10 THE TONER LECTURES. 



the U. S. Sanitary Commission, issued in 1867, I have pub- 

 lished a number of cases proving this view. To these I could 

 add others traced out since the publication of these investi- 

 gations. But as already indicated, I pi-efer here to draw m^' 

 illustrations from the records of private practice, and doing 

 this, will cite these examples in further proof of my 

 proposition. 



First. The case of a lady with very bad prolapsus, and other 

 uterine trouble. When I first saw her she had simply a func- 

 tionally disturbed, rapidly beating heart. I lost sight of her, 

 and when, after about a year, she consulted me again, the 

 impulse had grown heavier and more forcilile, and there was 

 beginning hypertrophy. Another year passed, a year which 

 had brought with it much mental worry and during which she 

 had paid very little attention to her health, and I found that 

 the slight cardiac enlargement had become marked dilated 

 hypertrophy. 



Secondly. The case of an inveterate and most extensive user 

 of tobacco in a man thirtj'-six 3^ears of age, who, in addition, 

 had great strain on him from continued attention to business. 

 The heart's action, at first, was rapid and intermittent ; there 

 was palpitation, with occasional cardiac pain. These symp- 

 toms gradually lessened, the action became more regular, but 

 some dilated hypertrophy ensued. The percussion dulness is 

 at present very marked, the impulse only moderately sti'ong, 

 and the tendency to dilatation may in time be greater than to 

 hypertrophy. Now there is a distinct, s^-stolic, functional 

 mitral murmur, and no increased second sound. 



To these cases I could add a list in which cardiac over- 

 exertion in special occupations has led to heart-growth and 

 distension, but we shall presently have to examine this part 

 of our subject at some length, and the examples there adduced 

 "will strengthen what I have just endeavored to make clear. 

 Let me here, however, say that no matter what the starting- 



