384 DISEASES OF THE HEART. 



puberty. It may be that, for a time, compensation for the congenital 

 deformity is effected by consecutive hypertrophy, but that insufficience 

 of the heart only appears after the development and growth of the 

 body and the increase of the volume of the blood have advanced so 

 fast that the puny heart can no longer keep pace with it. Physical 

 examination is of little value in the diagnosis, owing to the great 

 diversity of form which such malformations assume. The impulse 

 of the heart is usually strengthened and extended, the dulness greater ; 

 we feel .the fremissement cataire and hear confused murmurs. In 

 other cases the heart-sounds are normal. 



The ancient assumption, that imperfection in the septa caused cya- 

 nosis, is erroneous. This defect, alone, never occasions blueness, etc., 

 but is a harmless anomaly, which gives no evidence of its existence 

 during life. 



TREATMENT. Treatment of congenital deformity of the heart must, 

 of course, be purely symptomatic, and confined to combating the more 

 dangerous manifestations. The same rules hold good here which we 

 have laid down for the management of acquired disease of the heart. 



CHAPTER XIV. 



NEUROSES OP THE HEART. 



ETIOLOGY. There are a number of influences which tend to modify 

 t he functional energy of the healthy human heart, as well as the num- 

 ber of its beats. We may assume that the greater force and frequence 

 of the heart-beat, caused by mental or bodily excitement, or by the 

 use of ardent spirits, are not the effect of any structural change in the 

 muscles of the organ, but rather are due to a perversion of its inner- 

 vation. The term neurosis of the heart, however, is not applied to 

 functional derangements proceeding from causes of this nature, but 

 only to those forms of perversion of its action or abnormity of its sen- 

 sation which, without depending upon any structural change, arise 

 either without preceptible cause or else upon occasions which, in most 

 persons, would not give rise to any functional disturbance. Under 

 this head stand the so-called nervous palpitation and the train of 

 symptoms known as angina pectoris. The character of these two affec- 

 tions, particularly the paroxysms and the free intervals observed in 

 their course, entitle us in some measure to count them among the neu- 

 roses of motion and sensibility. It would be somewhat rash, however, 

 to ascribe them as yet to any particular class of these complaints, as 

 long as our knowledge regarding the influence of the cardiac nerves 

 upon the function of the heart remains in its present imperfect state. 



