|SURNAME:||Langley also recorded as Langly||FORENAMES:||William||BORN:||c1810||AT:||.||OCCUPATION[S]:||.||RELIGION/DENOMINATION:||.||FATHER:||.||MOTHER:||.||SIBLINGS:||.||OTHER RELATIONS:||.||NOTES:||.||1st REGIMENT NO:||659||2nd REGIMENT NO:||605||ENLISTED:||07 05 1830 London||ATTESTED:||.||HEIGHT AT ENLISTMENT:||.||TROOP NO:||1831: Troop 6||TROOP CAPTAIN:||1831: Captain William Parlby||RANK:||1830-1831: Private
|PROMOTIONS:||.||REDUCTIONS:||.||DESERTIONS:||.||COURT MARTIALS:||.||GIVEN UP TO:||.||GOOD CONDUCT BADGES:||.||MEDALS:||.||EMBARKATIONS:||02 02 1831 Duke of Sussex Gravesend England||DISEMBARKATIONS:||31 05 1831 Duke of Sussex Bombay India||CAMPAIGNS:||.||OTHER DUTIES:||.||TRANSFERRED FROM:||.||TRANSFERRED TO:||.||DIED:||03 10 1835 Kirkee India aged 25 years. See autopsy report below.||BURIED:||03 10 1835 Kirkee India||WILL:||.||BENEFICIARY:||.||NEXT OF KIN:||.||PRIZE MONEY:||.||NOTES:||.||AUTOPSY REPORT|| CASE OF CARDIAC DISEASE
WILLIAM LANGLEY, 4th Light Dragoons, aetat. 26. -
States that since his arrived in India, four years ago, he has been 5 times in hospital with hepatic symptoms. Admitted 2d August, with dyspnoea and palpitation, for which he has been bled, leeched, &c. with considerable benefit; aspect pale, condition good; apyrexia, pulse at present 108, tense, and fuller at right than left wrist; sleep disturbed by starting and frightful dreams; physical signs - cardiac region from 3d cartilage fuller [more raised] than corresponding part of right chest; heart betwixt 5th and 6th cartilages, and arteries over sternum, and up to the angles of jaw, visibly pulsating; hepatic region fuller than corresponding part of left side, drooping towards border of false ribs; resonance defective over 4th, 5th, 6th and 7th left cartilages, from sternum to half an inch beyond line of nipple; fleshy in right hypochondrium, from below 5th rib, over an unusually large space, extending into epigastrium; respiration high and distressed anteriorly; double sawing sounds over cardiac region, the first loudest above 4th cartilage, the other below that - both very audible in left lateral region; the first only in right axillary, neither in left axillary, though sounds of heart very distinct; systole short, at present scarcely with impulse; diastole, prolonged and large, shaking the chest as if the impulse accompanied it; diagnosis, dilatation with hypertrophy [by increased extent] of left ventricle; dilatation of left auricle, diseased mitral valve, enlarged liver, morbid state of aortic valve.
Died, October 1835.
Autopsy, by Deputy Inspector Collier. `Heart enormously enlarged, more than twice the size of the fist; all the chambers of great capacity, especially the left ventricle; the right auricle, if not attenuated, certainly not thickened; the left was rather, I think, in relation to its capacity; the right ventricle fell in when opened; the left was of thickness equal not to the size of the organ, but to a powerful healthy heart; the valves all healthy - two small pouches at base of aorta, the result of a true ulcerative process; one had eaten away the inner and middle linings, and a like process was going on higher up. The coats of the artery, thickened and indurated, creaking under the scissors, up to the innominata - liver greatly enlarged.' The diagnosis ought, therefore, to have been dilatation with hypertrophy [by increased extent] of left ventricle; dilatation, at least, of left auricle; and, in a minor degree, of right cavities. Morbid state of base of aorta - enlarged liver.
Remarks: - The grand error in the diagnosis, it will be observed, was the state of the mitral valve, which we supposed to have been indicated by the sawing sound, synchronous with the diastole; for though aware that dilatation with hypertrophy alone might give rise to a bellow's murmur, we were not aware that it could to the degree of saw. See Note. We had, it is true, only one opportunity of examining this patient, and that when, from nervous agitation, the pulse was 108; but as considerable allowance was, no doubt, made at the time, we are not disposed to lay much stress upon that, more especially as the state of the pulse, full and tense, ought of itself to have undeceived us. Besides, we are sure a similiar mistake is made in May's case [see October No. of 1835], for comparing the sounds in these, with that of Madden's [see May No.], the difference is very marked. In the former it was prolonged sawing, and diffused over a large space, whereas in the latter, it was abrupt, hoarse, and confined to a small. In Madden's, also, the state of the valve was rendered doubly certain by the additional signs of purring tremor and irregularity of the pulse. The state of the base of aorta was perhaps of minor importance. We suspected some morbid affection at the part, from the sawing sound, synchronous with the systole, louder above than below the 4th cartilage, and audible even into right axillary region, where that accompanying diastole was not. That it was not dilatation of aorta, we supposed from the want of hoarseness in the sound, and of pulsation and purring tremor over the clavicles. The dilatation of the left ventricle was sufficiently evident, from the shortness of systole, length of diastole, and extent of dull sound on percussion, and the powerful back-stroke, together with the tenseness of the pulse, showed that its walls were by no means attenuated. The dilatation of left auricle may have been a fortunate guess on the supposition of the morbid condition of the mitral valve; or it may have been turned in the reverse way, as the extent of dull sound on percussion in upper part of cardiac region could not well have been mistaken. We more than suspected also dilatation of right ventricle, but as the fleshy sound of liver extended so far in that direction, we did not even note the dull sound on percussion; and without that, it could only have been a guess, for the sounds and impulse of left ventricle might have completely masked those of right.
Note. - In a case like the above, if the dilatation extended to the os ventriculi, the valves in their natural state could not present regurgitation. Consequently there would be sawing sounds produced, though different from those where the valves were thickened or indurated.
N. B. - The hepatic symptoms and enlargement of liver may, no doubt, be referred to obstruction to the unsupported portal circulation, conveyed backwards from the right ventricle, and were consequently of very minor importance.
|OTHER SOURCES:||Boston Medical and Surgical Journal, Vol. XV, by Massachusetts Medical Society, 1837||LINKS:||.|
4th Light Dragoons Index