HYPERTROPHY OF THE HEART. 319 



excentric hypertrophy of the left ventricle, is to produce an abnormal 

 fulness and engorgement of the vessels of the aortic circulation, which 

 does not extend into the veins (the outflow from which, indeed, is 

 facilitated), to diminish the fulness of the vessels of the smaller circu- 

 lation, and to accelerate the current in both systems. The latter fact 

 is easy to account for, if we remember that both ventricles set an ab- 

 normally large amount of blood in motion with every systole ; the left, 

 because it is hypertrophied, the right, because it sends its blood through 

 scantily-filled vessels. 



Should the right ventricle alone be hypertrophied, then, conversely, 

 the volume of blood in the lesser circuit is increased, and that of the 

 greater is diminished. But here, no sooner does the right ventricle 

 discharge more blood than the left, than the flow from the right ven- 

 tricle into the over-distended pulmonary artery becomes embarrassed, 

 while the flow from the unhypertrophied left ventricle into the scantily- 

 charged aorta is rendered easier. Upon the other side the blood pours 

 into the left heart from heavily-charged veins, and into the right from 

 veins which are imperfectly filled, so that here, too, both ventricles 

 soon begin to propel an equal amount of blood, without which the 

 whole of the blood would collect in the pulmonary system. Hence, 

 hypertrophy of the right ventricle would result in augmentation of 

 the contents of the pulmonary system, reduction of that of the aortic 

 system, acceleration of the circulation, with easier outflow from the 

 pulmonary veins than from the vena cava. 



From the foregoing, in which we have mainly adopted the lucid 

 analysis of Frey, it is easy to perceive what symptoms hypertrophy 

 of the heart occasions, and what variations must arise, according as 

 the entire heart is involved, or portions of it. We are treating now, 

 however, of uncomplicated hypertrophy, where there is no obstacle to 

 the current of the blood, the effects of which hypertrophy would tend 

 to counteract, and can only consider the subject of consecutive hyper- 

 trophy when we discuss the subject of valvular diseases, the symptoms 

 of which they modify. 



Total excentric hypertrophy of the heart is the form which most 

 frequently arises without complication. In most instances, persona 

 thus affected feel perfectly well, and it often happens that the exist- 

 ence of the malady is not detected until the physician makes a phys- 

 ical exploration of the chest, after the occurrence of an apoplectic 

 stroke, or that it is first observed post mortem, after an apoplexy which 

 has cost the patient his life. The patient has had no occasion to con- 

 sult the doctor, the doctor none to examine the chest. Thus it is with 

 the majority of cases, which, though really under observation, are not 

 understood. The pulse of such patients is full and strong, the carotida 



