Hernia of the Caecum
Authors: F. Treves
Journal: BMJ (1887)

lai(d himn aside for several months.Two years after this another ott-ack occurred.Fifteen years ago he was carefully examined by a medical man, who told him ho had heart-disease.For all these years this main had followed his occupation-not so hard lately, he admits, as formerlywithout in the least having suffered from the effects of this lesion.His only complaint is that he suffers from flatulence, and at sense of fulness after eating.His pulse varies from 70 to 74 a tracing of it shows the tidal wave carried above the percussion, indi- cating, therefore, firm arterial tension.And if I might be allowed to quote a third case, it is that of a manager of a public-house, whom I was asked to see a year ago, as he was suffering from gout.His urine, beyond being extremely acid was healthy.On asking to examine his heart, he laughed, and toid me I would find something there, as years before he was told he had a peculiar affection of the heart, which, he said, was spoken of as "double action."To my astonishment I found aortic and mitral regurgitation, great heaving of the chest and vessels of the neck.And what was his history?Twenty-four years ago he met with an iDjury whilst in Edinburgh, for which he was taken to the infirmary, and his fractures treated under the direction of Professor Syme.On his recovery he was examined by Drs.Heron Watson and Gillespie, as well as others, and was after- wards, on account of his heart, made the subject of a clinical lecture in the theatre of the infirmary.His pulse is under 70, and is anacrotic.and, from the day on which he was told that he had a heart-affection, lie had suffered no inconvenience from it whatever.F,om a review of the life history of the above cases, therefore, and of others that have done well under treatmenit, or lasted more than five years without aiy serious symptoms, I am inclined to think that, all things being e(qual-good home, good food, regular rest, and tem- peranlee in the use of alcohol-the occupation of the individual has influenced but very little the after history of the case.For all that, however, we must reg,ard rest as very essential.And yet, at the present time, I know of a few youncg ladies who, a few years ago, were unider my care, some for mitral stenosis, others for mitral regurgita- tion, who, in winter, skate a good deal, and, at private and public dances, dlance every waltz on the programme; and, in the summer moonths, spend much of their time playing lawn-teninis, without suf- fering any inconvenience whatever.Speakinanow of girls, these are the hopeful cases whose developrnent has gone on menstruation has not been retardled, as in the other stunted individuals.In fact, as the result of the a(lvent of puiberty, there has been sent through the whole system an influence making for increased nutrition or development conlcurrently with the establishment of menstruation.As for aortic disease, however, the cases that do well are those where the pulse ratio remains from 60 to 74, or thereabouts, where, with a slowly, regularly acting heart, the pulse tracing shows heightened arterial tension.Theoreticallv, this is not what we expect, but, with a hypertrophied left ventricle behind or below the lesion, and the peripheral arteries in a state of good tension, I see in these a means whereby the circula- tion can be effectually carried on, and the growing wants of the system