STRAIN AND OVER-ACTION OF THE HEART. 5 



wide staircase. TLie girl was beside herself with agitation and 

 alarm — the mother, resolute, told them not to advance or she 

 would fire. The warning was unheeded; the flash of the 

 pistol followed. The fire desperately wounded one of the in- 

 vaders ; the other fled. But from that fatal night the girl was 

 a wreck ; the palpitations never left ; and after a few years, I 

 am sorry to record, the cardiac trouble led to death. 



You see, then, in these cases the effect of strain and over- 

 excitement of the heart in producing organic lesion. You will 

 say there must have been some previous disease of the struc- 

 tures, or they would not so readily have given way. But the 

 ages of the patient are not those at which degenerative tissue- 

 change is apt to happen. Moreover, I find in the literature of 

 medicine similar cases mentioned which have occurred in very 

 young children. Thus, in the Boston Medical and Surgical 

 Journal for November, 1866, Dr. Hitchcock records a rupture 

 of the ti'icuspid valve from fright iu a little girl two years and 

 nine months of age. She was often nervouslj^ excited by loud 

 noises, and when in the middle of the night the steam fire- 

 whistle was suddenly and protractedly sounded near her 

 window, awoke in terror screaming and panting ; and it was 

 hours before she could be quieted. Her breathing remained 

 labored, and at her death, seventy-eight hours after the fright, 

 the right auriculo-ventricular valves were found to be lace- 

 rated and broken in their substance, as were also several of the 

 coluranse carnere, and chordae tendinfe. 



The explanation of cases like these has been attempted on 

 the supposition of a rapidly developed endocarditis. Yet 

 where is the proof of this? There may be more likely, after 

 all, in many instances some imperfection which is the cause of 

 the break. But this does not always appear to the naked e3''e, 

 and even with the microscope the difference from health is not 

 invariably of pronounced character. Clinically it is undoubted 

 that the violent agitation produces the first evidence of disease, 



