452 



In the case now recorded the highest of the four pulmonary 

 veins appears to be a pulmonized bronchial vein joining the caval 

 system at the angle of junction of the vena azygos major and the 

 superior vena cava. The other three veins appear to be pulmonized 

 veins of the bronchial lymphatic glands which normally are exceedingly 

 small but which not infrequently open into the superior vena cav^a. 

 Somewhat similar cases have been recorded by Greenfield (6), 

 Hepburn (7) and Peacock (8). 



The greater interest of the specimen centres, however, in the 

 fact that the superior vena cava opens practically equally into the 



two auricles, the heart 

 and the great vessels 

 being otherwise normal. 

 In order that this 

 abnormality' might occur 

 it is necessary either 

 that some primary 

 failure or secondary 

 fenestration of the sep- 

 tum secundum occurred 

 or else that there was 

 a separation of the sep- 

 tum from the auricular 

 wall and a secondary 

 movement of the wall. 

 A failure or secon- 

 dary fenestration of the 

 septum secundum is 

 rare. Cases of this type 

 have been recorded by 

 Griffith (9), Greenfield 

 (6), Hepburn (7), Bir- 

 mingham (10), Thiele 

 (1 1), and Symington (12), 

 [compare also Blondel 

 (13)]. 

 A specimen showing this abnormality was recently obtained in 

 this dissecting room. It is shown in Fig. 4. The contrast between 

 it and the heart shown in Fig. 1 is marked. In the latter the inter- 



Fig. 4. Heart showing inter-auricular foramen 

 superior to the fossa ovalis. The right ventricle is 

 enormously increased. 



