342 DISEASES OP THE HEART. 



Moreover, in consequence of the emptiness of the arteries, the "veins 

 are over-filled, and the retardation of the current of the blood gives a 

 venous character to the latter, and occasions shortness of breath. The 

 patients may become exquisitely cyanotic. General dropsy appears, 

 and with it there is often great dyspnoea. If the atrophied heart bo 

 also dilated, an additional cause of engorgement of the veins and im- 

 pediment of the circulation comes into play, and all the symptoms are 

 much aggravated. But the progress of the malady is still more rapid 

 and serious upon addition of a third cause fatty degeneration of the 

 cardiac muscles the effects of which are quite similar to those of the 

 first two, and which usually accompanies them. Such cases are tolera- 

 bly common, and when old and feeble persons become blue and drop- 

 sical, without having any valvular disease, it is generally owing to 

 dilatation and degeneration of the substance of the heart, or else to 

 extensive endarteritis deformans. An approximate diagnosis, at least, 

 may be made sometimes by physical exploration. As long as the pa- 

 tient remains at rest the heart-shock may be very feeble, or quite im- 

 perceptible. The pulse is remarkably small. In some cases, the area 

 of cardiac dulness has decreased with the diminution of the heart, a 

 symptom which is only of value when it can be proved that diminution 

 of the heart has caused vicarious emphysema, distending the lungs. 

 In other cases, instead of extension of the lung, a large effusion into 

 the pericardium fills the vacuum caused by shrinking of the heart, and 

 the cardiac dulness is normal. In other cases, in which the lungs are 

 also reduced in size, the pericardial effusion may be so profuse as to 

 render the cardiac dulness abnormally large. The same is the case in 

 atrophy of the wall of the heart with dilatation of its cavity. As, in 

 hypertrophy, the heart-sounds are stronger and louder, so in atrophy 

 they are either feebler or indistinct, or else they are muffled, and some- 

 times murmurs are audible, which depend upon the conditions which 

 we have already mentioned, as causes of modification of the sounds of 

 the heart. 



TREATMENT. A real treatment of atrophy of the heart is out of 

 the question. Of course, all violent efforts must be avoided, rich food 

 be provided, and even the moderate employment of wine, " vinum lae 

 serum" may be permitted. 



CHAPTER IV. 



ENDOCARDITIS. 



ETIOLOGY. We entirely agree with Virchow as to the pathogeny 

 of endocarditis. He regards the hypothesis of the forma tion of a free 

 exudation in this disease as not proven and even doubtful, and counts 



