634 



ABNORMAL CONDITIONS OF THE HEART. 



veins of the left side entering behind the ap- 

 pendage. The right and left ventricles were 

 distinct, with the coronary vessels running 

 upon them ; and the aorta and pulmonary 

 artery were seen clearly emerging from them." 

 There is nothing in Dr. Baillie's description 

 to indicate positively whether the visceral layer 

 of the serous pericardium was absent or not, 

 although we may infer its absence ; what he 

 says bearing upon this subject is as follows : 

 " The heart was involved in the reflection of 

 the pleura, belonging to the left side of the 

 chest, which became its immediate covering, 

 and upon making the slightest incision into the 

 substance of the heart, its muscular structure 

 was laid bare, as in any common heart de- 

 prived of its pericardium." 



Breschet* has put on record a case in which 

 the pericardium was absent, not altogether, but 

 in greatest part. The subject of it was a 

 young man of twenty-eight years of age, who 

 died in the Hotel Dieu of an inflammatory 

 affection of the intestines. The heart lay free 

 under the left lung without any external fibro- 

 serous envelope. The mediastinum was 

 formed only by a simple serous lamina belong- 

 ing to the right pleura, and upon the left of 

 this lay a rudimentary fibrous capsule, attached 

 above to the origin of the great vessels. The 

 serous membrane was altogether absent, but 

 the heart was immediately inverted by a serous 

 lamella, which was prolonged from the left 

 pleura. In both this case and that of Baillie, 

 the left phrenic nerve was displaced and brought 

 towards the mesial line of the body, and not 

 covered by the serous membrane, an anato- 

 mical character, which, as Breschet suggests, 

 may serve to distinguish congenital absence of 

 the pericardium from the simple adhesion of 

 that membrane to the heart.f 



II. Malformations of the heart by excess of 

 developement. Plurality of the heart itself 

 may be obviously regarded as coming under 

 this head ; but I am not aware of any instance 

 in which a double heart has been found in a 

 perfect single foetus, nor can the possibility of 

 such an occurrence be deemed admissible. 

 It is in monsters formed by the junction of two 

 that this double form of the heart has been met 

 with. Thus, in one case referred to in Bouil- 

 laud's work, all the upper parts of the foetus 

 were double, while the inferior were simple. 

 There were two heads, two necks, quite separate 

 and of the ordinary size. The necks terminated 

 in a single very wide thorax, to the upper part 

 of which and between the insertion of the 

 two necks an arm was attached in the vertical 

 direction, one perfectly formed arm being 

 placed on each side of the thorax. There were 

 four lungs, each having a distinct pleura, but 

 only one diaphragm : there were also two 

 hearts and two pericardia, each of which had 

 two venae cavae and a pulmonary artery, four 

 pulmonary veins and an aorta. The two aortae 



* Mem. sur un vice de conformation congenitale 

 des enveloppes du cceur : Rep, Gen. d'Anat. t. i. 

 p. 212. 



t See references to other cases in Otto's Path. 

 Anat. by South, p. 254. 



united at the lower part of the dorsal region 

 of the spine, and formed the artery by which 

 the abdominal viscera and lower extremities 

 were supplied. 



The evidence respecting the occurrence of 

 an increase in the number of the parts of the 

 heart is very unsatisfactory. The often quoted 

 case of Kerkring,* with a double right ven- 

 tricle; one by Vetter,f with four auricles and 

 four ventricles, quoted by Otto ; a third by Che- 

 mineau,J with three ventricles, are, if genuine, 

 the most remarkable instances on record, be- 

 sides various instances in the lower animals, 

 especially birds. Andral states that he has 

 seen a heart with three auricles, and another 

 with four ventricles : it is much to be regretted 

 that he has given no description of these sin- 

 gular malformations 



Supernumerary cavities, or septa dividing 

 the primitive cavities of the heart, are the most 

 common instances of excessive developement. 

 Adopting the arrangement of Andral,|| we 

 find 1, a supernumerary cavity forming a 

 sort of accidental appendage to one of the 

 auricles or ventricles, and communicating with 

 the cavity of the part to which it is attached : 



2, a supernumerary septum, forming an im- 

 perfect division of one of the natural cavities ; 



3, a second cavity, completely partitioned off 

 by one of these septa, and giving off super- 

 numerary vessels, which communicate with the 

 regular vessels of the heart. It appears to me, 

 however, to be very questionable that all cases 

 of supernumerary cavities are the result of ex- 

 cessive development, but that, on the contrary, 

 they are sometimes mechanically consequent 

 upon defective formation in other parts. At 

 least it is in this way that I account for the con- 

 dition of the heart of a boy, aged ten years, 

 which I examined several years ago, and which 

 has been described by my respected friend, Dr. 

 John Crampton, in the Transactions of the 

 Dublin College of Physicians for 1830. In 

 this heart there were three instances of defective 

 developement absence of the valves of the 

 pulmonary artery, an open foramen, and an 

 imperfect septum ventriculorum. Attached to 

 the right ventricle there was a supernumerary 

 cavity with which the pulmonary artery com- 

 municated. This cavity communicated also 

 with the right ventricle, by an opening large 

 enough to admit the little ringer, and formed 

 under the columns carnese of the ventricle. The 

 pulmonary artery was not only destitute of 

 valves, but at the usual situation of the valves 

 its lining membrane was puckered, by which 

 its orifice was manifestly contracted. The su- 

 pernumerary cavity, in this instance, was in all 

 probability occasioned by a partial dilatation 

 of the infundibular portion of the right ventri- 

 cle, in consequence of the obstruction at the 

 pulmonary orifice. 



Increase in the number of the valves of the 

 large arteries may be counted among the ab- 



* Spicil Anat. obs. 69, p. 139. 



t Aphorism, aus der Pathol. Anat. 



J Hist, de 1'Acad. des Sc. an. 1699. 



$ Path. Anat. by Townsend, vol. ii. p. 333. 



II Loc. cit.j 



