362 DISEASES OF THE HEART. 



This state of comparative good health is common to both stenosis 

 and insufficience ; in general, however, the symptoms differ widely, 

 those of one or other malady usually predominating. Insufficience 

 gives rise to symptoms, and dangers which proceed from the consec- 

 utive excentric hypertrophy, which, no longer merely compensating the 

 disorder of the valves, produces an excessive action of the heart. The 

 patients then usually complain of dizziness, headache, and of spots 

 before the eyes. In other cases, they suddenly perish from apoplexy. 

 More rarely asthmatic attacks occur, but all these symptoms are due 

 to the hypertrophy (Chap. I.), and not to the valvular disorder. 



In stenosis, on the other hand, the symptoms of the circulatory 

 impediment outweigh those coming from the hypertrophy, and although 

 a patient may do well for a considerable length of time, evincing no 

 signs of venous engorgement, yet there will be tokens that the arteries 

 are but scantily filled, a symptom which must always precede those 

 which indicate overcharge of the veins. The patients look pale, are 

 prone to fainting-fits, and present signs of anaemia of the brain ; just as 

 others, who suffer from insufficience of the valves, seem to incline to 

 cerebral hyperaemia and to apoplexy. 



This period of comparative comfort, enjoyed by patients with dis- 

 ease of the aortic valves, often ceases in a somewhat sudden and 

 remarkable manner, after having lasted, perhaps, for many years. 

 Either because the hypertrophied heart has degenerated, or else from 

 insufficience of the mitral, caused by chronic endocarditis, which so 

 often complicates valvular disease, or through increase of the original 

 aortic defect, or finally because extensive atheroma of the aorta has 

 set in, thus giving rise to a new hinderance to the circulation, the 

 hypertrophy of the left ventricle is at last no longer able to compen- 

 sate for the deficience of the valves, and to overcome the impediments 

 to the circulation. Then the symptoms appear which we have men- 

 tioned at the beginning of this article. The patients grow short of 

 breath, the veins of the aortic system become overloaded, cyanosis 

 and dropsy arise. These symptoms set in much sooner in mitral dis- 

 ease, and hence shall be described in the next chapter. 



Death takes place either from oedema of the lungs (or else, when 

 there is insufficience, by apoplexy). Frequently, too, death results 

 from embolism, to which valvular disease of the aorta gives rise with 

 a frequence next to that of endo- and myocarditis. In most of the 

 cases wherein embolism of the arteria fossae Sylvii has been found to 

 have caused necrosis of the brain, valvular disease of the aorta has 

 existed. 



Physical signs of insufficience of the aortic valves. Inspection 

 and palpation furnish the usual signs of hypertrophy of the left ven- 



