340 DISEASES OF THE HEART. 



in the female sex (RoJcitansky), accompanied by retarded develop- 

 ment in general, but especially of the sexual organs. We know nothing 

 of the manner in which it originates. 

 Acquired atrophy occurs 



1. In general marasmus, such as is developed in the course of tuber- 

 cular consumption, cancerous cachexia, and cancerous suppuration, or 

 in consequence of old age. Even attacks of acute disease, of long 

 duration, such as protracted typhus, may cause atrophy of the heart. 

 We also find that, although an abundant supply of nourishment is not 

 sufficient, of itself alone, to cause the muscular tissue of the heart to 

 grow, yet a scanty supply, or an abnormal consumption of it, may give 

 rise to atrophy of the cardiac muscles, as well as to wasting of the 

 muscular system at large. 



2. The heart atrophies when exposed to unusual pressure from 

 without, just as the muscles of the extremities waste away under con- 

 tinued compression of shackles or bandages. Atrophy of the heart 

 also accompanies extensive pericardial effusion, fibrous thickening of 

 the epicardium, and may even result from large accumulations of fat 

 upon the organ. 



3. Contraction of the coronary arteries causes atrophy of the heart, 

 by limiting the supply of nutritive fluid. 



ANATOMICAL APPEARANCES. In congenital smallness of the heart, 

 the heart of an adult may be like that of a child of five or six years of 

 age, with thin walls, small cavities, and delicate valves (RohitansJcy). 



Acquired atrophy is almost always concentric that is, the thinning 

 of the wall of the organ is accompanied by contraction of its cavities. 

 Another characteristic sign, besides the reduction in size, and by which 

 it may be distinguished from congenital smallness, consists in the dis- 

 appearance of the fat of the heart, and in the serous infiltration of the 

 connective tissue, in which the fat formerly lay. The pericardium is 

 opaque, the white specks, which we so often find in the heart (Sehnen- 

 flecke), are wrinkled, and the coronary arteries remarkably tortuous. 

 The endocardium is also clouded, the valves of the veins swollen. 

 The substance of the heart is usually pale, and its consistence less 

 firm ; in other cases, it is hard and dark. Bamberger very properly 

 calls to our attention that, in many cases of concentric atrophy of the 

 heart, there is a considerable quantity of liquid in the pericardial sac. 

 This bears a certain analogy with the collections of water in the skull 

 in atrophy of the brain with hydrocephalus ex vacuo. 



Simple atrophy of the heart is much more rare. Here the organ 

 is of normal size, but its walls are thinned. Hence the normal size 

 can only be the result of dilatation of the cavities, so that this form 

 *f disease is allied to that described in a previous chapter. This ap- 



