358 DISEASES OF THE HEART. 



VALVULAR DISEASE OF THE HEART. 



BY valvular disease of the heart, in its narrowest sense, we mean 

 merely those anomalies cf its valves which affect the function of the 

 organ, and thus react upon the circulation. Valvular anomalies which 

 give rise to no symptoms, and which hence are purely matters of pa- 

 thologico-anatomical curiosity, and not of clinical interest, need but 

 little notice in the following chapter. They are 



The so-called simple hypertrophies of the valves, which are found 

 chiefly upon the mitral near its free border, whence is found growing 

 a series of little lumps of a jelly-like connective tissue. The fine web 

 uii the lower border, upon whose unfolding the valvular action mainly 

 depends, remains intact in hypertrophy, while endocarditis usually has 

 the effect of thickening it, and, as it were, rolling it up. 



The next deformity of the valves, which does not derange their 

 action, is enlargement, which often occurs in them with simultaneous 

 thinning, when the ostium is abnormally dilated. Most cases of per- 

 foration of the valves also belong under this head. Small oval fissures 

 or holes are often seen in them, which, however, do not seem to impai'- 

 their efficiency. 



The most important valvular changes are those known as imuffi* 

 cience and contraction. These two alterations nearly always coexist, 

 one usually prevailing over the other, however, in degree. By insuffi- 

 cience, we mean that condition of a valve which renders it incapable 

 of preventing regurgitation of blood into the cavity which, as a valve, 

 it should close. If the entire contents of the ventricles be not thrown 

 into the aorta and pulmonary artery during systole, and if a portion 

 nf the blood regurgitate into the auricles, the mitral or tricuspid are 

 insufficient. Again, if, during diastole of the ventricle, part of the 

 blood which had entered the aorta and pulmonary artery flow back 

 into the ventricle, the semilunar valves are insufficient. 



By stenosis (constriction) of a valve, or, more properly speaking, 

 of an orifice, we mean that condition by which the effluent blood 

 meets with abnormal resistance through contraction of the outlet of 

 the heart. 



Although valvular deformities have, in common^ the effect of re- 

 tarding the circulation, the influence upon the distribution of the blood 

 varies according to the seat of the affection. The system can endure 

 valvular deficience at one point much better than at another ; hence 

 we deem it better at once specially to describe its effects at the differ 

 ent outlets, rather than to go into a further general discussion of the 

 subject. We cannot altogether avoid repetition, by this method of 



