320 DISEASES OF THE HEART. 



pulsate visibly ; in all the greater arteries we hear, during the systole 

 of the ventricle, a distinct ring. The face is reddened, the eye glitters, 

 ind sometimes is remarkably prominent. The functions are normal. 

 Respiration, as long as the heart has not attained an excessive develop- 

 ment, is not materially embarrassed in pure hypertrophy. However, 

 when a " cor bovinum " displaces the lungs to either side, and de- 

 presses the diaphragm, there may be a sensation of fulness in the chest, 

 of pressure in the epigastrium, and often a considerable degree of short- 

 ness of breath. In many instances, the patients complain of palpita- 

 tion of the heart, particularly when excited, although these are not, 

 by any means, constant signs. We must often wonder that the im- 

 pulse of a hea*rt, strong enough to jar the chest like the blow of a 

 hammer, should cause the patient so little inconvenience, or afford ab- 

 solutely no subjective symptoms whatever. 



In the course of total excentric hypertrophy, especially if any par- 

 ticular cause excite the action of the heart, symptoms of active hyper- 

 aemia and fluxions arise in those organs whose vascular walls, possessing 

 but a feeble power of resistance, are liable to an increased afflux of 

 blood into them whenever pressure of the whole arterial system is 

 augmented, as in the brain and the bronchi. In consequence of the 

 fluxion to the brain, if the patient run, make use of heating drink, or 

 undergo any physical excitement, headaches arise, or spots before the 

 eyes, buzzing in the ears, dizziness, formication, etc., and fluxion to 

 the bronchial arteries occasions swelling of the bronchial mucous mem- 

 branes, wide-spread sibilant rhonchi, great dyspnoea, attacks of asthma, 

 which often soon subside after the patient has lost a little blood, or 

 after the administration of a cathartic, which, by relieving pressure 

 upon the abdominal arteries, facilitates the circulation in the thoracic 

 and abdominal aorta. These attacks must not be attributed to hyper- 

 aemia in the region of the pulmonary artery. The symptoms, especially 

 the wide-spread cooing in the chest, and the character of the dyspnoea, 

 which strikingly resembles that of a bronchial asthma, show distinctly 

 that the fluxion has taken place in the province of the bronchial arteries, 



It is by no means rare for cerebral apoplexy to occur in a case of 

 total excentric hypertrophy ; indeed, we shall see that, in the majority 

 of cases of ruptured blood-vessels of the brain which have been ob- 

 served in young subjects, hypertrophy of the heart, either total or left- 

 sided, was the assignable cause. The frequence of apoplexies of the 

 brain is in part due to the fact that the vessels of the brain are thinner 

 than those of other organs, and hence are more liable to rupture when 

 unduly distended ; and in part, also, to the circumstance that the coats 

 of the arteries in hypertrophy of the heart are often atheromatous, 

 and hence give ^ T ay easily. That there is a genetic connection between 



