368 DISEASES OF THE HEART. 



rather, physical demonstration. Patients with mitral disease are al- 

 ways short of breath, in consequence of hyperaemia of the lung. As 

 the vessels of the bronchi are less affected than those of the air-cells 

 by this engorgement, the dyspnoea is not always combined with bron 

 chial catarrh ; as, however, the bronchial and pulmonary arteries anas- 

 tomose, nay, as part of the blood of the capillaries and bronchial 

 arteries flows into those of the pulmonary artery, the dyspnoea is gen- 

 erally accompanied by bronchial catarrh. Even at this early stage of 

 the disease, unusual exertion, or other stimulant to the action of the 

 hypertrophied right heart, may cause the death of the patient from 

 acute pulmonary oedema, although such an event is of more commor 

 occurrence at a later period, after obstruction of the aortic veins and of 

 the thoracic duct has thinned the serum of the blood. 



Patients with insufficience and constriction of the mitral valve often 

 enjoy tolerable health, excepting that they are short of breath, and 

 we should err greatly in supposing that disease of the mitral valve is 

 always accompanied by cyanosis. In constriction of the valve, par- 

 ticularly if combined with insufficience, the compensation soon becomes 

 imperfect. The patients look pale from lack of blood in their arte- 

 ries ; but this derangement of distribution does not cause engorgement 

 of the veins, mainly because most of the blood is collected into the 

 pulmonary circulation. 



Sooner or later, the picture changes. Compensating hypertrophy 

 of the right ventricle has its limits, while deformity of the valves grows 

 worse and worse from fresh endocarditis, or else the conditions de- 

 scribed in the previous chapter arise, and compensation becomes im- 

 perfect. Then the contents of the aorta and its branches diminish 

 more and more, the secretion of urine is lessened, the veins and 

 capillaries become overloaded, the lips and cheeks assume a bluish or 

 even a deep-blue hue. The embarrassed outflow of the cerebral veins 

 creates heaviness in the head, headache, etc. The liver soon becomes 

 enlarged, the patient complains of fulness and oppression in the right 

 hypochondrium ; the liver forms a tumor, distinctly demonstrable by 

 percussion and palpation, and which may extend down almost to the 

 navel. Obstruction of the hepatic veins may so increase that the re- 

 pleted vessels compress the biliary passages, so as to give rise to re- 

 tention and reabsorption of the bile. The mucous membrane of these 

 passages may also become the seat of a catarrh, and the flow of mucus 

 thus produced may so obstruct, the bile-ducts as to cause biliary ab- 

 sorption. A yellow color is thus added to the previous cyanotic as- 

 pect, which may impart a greenish tint to the complexion. Chronic 

 gastric and intestinal catarrh arises from obstruction of the gastric and 

 Intestinal veins ; the haemorrhoidal veins swell ; engorgement of the 



