378 DISEASES OP THE HEART. 



Persons in whom a general obesity has developed, through luxuri- 

 ous living, and in whom an accumulation of fat may also be suspected 

 about the heart, should be sent to Karlsbad, Marienbad, etc. It is an 

 indisputable fact that, during treatment at these baths, the fat decreases 

 and the garments of patients grow too loose for them, although we 

 have no better physiological explanation of the circumstance than a 

 somewhat feeble hypothesis. 



In true fatty degeneration of the heart we must confine ourselves 

 to a treatment of symptoms, and, if it form one of the accompaniments 

 of general marasmus, we should prescribe a generous diet and cor- 

 responding medicines. We may, perhaps, succeed in restraining the 

 progress of the malady, if we do not entirely allay it. 



Treatment of amyloid degeneration, cancer, tubercle, and parasites, 

 is out of the question, as the diseases are never recognizable. 



CHAPTER XI. 



RUPTURE OF THE HEART. 



WE refer exclusively to the so-called spontaneous ruptures, and 

 shall not allude to traumatic solutions of continuity of the heart. A 

 healthy heart never bursts, in spite of the greatest strain. If the organ 

 be diseased, strains of any kind may, no doubt, aid in causing its rup- 

 ture. The most frequent cause of rupture is fatty degeneration ; more 

 rarely, myocarditis, cardiac abscess, and acute and chronic cardiac 

 aneurism. As all of these affections usually arise in the left side of 

 the organ, rupture nearly always occurs there also. Upon autopsy, 

 we find the pericardium distended by blood, and, if fatty metamorphosis 

 have occasioned the rupture, an irregular but outwardly smooth rent, 

 of variable length, is found ; while at a deeper point the flesh is torn 

 asunder and mangled. The rent is occasionally filled throughout by 

 coagula ; again more than one rupture is found. 



Sometimes the heart bursts during some unusual exertion, or it may 

 give way without any apparent cause, and death usually ensues sud- 

 denly with the symptoms of internal haemorrhage. The pressure of the 

 extravasated blood, however, also seems to have some effect in pro 

 moting speedy death. In rare instances the rupture has been precedec 

 by a brief period of violent pain under the sternum, shooting toward 

 the left shoulder and along the arm. In cases equally rare, patients 

 have survived rupture of the heart for several hours. This seems to 

 happen when the extravasation consists, at first, of a mere filtration of 

 the blood through the broken-down, disintegrated cardiac wall, the 

 rent gradually growing larger. Symptoms then appear of a less active 



