incompetence of the aortic valves.Of the C84 cases reported by Sir Andrew Clark, 41 per cent, had mitral régurgitation, 24-]per cent, had aortic stenosis, 14 per cent, had affections of both valves, 9 per cent, had mitral stenosis, 4£ per cent, aortic régurgitation, 3£ per cent, aortic obstruc- tion and régurgitation, and 2£ per cent, mitral ob- struction and régurgitation.According to his experience, therefore, we might infer that mitral régurgitation is the least unfavorable valvular disease, and next to it aortic stenosis ; but different authorities differ widely about this question.Fagge regards aortic stenosis as of the least relative importance, followed by mitral stenosis, next to which but separated by a long interval-come mitral régurgitation and aortic régurgitation.Strümpell believes that aortic régurgitation generally gives the best prognosis, that mitral insufficiency is rather worse, and that worst of all are mitral stenosis and aortic stenosis.If we search for an explanation of these apparent contradictions, we shall find it in the all-iraportant fact that every case of heart-disease must be judged inde- pendently.The crucial test for the heart is its ability to carry on the circulation.Now it is easy to see