ABNORMAL CONDITIONS OF THE HEART, 



637 



eases of the Heart,* an abstract of several cases 

 in which pus was found in the substance of the 

 heart. Those quoted from Corvisart, Raikem, 

 and Simonet, and probably that from Dr. 

 Graves,t may be regarded as examples of puru- 

 lent formation following carditis, general or 

 partial. So likewise is Laennec's case, in 

 which, however, the carditis was consequent 

 upon pericarditis. There is no anatomical cha- 

 racter which will enable us to distinguish whe- 

 ther a simple purulent deposit, surrounded by 

 natural muscular texture, be inflammatory or 

 not, for there is no reason why the heart should 

 be exempt from that which we know often 

 occurs in other muscles, namely, non-inflam- 

 matory deposits. 



Ulceration. As true carditis seems to be 

 generally admitted to be rare, so we may con- 

 clude that ulceration is equally so. It is by 

 the ulcerative process that some of the perfora- 

 tions or ruptures of the parietes of the heart 

 take place ; it is probable, however, that the 

 great majority of the ulcerations we meet 

 with commence from the surface, and result 

 from membranous inflammation rather than 

 from that of the muscular substance ; the ulcer 

 commences on the surfaces, either in or imme- 

 diately subjacent to the internal or external 

 membrane ; and as it burrows deeply, it may 

 perforate the muscular wall, and so destroy the 

 membrane on the side opposite to that on which 

 the ulceration had commenced. Sometimes an 

 ulceration of this kind gives rise to aneurismal 

 tumours or sacs, very variable in size, projecting 

 from that part of the cavity which corresponds 

 to the artery. It seems evident that these 

 tumours are produced by the pressure of the 

 contained blood distending the thinned and 

 yielding wall of the heart. We shall return to 

 this subject further on in treating of aneurisms 

 of the heart. 



Induration. This condition of the muscular 

 structure of the heart seems most probably to 

 be a result of inflammation, especially of the 

 chronic kind. It is generally found in small 

 circumscribed portions ; it may occur in any 

 part of the heart, and may even co-exist with 

 softening : the hardened portion has become 

 particularly firm, is cut with difficulty, and when 

 struck with the scalpel sounds, as Laennec 

 says, like a leather dice-box. It is harder, 

 denser, less elastic, and as regards colour is 

 paler than the hypertrophied muscular tissue. 



Cartilaginous and osseous transformations. 

 Induration of the subserous cellular tissue of 

 the heart is in general the precursor of many of 

 these transformations. This indurated portion 

 increasing in thickness gradually assumes the 

 appearance of cartilage in this cartilage the 

 calcareous particles are deposited. I have not 

 been able to ascertain whether this so-called 

 ossification exhibits, on examination by the mi- 

 croscope, the lamellar arrangement of true bone, 

 as osseous transformations of certain permanent 

 cartilages do, those of the thyroid cartilage for 

 example. These calcareous or osseous patches 



* Diet, of Medicine, part iv. p. 191. 



t Loud. Med. and Surg. Journal, vol. vii. 



or tumours compress the subjacent muscular 

 tissue, and produce atrophy of them, and ac- 

 cording to Andral, sometimes are connected by 

 prolongations of the same material with other 

 calcareous deposits formed round the orifices. 

 Many pathologists believe that these transfor- 

 mations are the result of inflammation. I sup- 

 pose there can be no doubt that they follow an 

 increased afflux of blood, and so they may be 

 considered, although not an immediate, at least 

 a remote effect of inflammation, or rather of the 

 altered nutrition and secretion to which inflam- 

 mation gave rise. 



In a case recorded by my friend Mr. Robert 

 Smith, of Dublin, the apex of the left ventricle 

 was converted into a dense, white, firm, car- 

 tilaginous structure, the division of which with 

 a scissors required the employment of con- 

 siderable force ; the alteration of structure had 

 extended to some of the carneae columnae.* 



Tubercles. These productions are very 

 rarely if ever met with in the heart. No re- 

 liance can be placed on most of the instances 

 recorded, in consequence of the imperfect and 

 unsatisfactory descriptions accompanying them; 

 what appears to one person to be tubercular 

 may present a totally different aspect to another. 

 Laennec says vaguely, " only three or four 

 times have I met with tubercles in the muscular 

 substance of the heart." And Andral states, 

 that they are never met with in the heart, 

 except when they likewise occur in other 

 muscles. Otto says, "although I have dis- 

 sected a great number of scrofulous men and 

 animals, I have never found a tubercle on the 

 heart, and therefore consider them very rare." 

 Dr. Elliotsonf mentions a case in which there 

 were scrofulous deposits in the walls of the 

 left ventricle, surrounded by white and almost 

 cartilaginous induration. In a case which came 

 under my own observation, in a woman be- 

 tween 50 and 60 years of age, there were several 

 white tumours in the parietes of the right 

 ventricle, each about a quarter of an inch in 

 diameter, of uniform consistence throughout, 

 nor showing any disposition to softening in the 

 centre. 



Scirrhus. Equally unsatisfactory are the 

 reports of anatomists respecting this alteration. 

 Rullierand Billard relate cases in which scirrhus 

 had developed itself on the heart. Rullier'sJ 

 case was an instance of degeneration of the 

 whole substance of the heart into a scirrhous 

 mass, which formed irregular knobs on the ex- 

 ternal and internal surfaces of the heart. Bil- 

 lard found three scirrhous tumours embedded in 

 the heart of an infant only three days old. 



Medullary fungus, or encephaloid tumours. 

 Of these, several instances are quoted by Andral 

 from others, and he describes two which he 

 saw himself.|| In the first of Andral's cases the 

 whole of the walls of the right auricle and 

 ventricle were converted into a hard, dirty 

 white substance, traversed by a number of 



* Dub. Journal, vol. ix. p. 418. 

 f Lumleyan Lectures, p. 32. 

 $ Bull, de la Faculte, 1813. 

 \ Malad. des Enfans. 

 f| Loc. cit. vol. ii. p. 346. 



