HYPERTROPHY OF THE HEART. 321 



atheroma of the arteries and cardiac hypertrophy (which Rokitansky 

 and Virchow also admit) can hardly be longer called in question, after 

 the observations of J)ittrich, according to whom the pulmonary artery 

 which is otherwise rarely the seat of atheroma, is often found to be 

 atheromatous where there is a hypertrophy of the right side of the 

 heart. Should the patient survive the first or second attack of apoplexy, 

 he may attain a tolerably advanced age. In other cases the hyper- 

 trophied heart degenerates, when the malady assumes a very different 

 aspect. Venous obstruction, dropsy, etc., arise, symptoms which we 

 shah 1 discuss more in detail in treating of degeneration of the sub- 

 stance of the heart. 



The symptoms of total, simple, uncomplicated, excentric hypertro- 

 phy of the left side of the heart, which is next in frequence of occur- 

 rence, must, of course, closely resemble those of total hypertrophy. 

 Here, too, the circulation is accelerated, the arteries are extremely full, 

 and there is no engorgement of the veins or capillaries, the blood flow- 

 ing into the right side of the heart with ease and rapidity. The res- 

 piration is not injuriously affected by diminution of the contents of the 

 pulmonary system, as the negative influence exerted upon oxygenation 

 by emptiness of the vessels is fully counterbalanced by the positive 

 one of acceleration of the circulation. Here, too, we seldom hear any 

 complaint from the patient. The pulse is full and strong, the com- 

 plexion healthy, and the functions normal. Derangement of the respi- 

 ration is even still more rare in this form of disease than in total hy- 

 pertrophy of tne neart, as, in these cases, the heart seldom encroaches 

 upon the cavity of the thorax. Palpitation is a frequent, but by no 

 means constant, symptom. The malady usually terminates in apo- 

 plexy. 



Often as the right ventricle takes part in an excentric hypertrophy 

 of the left ventricle, and extremely often as hypertrophy of the right 

 side of the heart accompanies derangements in the pulmonary circula- 

 tion, and lesions of the valves of the heart, yet simple hypertrophy is 

 extremely rare in the right ventricle, indeed it is questionable whether 

 it ever has been seen. Any description of simple hypertrophy of the 

 right side of the heart, which we might make, must be a fictitious one, 

 not based upon actual observation. At all events, intense dyspnoea 

 and oedema of the lung, which have been set down among its symp- 

 toms, are as little dependent upon hypertrophy of the right ventricle 

 as are cyanosis and dropsy caused by hypertrophy of the left ; indeed, 

 as we shall see, hypertrophy actually diminishes the dyspnoea which 

 the main disease has occasioned, just as hypertrophy of the left side, 

 when complicating valvular derangement, long averts the occurrence of 

 cyanosis and dropsy. 



