ABNORMAL CONDITIONS OF THE HEART. 



631 



by the abdominal viscera, which had passed 

 up through a fissure in the diaphragm. In a 

 second instance of this high displacement the 

 apex of the heart adhered to the palate; but in 

 this case the malposition appears to have been 

 owing to a morbid adhesion of the umbilical 

 cord to the head, by which all the viscera were 

 drawn out of their natural positions. A less 

 degree of cervical displacement is where the 

 heart is found immediately above the thorax, 

 in the front of the neck, which, however, is 

 very rare. 



When the malposited heart is found in the 

 abdomen, the diaphragm is generally deficient 

 to a greater or less extent. 



In a case narrated by Mr. Wilson,* the 

 heart was in a fissure on the convex surface of 

 the liver the infant lived seven days ! Ramel 

 also gives an instance of the heart being placed 

 in the region of the stomach, and the indi- 

 vidual in whom he observed it was ten years 

 of age. And in the extraordinary case related 

 by Deschamps, the heart occupied the place of 

 the left kidney ! Not the least marvellous cir- 

 cumstance about this case is, that the indi- 

 vidual was an old soldier, who had served 

 several campaigns, and enjoyed excellent health, 

 with the exception of nephritic pains, which 

 ultimately procured him his discharge from the 

 service. The right kidney alone existed, and 

 was found in a state of suppu ration .f The 

 vessels emanating from the heart passed through 

 an opening in the diaphragm into the thorax. 



Dr. Paget mentions some instances of vari- 

 eties of position which parts of the heart may 

 assume with respect to each other. In a case 

 recorded in the first volume of the Edinburgh 

 Medico-ChirurgicalTransactions by Dr.Holmes 

 of Canada, the right auricle, enlarged to the 

 capacity of a pint, was found to open into the 

 left ventricle in place of the right, into which, 

 however, the blood afterwards found its way 

 through a small perforation in the septum of the 

 ventricles. 



The aorta and pulmonary artery may arise 

 from one ventricle alone, either right or left, and 

 instances of each preternatural origin are pre- 

 served in the museum of the Edinburgh Col- 

 lege of Surgeons. 



When the anterior wall of the thorax is de- 

 ficient, the heart may be found protruding 

 through the opening, as in fissure of the ster- 

 num, or a defect in its inferior portion as well 

 as in some of the ribs; nor does this mal- 

 position necessarily destroy life. Where the 

 deficiency is not confined to the wall of the 

 thorax, but also extends to the abdomen, the 

 stomach, liver, and spleen, with the heart, are 

 found occupying a large hernial sac in front 

 of the opening, which is sometimes contained 

 in the sheath of the umbilical cord, or covered 

 by an extension of the common integument. 

 In the case of simple fissure of the sternum, 

 it has occurred that the heart had not protruded, 

 but occupied its natural position, being simply 



* Phil. Trans. 1798. 



t Quoted by Breschet from the Journ. Gen. dc 

 Med. t. xx vi. 



exposed to view by the abnormal opening in 

 the chest.* 



2. ]\Ial formations by defect in dcvelopewent. 

 Our limits compel us to restrict the present 

 account to little more than an enumeration of 

 the congenital malformations which may be 

 placed in this class. In these malformations 

 we find a diminution in the normal number of 

 the heart's cavities, either from a very early 

 arrest in the developement of the whole organ, 

 or from a total non-developement of the sep- 

 tum, or from its imperfect developement. A 

 few rare instances, many of which have oc- 

 curred in the lower quadrupeds, of an ex- 

 tremely imperfect state of the heart, are quoted 

 by Otto, in which that organ seemed to consist 

 of nothing but a fleshy enlargement at the 

 commencement of the aorta, described as " a 

 mere fleshy mass without any cavity," or " a 

 longish solid mass from which the vessels arise," 

 '* or a mere expanded vascular trunk." 



The dicalious heart of Hunter, or that with 

 two cavities, exists at a very early period of the 

 developement of the Mammiferous embryo : 

 it is described and figured by Baer in the em- 

 bryo of a dog, of three weeks, only four lines 

 in length, as consisting of a single auricle and 

 a single ventricle.-}- The permanence of this 

 state of the heart, similar to the natural con- 

 dition of that organ in fishes, constitutes one 

 of the simplest but rarest malformations in the 

 human subject. From the ventricle a single 

 vessel arises which subdivides into the aorta 

 and pulmonary artery. A very perfect example 

 of this malformation is described by Mr. Wilson 

 in the Philosophical Transactions for 1798; 

 it is the same case which has been already al- 

 luded to as affording an instance of malposition. 

 In this case the blood was returned from the 

 lungs by two veins which joined the superior 

 vena cava, and entered the auricle along with 

 it, the inferior cava being formed in the usual 

 way. Other examples are recorded by Mr. 

 Standert,t Dr. Farre, Professor Mayer,|| and 

 Dr. Ramsbotham.^f 



The heart with three cavities (tricoilia of 

 Hunter), that is, containing two auricles and 

 one ventricle, or that form of the heart which 

 belongs to the Batrachian reptiles, must be 

 very rare, if indeed it ever occurs. 



A case is related by Breschet,** in which a 



* The reader who desires farther information on 

 the congenital ectopia of the heart, may consult 

 Breschet's memoir already referred to ; Dr. Paget's 

 Inaugural Dissertation on Malformations of the 

 Heart, Ed. 1831 ; the article on Displacement of 

 the Heart, by my valued friend Dr. Townsend, in 

 the Cyclopaedia of Practical Medicine, vol. ii.; 

 Fleischman de vitiis congen. circa thoracem et 

 abdomen, Erlang. 1810; Weese de Ectopia Cordis, 

 Berol. 1819 ; and Haan de Ectopia Cordis, Bonn. 

 1825. 



t De ovi Mammal, et Hominis Genesi ; also 

 in Forbes* Journal another case by Baer, vol. i. 

 plate 2, fig. 9, human embryo about the fifth 

 week. 



J Phil. Trans. 1805. 



6 On the Malformations of the Human Heart. 



[j Arch. Gen. de Med. torn. xvii. 



T| Lond. Med. and Phys. Journal. 



** Rep. Gen. d'Anat. torn. ii. 



