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HEART, DISEASES OF THE. 



HEART, DISEASES OF THE. 



the parietes are thickened without any change of capacity in the cavity ; 

 excentric or aneuriamal hypertrophy, the form most frequently met 

 with, in which the parietes are thickened and the incloaed carity or 

 cavitiw proportionally enlarged; and concentric hypertrophy, where 

 the cavity is diminished in proportion to the Urn-know of the parietes. 

 Any one of time kinds of hypertrophy may affect the parietal of either 

 cavity of the heart, or of the whole organ. The extent to which thin 

 increase of sue may proceed is enormous; heart* have been found 

 weighing upwards of twenty ounces, whereas the average weight of a 

 healthy heart is from seven to nine ounces. In hypertrophy, the 

 shape of the heart is also much altered, the transverse often exceeding 

 the vertical diameter; but these changes must depend upon whether 

 the whole organ, or only a part, be implicated in the disaailB. The 

 chest is often bulged out towards the left side, the sound produced by 

 percussion more dull than in the healthy state, and the pulsations 

 very strong ; indeed, the bed-clothes are often visibly raised, and the 

 head or hand of the observer when applied to the cheat forcibly 

 repulsed, yet the pulsations ore for the most part regular, unless palpi- 

 tations be induced by over-exertion. The sounds perceived by auscul- 

 tation will be found very loud, but not otherwise unnatural, if the 

 itiinann be not combined with some obstruction to the passage of the 

 blood ; and unless some obstruction exists, the functions of other organs 

 will not be much deranged, provided that the hypertrophy be not of 

 great extent ; but it seldom does exist to considerable'extent without 

 the simultaneous occurrence of some impediment to the passage of the 

 blood, already circulating with extraordinary force. 



The accidents referrible to hypertrophy of the left ventricle of the 

 heart are apoplexy and haemorrhages ; it will also contribute to the 

 production of aneurism of the aorta. It frequently happens that the 

 rupture of vessels in the brain by the too forcible expulsion of blood 

 from an hypertrophied left ventricle is materially facilitated by an 

 earthy or osseous state of the coats of those vessels. When the right 

 ventricle, being hypertrophied, sends its blood too forcibly through 

 the lungs, there will be a disposition to congestion of those organs. 

 These effects will be combined when the whole heart is hypertro- 



This is a disease in which great perseverance is required on the part 

 of the patient and the practitioner, but with proper care it frequently 

 admits of much alleviation. Rest, abstinence, sedative medicines, and 

 more or less depletion, according to the circumstances of the case, ore 

 the most efficacious plan of treatment. 



Atrophy of the Heart is a wasting of the heart's structure, dependent 

 on deficiency of the nutritive process. This disease is the reverse of 

 hypertrophy, and, like it, may affect the whole organ or only parts of 

 it ; its extent is often such that the heart does not exhibit more than 

 half its ordinary weight. Like hypertrophy, it has been divided into 

 simple atrophy, when the walls of one or more cavities are thinned 

 without any change of capacity in the cavity itself; excentric or 

 aneurismal atrophy, when the enlargement of the cavity keeps pace 

 with the thinness of the walls; and concentric atrophy, where the 

 cavity in diminished, but the walla maintain their usual thickness. 

 Thi.t state of the heart is usually accompanied by general emaciation, 

 and the pulsations and sounds of the organ will be found feeble in 

 proportion to the extent of the atrophy. In concentric atrophy, how- 

 ever, the pulse will be firm and resistant, though small, whilst in the 

 excentric form of the disease it will be proportionally soft, feeble, and 

 large. 



When the heart is examined after death from atrophy, it is found 

 that its tissues have undergone a change which has been called " fatty 

 degeneration." The muscular fibre, instead of presenting the striped 

 character found in health, loses the stripes, and presents a homogeneous 

 appearance. In the interior of the fibrilUe will be found also fat 

 globules, and the central portion of the muscle-cells, coniting natu- 

 rally of fibrine, is converted into adipocire or choleaterine. It is in 

 this state of the heart that rupture of its membranes so frequently 

 occurs. (Quain, Fatty Diseases of the Heart.') 



In atrophy the powers of the patient are all below par, and the 

 proper treatment will be to support the system by wholesome, gene- 

 rous, but unexciting diet, and a salubrious atmosphere. Medicines, 

 as quinine and iron, may be prescribed as auxiliaries, when any 

 additional symptoms appear indicating obstruction to the nutritive 

 functions. 



Dilatation of the Start. It has been shown that the heart may be 

 increased or diminished in substance, or, in other words, may be 

 hypertrophied or atrophied ; it is also found that the whole organ, or 

 either of its cavities singly, or the orifices of these cavities, may be 

 dilated, the solid parietes being merely extended, without any increase 

 of substance, and the contained cavities proportionally enlarged. As 

 in hypertrophy, so in this disease, according to its extent, the shape of 

 the heart will be much changed. The muscular parietes being thinned 

 and feeble, the circulation of the blood will not be carried on with 

 vigour, and the patient will be weak and unfit for exertion, easily 

 exhausted by small losses of blood, and sometimes carried off by what 

 under ordinary circumstances would be deemed a trifling hemorrhage. 

 Partial dilatations sometimes occur after carditis ; the muscular struc- 

 ture being thinned at some spot by ulceration, the parietes give way, 

 and form a dilated aneurismal pouch. This disease, though it doubt- 

 Ion does sometimes occur in persons of relaxed muscular fibre without 



any pre-existing impediment to the circulation, is most frequently the 

 consequence of some obstruction to the free passage of the blood from 

 the dilated cavity, and is the natural effect of distension from within. 

 It however not (infrequently happens, that when the obstruction 

 occurs at the orifice situated between the ventricle and artery the 

 corresponding auricle will be the cavity dilated, iu parietes being so 

 much less strong than those of the ventricle. When the orifice of 

 either of the cavities of the heart is dilated to such extent a* to pre- 

 clude it* proper closure by the valves, a reflux of blood will be the 

 result, causing the anonnal bellows sound, and a sensation of purring, 

 or of vibration such as would be produced by putting a cli 

 motion ; and should this defective closure exist in the right auriculo- 

 ventricular opening, it will give rise to a fluctuating motion in tin- 

 jugular vein, called " venous pulse." Excessive exertions and strong 

 passions seem to be exciting causes of this disease, and from the in- 

 fluence of these causes the patient xhould be sedulously guarded, and 

 at the same time every remedy must be adopted which may contribute 

 tojsqualisc the circulation. 



ro iTi.wt fro.itionV v , .. . . 



often accompanied by the 



The preceding diseases are most frequently the result of dinMB of 

 the lining membrane of the heart, and are oft 

 signs of valvular derangement. 



III. Diieata of the Internal Membrane*. 



Kiitlvranlitii ; Inflammation of the interior Unity membrane of the 

 Heart. The symptoms of endocarditis are more or leas fever and 

 anxiety ; some bulging of the pnccordial region, if accompanied by 

 pericarditis ; an extension of the dull sound heard on percussion in the 

 healthy state ; the pulsations of the heart unusually strong, and some- 

 times very rapid and intermittent, repulsing the hand when applied to 

 the chest, and producing a peculiar vibratory sensation. Upon auscul- 

 tation the bellows sound will be heard, masking one or both of the 

 normal sounds, and sometimes, during the ventricular contraction, a 

 metallic tingling is heard, resembling the sound produced by dropping 

 sand into a bell of metal. The pulse as felt at the wrixt will not 

 always accord with the beatings of the heart ; often whilst the latter 

 are very forcible, the former will be found small and weak, and some- 

 times less frequent : this indicates some obstruction to the free passage 

 of the blood from the heart, notwithstanding the forcible contractions 

 of that organ to propel it, and the patient will exhibit symptoms of 

 much distress, as great anxiety of countenance, restless toasings of the 

 body, dazzlings of the sight, and faintings ; if the obstructions in the 

 right side of the heart are extensive, as they often are from fibrinous 

 concretions, thickenings, and other morbid growths of the valves, the 

 venous circulation will be affected, as indicated by the livid bloated 

 state of the countenance, and serous effusions into the extremities ; 

 various apoplectic symptoms seem to be sometimes induced by the same 

 cause. The breathing is not affected generally beyond a sense of opj .1 . s 

 sion, unless a considerable impediment is experienced by the circulation, 

 but then the distress and restlessness of the sufferer i often extr. m< . 

 accompanied by an inability to lie down, and a state of alarm and 

 wandering amounting almost to delirium. 



The causes of this serious malady are similar to the causes of peri- 

 carditis, and the treatment should be conducted on the same jjrin 

 It frequently arises in the course of an attack of rheumatism, and may 

 or may not be accompanied by pericarditis. 



Valvular dittate of the Heart. Upon examination after death from 

 endocarditis, there will often be found, particularly in the right 

 cavities of the heart, and entangled in the muscular fibres, clots or 

 concretions of fibriuous matter, which are not only caused by stagna- 

 tion of the blood at the time of death, but also by inflammation of the 

 internal lining membrane. This membrane is also often thickened, 

 especially at the valves ; and after repeated attacks, or a long chronic 

 attack of endocarditis, the valves will not merely be thickened, but will 

 become the seat of a variety of warty excrescences, or even cartilagi- 

 nous and osseous formations of considerable size, extending into the 

 cavities of the heart. This ossification is most frequently met with in 

 old persons, and especially those who have been addicted to a too 

 generous mode of living. The morbid sounds produced by these 

 obstructions at the various orifices will resemble those of the bellows, 

 file, or saw, according to the degree of obstruction ; and sometimes a 

 triple or quadruple sound will be perceived instead of the two normal 

 sounds. The effects of these obstructions will be sanguineous and 

 serous congestions, oppressions of the breath, apoplectic seizures, and 

 other symptoms of embarrassed circulation. 



The treatment of such cases must depend on the nature of the 

 symptoms present. Where anasarca is present, the water may be got 

 rid of by rest and by acting on the bowels and kiducys. Asthma is 

 I'P <|i ntly the result of valvular disease of the heart, and i< < 

 nin-t. lie applied to facilitate the passage of the blood through ill. 

 obstructed lungs. Haemorrhage from the lungs and extravasation ..i 

 blood are produced by disease of the heart. Congestion of the brain 

 and apoplexy are also the result of disease of the heart, and it is of 

 the greatest consequence to detect the cause of these attacks in the 

 state of the heart, and adopt treatment accordingly. 



fferrout DittaKt of the Heart. The last class of diseases affecting 

 the heart which remains to be noticed differs from all the precede 

 not presenting any organic changes. They are met with chielly in 

 women suffering from amemia, chlorosis, hysteria, and other nervous 



