STRAIN AND OVER-ACTION OF THE HEART. 3 



one damaged. Xo matter what valve be the seat of the acci- 

 dent, severe pain, occurring suddenly, and returning in parox- 

 ysms, is apt to be a symptom of valve tear, and often the 

 patient will remember that just preceding the first attaclv of 

 pain he has felt something give way witliin the chest. The 

 valves which suffer most frequently from injury are the aortic 

 and the mitral valves. A segment of the mitral has been often 

 observed torn from its attachment; but the same thing may 

 happen at the tricuspid. Thus a case was brought to my 

 notice by Dr. Thomas, F. Wood, of Wilmington, ]Sr. C, in 

 which in a man, forty years of age, severe paroxysms of car- 

 diac pain happened at irregular intervals, and were attendea 

 with distinct venous pulsation. This was, however, also noticed 

 independently of the cardiac distress; though onh^ markedly 

 while this lasted, or just before, or soon after. At the autopsy 

 the heart was found to be enormously hypertrophied ; one of 

 the papillary muscles of the tricuspid valve was torn from its 

 attachments both from the walls of the heart and the tendinous 

 cord ; and a piece was really found floating in the pulmonary 

 artery. The right auricle and ventricle formed a continuous 

 pouch filled with coagulum. The muscular structure of the 

 heart was not examined microscopicallj' ; but to the eye it did 

 not appear fatty. 



You have, in the class of cases just alluded to, the result of 

 muscular strain, or violent muscular exertion. But the same 

 result, I am sure, ma}^ happen from extraordinary mental emo- 

 tion or shock. Let me give you some instances. 



Mrs. B., a woman of intelligence and character, about thirty 

 years of age, was awakened one night in September, 1862, by a 

 noise in her house, and in getting out of bed she came in con- 

 tact with a strange man. She was very much frightened, but 

 succeeded in getting him out of the door. Listening, still 

 greatly alarmed, she overheard a conversation that the party 

 would return when the moon went down. Her husband was 



