HYPERTROPHY OF THE HEART. 317 



Concentric hypertrophy is exceedingly rare, although a normal 

 heart, which has contracted strongly at the moment of death, has often 

 been mistaken by inexperienced persons for such a condition. The 

 very existence of this form has been doubted by Cruveilhier. Moki- 

 tansky and Bamberger express their opinion that, although rare, it 

 sometimes occurs. 



The shape of a heart in a state of general hypertrophy is that of 

 an obtuse-angled triangle. If the hypertrophy be limited to the left 

 side, the organ is usually longer, and has a more conical form. The 

 lower end of the right side does not extend as far downward toward 

 the apex as it otherwise should. In excentric hypertrophy of the right 

 ventricle, the heart grows broader, and assumes a more spherical form. 

 The right ventricle lies farther forward ; the left is, as it were, pushed 

 away from the thoracic wall. The apex is often small, consisting 

 principally of the right ventricle. 



The heavier the heart becomes, so much the deeper does it lie. 

 The diaphragm is pressed downward, and the heart generally inclines 

 more to the left side of the thorax. When the hypertrophy is exces- 

 sive, and accompanied by dilatation, the base always keeps sinking 

 deeper, and the organ assumes a transverse attitude, the base toward 

 the right, the apex toward the left. When the right ventricle alone 

 is affected, the heart projects more into the right side of the thorax 

 If the left alone is involved, the prominence is rather into the left side 

 of the thorax. Hypertrophy of the heart depends, probably, upon a 

 multiplication of the muscular fibres and primitive fasciculi of which its 

 walls are formed, as Foerster has never been able to demonstrate the 

 existence of any " thickening " in them.* 



The color of the substance of the heart is a dark, brownish red. 

 Hie consistence is often considerably increased, so that the walls of a 

 hypertrophied heart do not collapse when cut open, as they otherwise 

 should do. 



SYMPTOMS AND COFESE. It is difficult to furnish a picture of pure 

 hypertrophy of the heart, since this affection, as we have seen, scarcely 

 ever exists independently, but is almost always an accompaniment of 

 other grave diseases of the organ, or of the great vessels, etc. In fact, 

 these complications often completely neutralize the effect which the 

 hypertrophy would have, were it to exist alone. A great number of 

 the phenomena set down as symptoms of cardiac hypertrophy certainly 

 are not dependent upon that cause ; and indeed would exist in a much 

 more marked degree were it not for the coexistence of the hypertrophy 

 of the heart with the main disease. This is especially true of cyanosis 



* Rokitansky and Bamberger certainly speak of an increase in bulk of the primitive 

 muscular bundles. 



