ABNORMAL CONDITIONS OF THE HEAUT. 



C43 



sin face, to fat. A mere layer of red muscular 

 Mitictuic covered the internal and external parts 

 of the heart and the columns carnea; : within 

 cvrr\ >|,ot was fatty matter."* 



Kttpturt /' t/ie heart. A degenerate con- 

 dition of the muscular tissue is the most com- 

 mon cause of rupture of the heart: the states 

 last described are those in which it most fre- 

 quently occurs ; they correspond to the senile 

 Hi/Jinn//; of Bland:-}- the wall literally gives 

 wav at a certain point, and a laceration fre- 

 quently to a very trifling extent is found in that 

 situation on examination after death : in some 

 cases, moreover, several ruptures are found in 

 tlie wall of the same cavity, and sometimes 

 the rupture is very extensive, or it is large in- 

 ternally and small externally, or vice versa. 

 Any of the cavities may afford examples of 

 this form of rupture, but the left ventricle is 

 by far the most frequent seat of it, as may be 

 understood from the following numerical state- 

 ment by Ollivier: " out of forty-nine cases the 

 rupture was seated in the left ventricle in thirty- 

 four, in the right ventricle in eight, in the left 

 auricle in three, and in two cases the ventricles 

 presented several ruptures. In these cases 

 the apex was the situation of the rupture in 

 nine; in the rest the rupture took place near 

 the base. Rupture, however, may occur in 

 a healthy state of the organ, from violent bodily 

 exertion; of this a remarkable example was 

 afforded in the case of one of Whitbread's 

 diHuuen, who in attempting to raise a butt of 

 porter, fell dead, from a large laceration of the 

 left ventricle, the structure of which was per- 

 fectly healthy. I had lately an opportunity of 

 examining the preparation of this heart in the 

 Museum of (iiiy's Hospital. 



Rupture is also found to ensue upon abscess 

 in the heart, or upon ulceration and conse- 

 quent perforation ; it is sometimes caused by 

 dilatation of it, and sometimes by contraction 

 of one or more of the orifices. 



Partial rupture may occur, i. e. the external 

 fibres may be ruptured to a certain depth, 

 without penetrating the cavity, or the internal 

 ones may lie similarly lorn, the exterior being 

 unallectcd. A more remarkable kind of par- 

 tial rupture is that in which the carnese co- 

 luinna! or chorda; tendinex are engaged. Cases 

 of this form of rupture seem to have been 

 detailed first by Corvisart, who attributed the 

 rupture to violent efforts. Other cases have 

 been subsequently recorded by Cheyne, Adams, 

 and Townsend. In Dr. Cheyne's case, " the 

 internal surface of the left ventricle was much 

 inflamed, several irregular excrescences were 

 attached to the mitral and semilunar valves. 

 The chorda.' tendineiv, which connected the 

 larger portion of the mitral valve to the wall 

 of the left ventricle, were torn oil" just at the 

 point of their insertion into the edge of the 

 valve; four of these ruptured tendons hung 

 loose into the ventricle." \ 



* Crnoiiian Lectures on the Heart, p. 32. 

 t Blaid, Bihl. Mrd. an. Win. 

 j Dublin Hop. Hep. vol. iv. On the subject of 

 ru| tun- of the heart the reader may coniult Olli- 



MORBID STATES OP THE MEUDRANES OP 

 TUE HEART. 



I . Mur/iiii stii/i:- nl 'the pericardium. 1 . Pe- 

 ricarditis. The morbid changes of the serous 

 pericardium which most frequently come under 

 the notice of the anatomist, are those 

 which are consequent upon inflammation. 

 \\hat the alterations are which indicate the 

 firsl onset of inflammatory action it is not easy 

 lo determine precisely, as the opportunities of 

 inspecting the parts in this early stage of peri- 

 carditis are extremely rare. The following, 

 however, may be slated as indicalive of the 

 earliest period of pericarditis. The natural 

 exhalation becomes diminished or totally 

 suppressed, and consequently the surfacesof the 

 membrane do not present their usual moist 

 appearance ; the visceral layer of the pericar- 

 dium is not so transparent as in the natural 

 state, and several red points, which to the naked 

 eye appear like extravasalions of blood, are 

 manifesled on a considerable portion of the 

 membrane. These spot?, however, are not 

 extravasations, but when examined with a lens, 

 they are seen to be produced by a close net- 

 work of extremely minute capillary vessels; 

 as inflammation advances these spots increase 

 in number, neighbouring ones coalesce, a more 

 or less diffused redness is produced, as well 

 from vessels subjacent to, as in the membrane, 

 the membrane becomes less and less transparent, 

 and now an exudation is distinctly formed on 

 its surface of a very soft semifluid material (co- 

 agulable lymph), which, on looking carefully 

 along the inflamed surface, is seen to be de- 

 veloped in minute granules. The further pro- 

 gress of the disease is characterised by the 

 increased deposition of this plastic material, 

 and the effusion of a straw-coloured serous 

 fluid into the bag of the pericardium. These 

 morbid changes, of course, vary in extent ; but 

 it is not uncommon to find them extending 

 over the greatest part or even the whole heart, 

 so that in some cases a second complete enve- 

 lope is formed for the heart between the visce- 

 ral and parietal layers of the serous pericar- 

 dium ; on the other hand a very circumscribed 

 spot may be occupied by these changes, not ex- 

 ceedinga half-crow nor a crown piece incircumfe- 

 rence ; but we seldom or never have opportu- 

 nities of seeing the disease on this limited 

 scale in so early a Mage, and judge of its 

 occurrence only from the existence of alterations 

 which may justly be regarded as its sequelae. 



Certain varieties are observed as regards the 

 form assumed by the lymph, and the quantity of 

 the fluid effused in this disease. The lymph 

 varies in its characters ; almost always depo- 

 sited in a membranous form, it is sometimes 

 quite smooth and uniform on its free sur- 

 face ; at other times it is rough, and hangs in 

 flocculi into the fluid contained in the sac of 

 the pericardium ; acain it presents a reticulate 

 appearance, compared by Corvisarl, Laennec, 

 and Berlin, to the inner surface of the second 



vier's article (Co?nr Rnptuie") in Diet, de Med., 

 Towiiscud in Cyclop. Pract Med. vol. iv. p. 630., 

 and L'o\iHUi.d' work. 



S VI 



