Malformations of the Bulbus Cordis. 



An Unrecognised Division of the Human Heart* 



In this paper I propose to set out as briefly and clearly as I may, the 

 evidence which has led me to the two following conclusions: — (i) that 

 besides the sinus venosus, the auricular and the ventricular divisions 

 — the three parts out of which the whole mammalian heart is believed to 

 be formed, there is present a fourth, namely, the bulbus cordis ; (2) that 

 the great majority of cases which are classified, at the present time, as 

 congenital stenosis of the pulmonary or of the aortic orifices are, in 

 reality, due to an arrest of development or malformation of the bulbus 

 cordis. It is with the second of these two conclusions that I now intend 

 to deal here, and it will be apparent that if the congenital constrictions, 

 which are found at the orifices of the pulmonary artery and aorta, can 

 be shown to be due to an arrest or vitiation of development, then the 

 theory, which has still a wide currency amongst medical men that these 

 lesions are the result of foetal endocarditis, must be finally abandoned, 

 and these conditions classified with hare-lip, cleft palate, hydrocephalus, 

 spina bifida, club-foot, atresia ani, hypospadias, and other congenital 

 malformations with which the cardiac lesions are so often associated. 



Note. — The interpretation which I give of the malformations of the heart described in this 

 article is a new one, and it is not necessary, therefore, to give an exhaustive list of references. 

 As regards our present knowledge of this subject, Peacock's work On Malformations of the 

 Human Heart (2nd Edition, London, 1866), is still the most authoritative work which has been 

 produced in England ; Rokitansky^s Die Defecte der Scheidewdnde des Herzens (Wien, 1875), 

 holds a corresponding place in German medical literature, while Moussous' Maladies 

 Congenitales du Coeur (Paris, 1896), and Theremin's Etudes sur les Affections Congenitales dtc 

 Coeur (St. Petersburg, 1895), may be accepted as representative of the more recent work done 

 in France and Russia. 



This article deals with one of the results of an effort I have made during the last two years 

 to systematise our knowledge of congenital malformations of the heart. I have had an oppor- 

 tunity of examining over 200 malformed hearts in the medical museums in London (50 of these 

 were obtained at the London Hospital). In the Transactions of the Pathological Society of 

 London, I obtained descriptions of 123 cases; from other sources in medical literature I 

 obtained over 200 cases more, so that, altogether, I have accounts of over 500 specimens. The 

 Index Catalogue, issued from the Surgeon General's office of the United States, contains 12 

 columns of references to records of isolated cases of congenital morbus cordis, and it was an 

 examination of some of these records which convinced me of the necessity of a systematisation of 

 our knowledge of this subject. 



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