96 PRACTICE OF MEDICINE. 



varieties of it, viz., — Simple hypertrophy, in which the muscular 

 parietes are thickened, but the cavities unaltered in size; hypertrophy, 

 with dilatation, or eccentric hypertrophy, in which there is also an 

 increase of the capacity of the cavities ; and concentric hypertrophy, 

 in which the substance of the heart is thickened, and its cavities 

 diminished. 



Modern pathologists have decided that the concentric hypertrophy 

 is a pathological mistake ; that, in fact, it depends on the state of 

 contraction in which the heart happens to be left at the moment of 

 death ; and that the so-called concentric hypertrophy often vanishes 

 as the rigor tnortis goes off, and the heart dilates and becomes flabby. 



Hypertrophy of the left ventricle may be caused first, by circum- 

 stances that excite the action of the organ to a great degree ; such 

 as high living, violent exercise, afid mental excitement ; and, secondly, 

 by obstructions of the mouth of the aorta. These, of course, require 

 greater muscular force to be exerted in order that the blood may be 

 propelled in the same time through a small aperture as through one 

 of the natural size. 



Hypertrophy with dilatation is much more common under the 

 last mentioned circumstances, than simple hypertrophy; for the same 

 cause that obstructs the current of blood, will also give the cavity a 

 tendency to dilate, especially if the patient has but little tone and 

 vigour in the muscular system. 



Dilatation without hypertrophy. — This is a kind of muscular 

 atrophy, and happens to flabby cachectic patients, in whom the heart 

 gives way and stretches in its efforts to carry on the circulation. 



Hyj)er trophy of the left veyitricle, without valvular disease, causes 

 the patient to feel an unnatural beating ; the pulse is full and strong, 

 the face florid, and there is a disposition to hemorrhage and inflam- 

 mation. On auscultation, the impidse is felt to be strong and widely 

 diffused ; the systolic sound less loud and clear than natural. 



Treatnieyit. — Spare, unstimulating diet, repose of body and mind, 

 small bleedings and purgatives. 



Hypertrophy of the left ventricle, ivith valvular disease. — This is 

 much more common than the last variety ; its symptoms are much 

 the same, except that if there is much obstruction of the aortic valves, 

 the pulse cannot be strong or full : if the obstruction is very great, 

 the pulse will be feeble or intermitting. The valvular obstruction 

 will cause a blowing murmur. 



Hypertrophy with dilatation of the left ventricle from valvular 

 disease, is, as was before said, much more common than simple 

 hypertrophy ; and the greater tlie dilatation, the feebler will be the 

 iinpulse and clearer the sound. A great amount of dilatation, like 

 great obstruction of the aortic valves, causes the pulse to be feeble 

 and intermittent ; the extremities cold, and a tendency to faintness. 



Hypertrophy of t/ie right ventricle with dilatation is often a con- 



