570 chronic; diseases of the heart. 



Symptoms. — In many cases of simple hypertropliy, and where 

 it has been gradualy developed and purely compensatory, no 

 indications, general or local, may exist to point to these struc- 

 tural changes. When the hypertrophy is considerable and in 

 excess of the dilatation, the general symptoms usually observed 

 are at first a full, rather hard, strong pulse, which after some 

 time, as dilatation increases, becomes altered to one much 

 smaller and feebler, even while the cardiac action is bounding. 

 The impulse of the heart is increased ; it is sometimes slow 

 and prolonged ; the sound may be more intense, but less dis - 

 tinct and sharp ; it seems to hang in delivering the impulse 

 and in the production of the sound, which is distributed over 

 a great extent laterally. 



The impulse of the heart in cases of considerable h3'per- 

 trophy is often so great that it may be observed at a little 

 distance from the animal, and is distinctly felt when the hand 

 is placed over the cardiac region. 



Percussion, although in some instances indicating the greater 

 space occupied by the hypertrophied and dilated organ, is not 

 to be depended on as affording much information. 



As dilatation increases and is in ascendency to hypertrophy, 

 the impulse of the heart becomes feebler, although neither the 

 sound given out nor that which is elicited by percussion may 

 be less clear. The pulsations are lessened in frequency, smaller, 

 more feeble, unequal, irregular, or intermittent, with occasional 

 dyspno3a, particularly when excited. In advanced cases there 

 is coldness of the extremities and a tendency to oedema or 

 general dropsy. With other observers I have noted when the 

 right side in particular has been the seat of dilatation, that the 

 peculiar movement in the jugular vein, known as the jugular 

 venous pulse, is most frequently noticed. 



There is always less danger and fewer distressing symptoms 

 attendant upon dilatation of the heart, accompanied with 

 hypertrophy, than when the opposite condition exists. 



So long, therefore, as hypertrophy keeps pace with the in- 

 creasing capacity of the cardiac cavities, organic change of the 

 organ may not be suspected ; when the dilatation becomes in 

 excess of the increase in substance the impairment of function 

 rapidly becomes obvious, the performance of even moderate 

 exertion being attended with difficulty. 



