CASES OF MALFORMATION. 533 



order to preserve life, are confirmed by a number of cases of malformation 

 of the heart or the great vessels, in which the structure was such that a con- 

 siderable portion of venous blood passed from the right side of the heart to 

 the aorta, without going through the lungs. In these different cas^s, not- 

 withstanding the structure was somewhat varied, the symptoms produced 

 were very much alike j differing in the respective patients in degree only, 

 and not in kind. 



The symptoms indicating this structure, are blue color of the face, (such as 

 generally accompanies suffocation,) extending more or less over the whole 

 body, and particularly apparent under the nails of the fingers and toes ; 

 anxiety about the region of the heart ; palpitation ; laborious respiration ; 

 sensations of great debility, (fee. : all of which are greatly aggravated by 

 muscular exertion. These effects have generally appeared to be proportioned 

 to the quantity of venous blood admitted into the aortic system.* 



When these appearances take place immediately after birth, it is probable that 

 they depend entirely upon malformation of the heart or great vessels ; but 

 when they commence at a subsequent period, they are commonly the effect of 

 a diseased alteration in the lungs. They sometimes occur near the termina- 

 tion of fatal cases of pneumonia or catarrh ; but a different cause, which has 

 not latterly been suspected, appears to have produced them in the following 

 case, related by Dr. Marcet, in the first volume of the Edinburgh Medical 

 and Physical Journal. 



The blue color occurred in a young woman, twenty-one years of age, in whom 

 it had never been observed before. It came on during an affection of the 

 breast, and was attended with great prostration of strength and difficulty of 

 breathing, as well as cough, oedema of the hands and feet, and several other 

 symptoms. About seven weeks after the commencement of these symptoms, 

 she died ; when it was ascertained by dissection, that there was no unnatural 

 communication whatever between the cavities of the heart, and that its valves were 

 all in a perfect and natural state. The lungs were free from tubercles, or any 

 other appearance of disease. Their substance seemed more compact than 

 usual, especially the left lung, although it did not sink in water; but they 

 adhered every where to the inner surface of the thorax, to the diaphragm and to 

 the pleura covering the pericardium. This case is the more remarkable, be- 

 cause numberless instances have occurred, in which very large portions of 

 the external surface of the lungs have been found, upon dissection, to adhere 

 to the internal surface of the thorax, without the occurrence of such symp- 

 toms during life. 



It may be inferred, from a statement published by M. Dupuytren, in a volume 

 of the Proceedings of the National Institute of France, that the oxygenation 

 or decarbonation of the blood is much affected, in respiration, by an influence 

 exercised by the nerves which are appropriated to the lungs. From his 

 account it appears, that although the complete division of the eighth pair of 

 nerves produces death after some time ; yet in the horse, whose nerves are 



* Cases of this kind are related in several of the periodical publications on medical sub- 

 jects. Two of them were described by Dr. William Hunter in the sixth volume of " Medical 

 Observations and Inquiries by a society of Physicians in London ; " one quoted by Dr. 

 Goodwyn, is in the Observationes Anatomicae of Sandifort ; and another by Dr. J. 8. 

 Dorsey, has been published in the first number of the New England Journal of Medicine and 

 Surgery. 



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