STRAIN AND OVER-ACTION OF THE HEART. 13 



For instance, in soldiers we have, owing to their occupation, 

 heart disease as a very common affection, originating in the 

 way already mentioned. But also there may ensue, as I have 

 had occasion to note, and as is ably brought out by Dr. Maclean 

 in the British Army Medical Reports, and by Dr. Myers in his 

 recent interesting work on the Diseases of the Heart among 

 Soldiers, by the direct strain on and over-distension of the aorta, 

 alteration of sti'ucture, leading to aneurism or aortic valve 

 trouble; and, as Dr Maclean has shown, that white patches 

 on the pericardium, the result of inflammator}^, or at least 

 nutritive tissue changes occur, it is very likely that the same 

 or kindred alterations may be produced in the arterial coats. 

 How far the dress and accoutrements of the soldier, and the 

 mechanical obstructions to free circulation which they may 

 occasion, determine the malady ; how far it is the heavy exer- 

 tion which his calling may necessitate that brings it on, is not 

 a question for discussion here. The fact alone of the occupa- 

 tion causing the affection is being commented upon. Then, as 

 we know from Dr. Peacock's observations in his Lectures on 

 Valvular Disease of the Heart, men who work in the tin and 

 copper mines, and return to the surface by ladders, are par- 

 ticularly subject to heart disease; and the same authovit}^ tells 

 us that disease of the aortic valve is more commonly the result 

 of over-exertion than is disease of the mitral. And another 

 well-known physician, Dr. Allbutt, in an essay published in the 

 Clinical Society Transactions for 18T3, states that he found, by 

 post-mortem examination, that men who had worked at heavy 

 employments, such as bargemen, porters, strikers in iron- 

 foundries, often present evidences of such exertion in an in- 

 creased volume of the heart itself, and in marks of chronic 

 inflammation, old or recent, in the first portions of the aorta. 

 In truth, all occupations such as those mentioned, or in which 

 continual lifting is required, favor the production of dilated 

 hypertrophy, or aneurism, or valvular disease, or valvular rup- 



