ABNORMAL CONDITIONS OF THE HEART. 



636 



from external violence. The patient was 

 crushed between a water-wheel and the em- 

 bankment on which the axle was supported. 

 Several ribs were broken, as well as the right 

 clavicle and humerus. The heart, which, ac- 

 cording to the statement of the patient, had 

 always occupied its natural situation, was now 

 found beating at the right side.* 



MORBID ALTERATIONS OF THE MUSCULAR 

 SUBSTANCE OF THE HEART. 



1 . Inflammation of the muscular structure of 

 the heart, or carditis (the carditis proper of some 

 pathologists). The same anatomical characters 

 which would lead us to pronounce any muscu- 

 lar tissue in a state of acute inflammation, 

 would justify a similar conclusion respecting the 

 heart. But from the sparing deposition of cel- 

 lular tissue around this organ and between its 

 fibres, the anatomical phenomena which denote 

 the previous existence of inflammation are not so 

 marked in it as in the muscles of animal life ; and 

 judging from the rarity of these organic signs, as 

 well as from the unfrequent occurrence of those 

 symptoms which so great a morbid process could 

 scarcely fail to produce, we may reasonably 

 conclude that active inflammation deeply im- 

 plicating the carneous fibres of the heart, and 

 originating in them, is very seldom met with. 



The anatomical characters indicative of car- 

 ditis are a dark, almost black, colour of the 

 muscular substance, the fibres of which have 

 lost in a great measure their cohesive power; 

 they are very compressible and readily torn, 

 and consequently cannot be easily isolated to 

 any great extent, although easily separable en 

 masse. When the muscular wall of either ven- 

 tricle is pressed, the blood oozes out from the 

 divided vessels on the cut surface in much 

 greater quantity than usual. In Mr. Stanley's 

 case, as in all cases, the dark colour of the 

 fibres " evidently depended on the nutrient 

 vessels being loaded with venous blood." When 

 in addition to these signs we find purulent de- 

 posits in various parts of the muscular struc- 

 ture, and moreover, when it is manifest that the 

 internal and external membranes are implica- 

 ted, from the effusion of coagulable lymph on 

 them to a greater or less extent, no doubt can 

 be entertained respecting the exact nature of 

 the lesion. In Mr. Stanley's case, " upon 

 looking to the cut surface exposed in the section 

 of either ventricle, numerous small collections 

 of dark-coloured pus were visible in distinct 

 situations among the muscular fasciculi."f A 

 similar case has been recorded by Dr. P. M. 

 Latham, the anatomical characters of which ac- 

 corded with those above mentioned. " The 

 whole heart was found deeply tinged with dark- 

 coloured blood, and its substance softened ; and 

 here and there, upon the section of both ven- 

 tricles, innumerable small points of pus oozed 

 from among the muscular fibres." J 



Every anatomist must have noticed how 

 variable is the colour and the consistence of the 

 muscular structure of the heart, even indepen- 



* Med. Gazette, vol. viii. 

 t Med. Chir. Trans, vol. vii. 

 t Med. Gazette, vol. iii. 



dent of disease of the lining tissues. The pale, 

 soft, compressible, flexible, and, to use a com- 

 mon word, flabby heart, strongly contrasts wit^i 

 the firm, plump, fresh-looking elastic one ; in 

 the former, the flaccid parietes fall together im- 

 mediately the cavities are emptied ; in the lat- 

 ter, the surfaces retain their convexity, although 

 the contents of the cavities have been com- 

 pletely removed. Between these two extremes 

 there are various grades of colour and consis- 

 tence, of which Bouillaud particularises three 

 as being the result of inflammation, the red 

 softening , the white or grey, and the yellow. 

 The first is probably that which may be said 

 unequivocally to follow primary inflammation 

 of the muscular texture ; the other two, how- 

 ever, as Bouillaud admits, occur most fre- 

 quently in connection with pericarditis : they 

 occur, too, as Dr. Copland observes, where no 

 sign of inflammation is manifest, and where 

 during life there had been no evidence of car- 

 diac disease ; in cases of general cachexia and 

 of constitutional disease, attended by discolora- 

 tion of the surface of the body, arising, in fact, 

 as Dr. Williams explains, from an altered state 

 of the nutrition of the organ, owing perhaps to 

 partial obstructions in the coronary vessels ra- 

 ther than to the immediate influence of inflam- 

 mation. This last excellent observer makes the 

 following judicious remarks in reference to this 

 matter.* " To judge that the tissue of the 

 heart is especially diseased, we must see that it 

 differs much in appearance from the other 

 muscles of the same subject. You will find, 

 on comparing the same muscles in different 

 subjects, a remarkable variety of colour; and 

 in some there is no freshness in any of the 

 muscles, but all are pale, and verging on a 

 pinkish drab or dingy brick colour." Perhaps 

 the most correct arrangement of the various cir- 

 cumstances under which softening of the heart 

 may take place is that given by Andral. 1st, 

 Softening connected with active hypersemia of 

 the heart ; 2d, softening connected with anaemia 

 of the heart; 3d, softening connected with 

 atrophy of the heart; 4th, softening connected 

 with an acute alteration in the general nutritive 

 process (as in typhus); 5th, softening connected 

 with a chronic alteration in the general nutritive 

 process (as in a variety of chronic diseases) ; 

 6th, softening which we are not yet enabled to 

 refer to any morbid condition of the heart itself 

 or of the rest of the system.f 



Suppuration. 'The occurrence of an abscess 

 uncomplicated with any other lesion in the 

 walls of the heart, does not unequivocally de- 

 note the previous existence of carditis, although 

 it may afford strong presumptive evidence of 

 the fact : when, however, we find abscess, with 

 lymph or adhesions of recent date, we may rea- 

 sonably infer its inflammatory nature. Dr. 

 Copland has introduced in a note to his inva- 

 luable and profoundly learned article on Dis- 



* Lectures on Diseases of the Chest, Med. Gaz. 

 vol. xvi. 



t Otto says that violent exertion appears as in 

 other muscles to render the heart easily broken 

 down ; thus, for instance, it is found very weak in 

 hunted deer. 



