638 



ABNORMAL CONDITIONS OF THE HEART. 



reddish lines, and possessing all the characters 

 of encephaloid. In the second case, the 

 external wall of the right ventricle was occu- 

 pied by a tumour extending from its apex to 

 its base, which projected so far externally as to 

 lead him to mistake it for a supernumerary 

 heart, and likewise protruded internally into 

 the cavity of the ventricle. In a case which I saw 

 myself, the tumour resembled the well-known 

 encephaloid or cancerous tumour of the liver, 

 being, like it, raised above the surrounding 

 muscular structure, and irregular on its surface. 



Melunosis. This deposit is also found very 

 distinctly in the heart. It appears in the form 

 of small spots under the pericardium or endo- 

 cardium, or as tumours in the substance of the 

 ventricle. In a specimen in the Museum of 

 King's College, London, the melanotic deposits 

 are situated, some beneath the pericardium 

 covering the right ventricle, and others on the 

 carnese columns of the same cavity, immediately 

 subjacent to the endocardium. Neither Andral 

 nor Bouillaud notices the occurrence of me- 

 lanosis in the heart. 



Hypertrophy of the heart.- When the walls 

 of any of the heart's cavities experience an in- 

 crease of thickness, owing to the developement 

 of the muscular substance, they are said to be 

 in a state of hypertrophy ; and there is no 

 morbid state of this organ which is more fre- 

 quently brought under the notice of the phy- 

 sician than this, as affecting the parietes of one 

 or more of its cavities. There is no alteration 

 in the muscular texture apparent to the naked 

 eye, except, perhaps, a slight increase of the 

 red colour the heart is firm, dense, and 

 elastic ; in short, it presents all those characters 

 which we so often see manifested in the ex- 

 ternal voluntary muscles, the developement of 

 which is increased by frequent use.* Hyper- 

 trophy may affect all the cavities simultaneously, 

 but in general it is limited to one or at most 

 two cavities. The left ventricle is that in which 

 it most frequently occurs, next the right, and 

 lastly and rarely the auricles. Nor does the 

 hypertrophy affect necessarily the whole pa- 

 rietes of the cavity, but sometimes it is 

 limited to a small portion, or to the septum, 

 or to one or more of the carneae columns. In 

 some cases, as Andral remarks, the thickening 

 may be at its maximum at the base of the 

 heart, and diminish gradually towards its apex, 

 which sometimes retains its natural thinness, 

 when all the rest of the parietes are three or 

 even four times as thick as natural ; or at other 

 times, as Cruveilhier observes, becomes so thin 

 that one is astonished that perforation or dila- 

 tation of the heart at its apex is not more com- 



* Dr. Williams mentions that in leucophlcgmatic 

 subjects the muscular texture is soft and flabby 

 and of a duller colour. This is obviously a con- 

 dition resulting from other causes, and not a cha- 

 racter of the hypertrophous heart as such. And 

 the threads or laminae of dirty white tissue inter- 

 mingled with the muscular tissue, described by 

 him, seem clearly the result of the inflammation 

 which caused the concomitant adhesion of the peri- 

 cardium. In the same light I would regard the 

 dense fibrous tissue described and delineated by 

 Carswell. See lied. Go*, vol. xvi. p. 915. j 



mon. In other individuals again the thickening 

 is equal and uniform from trie base to the apex, 

 which then loses its pointed form and acquires a 

 rounded shape. Lastly, it sometimes happens 

 that the hypertrophy is greatest about midway 

 between the apex and base of the heart, or is 

 even exclusively confined to that part. When 

 the septum is principally affected, the capacity 

 of the right ventricle is so diminished that it 

 sometimes looks like a small appendix attached 

 to the left ventricle.* When the hypertrophy 

 affects chiefly or exclusively the right ventricle, 

 the apex of the heart seems to be formed by it, 

 whereas in the normal state the apex belongs 

 to the left ventricle. 



An hypertrophous state of the parietes of 

 all the cavities not only affects the form of the 

 heart by changing it from the oblong to the 

 spherical, but, as was first noticed by Dr. 

 IIope,f its position is altered ; " as the dia- 

 phragm does not retire sufficiently to yield 

 space downwards for the enlarged organ, it 

 assumes an unnaturally horizontal position, 

 encroaching so far upon the left cavity of the 

 chest as sometimes to force the lung upwards 

 as high as the level of the fourth rib or even 

 higher." 



BertinJ distinguishes three varieties of hy- 

 pertrophy of the heart. 1. That in which the 

 hypertrophy is not accompanied with any alte- 

 ration in the capacity of the cavities of the 

 heart simple hypertrophy. 2. That in which 

 there is dilatation of the cavity along with 

 the increased substance of its walls acentric 

 hypertrophy or active aneurism of Corvisart. 

 3. Where the capacity of the ventricle is dimi- 

 nished as if the walls had encroached by their 

 increase of thickness upon the cavity, or a; 

 Bouillaud expresses it, as if the internal mus- 

 cular layers and the carnese columns were prin- 

 cipally the seat of hypertrophy concentric hy- 

 pertrophy.^ Of these the most frequent is that 

 which is accompanied by dilatation, the dilata- 



* Cruveilhier doubts the occurrence of partial 

 hypertrophy affecting the septum or one or more 

 carneae columnae. 



t Cyclop, of Pract. Med. art. Hypertrophy of 

 the Heart. 



t Maladies du Cceur. 



$ A certain standard of health is absolutely 

 necessary to enable us to determine as to the ex- 

 istence of disease. With this view we transcribe 

 here the table of weight and dimensions drawn up 

 by Bouillaud as the average of health. 



In an adult of ordinary size and good constitu- 

 tion the mean weight = 8 to 9 oz. ; mean circumfe- 

 reuce = 8 to 9 inches; mean of the longitudinal 

 and transverse diameters = 34 inches (the latter 

 generally predominates slightly over the former) ; 

 the mean of the antero-posteriordiameter=2 inches. 

 Mean thickness of the walls of left ventricle at the 



base= . . . . 6 to 7 lines. 



Ditto, right ventricle at the base = . 2J lines. 

 Ditto, left auricle = . . . 1J lines. 



Ditto, right auricle=. . . 1 line. 



The average capacity of the ventricles is suffi- 

 cient to contain a hen's egg (that of the right ven- 

 tricle slightly exceeding the left). 



For some useful observations on this subject, and 

 on the normal weight, bulk, &c. of the heart in 

 relation toother viscera, see Dr. Clendinuing's Lec- 

 tures in Med. Gazette, vol. xvi. 



