26 



THE TONER LECTURES. 



but they were inadequate to close the enlarged mitral opening. 

 In the accompanying drawing (Fig. 2) the heart is laid open 



along the septum, and the flaps are turned back, so that the val- 

 vular apparatus between the auricle and ventricle of each side 

 shows. The valves are stretched with bristles, but it may be 

 seen how utterly insufficient those on the right hand side of the 

 drawing, representing the mitral valves, are to close the gaping 

 orifice. 



This case proves that dilated hypertroi^hy may lead to val- 

 vular disease. And no matter how the enlargement of the 

 heart is brought about, the same effect may follow. Now, as 

 we have found that dilated hypertrophy may succeed functional 

 disorder from over-work or strain of the organ, we perceive 

 the links of a chain, at one end of which is merely deranged 

 action, at the other valvular affection ; and for the latter to 

 ensue, the stretching and increase of the heart must happen 

 first. But you will ask me, does this often occur? I answer, 

 no. Functional disorder of the heart from excitement of the 

 organ is very common ; organic changes in the walls and cavi- 

 ties, especially what is technically known as dilated hypertro- 



