ABNORMAL CONDITIONS OF THE HEART. 



639 



lion in all probability preceding and giving rise 

 to the hypertrophy by rendering an increased 

 force of contraction necessary. Simple hyper- 

 trophy is the least common, according to 

 Bouillaud ; concentric hypertrophy, according 

 to this physician, is not rare. Considerable 

 doubt, however, has been excited recently by 

 the high authority of M. Cruveilhier as to the 

 real existence during life of such a condition 

 as this. This anatomist believes the diminished 

 cavity to be merely the result of a tonic con- 

 traction of the muscular \vall of the ventricle 

 in death. " The concentrically hypertrophied 

 hearts of Berlin and Bouillaud appear to me," 

 he says, " to be hearts more or less hypertro- 

 phied, which death surprised in all their energy 

 of contractility."* The hearts of all those 

 examined by Cruveilhier, who died by the 

 executioner, presented to his observation to a 

 great degree the double phenomenon of in- 

 creased thickness of walls and diminished 

 cavity, and he has observed the same with per- 

 sons who died a violent death.f On one occa- 

 sion I was particularly struck with a similar 

 condition of the heart of a donkey which had 

 been accidentally transfixed by a large trocar, 

 whereby the death of the animal was caused in 

 a few minutes. The muscular structure of the 

 heart was singularly dense. It had contracted 

 at its apex quite to a sharp point, and on cut- 

 ting into it the cavity of the left ventricle ap- 

 peared almost obliterated, and the muscular 

 wall much increased in thickness. I have 

 many times, too, observed the fact noticed by 

 Cruveilhier, that the cavity may be easily en- 

 larged or restored to its natural dimensions by 

 introducing the finger and dilating it, or still 

 more easily, if the heart have been macerated 

 in water for a short time previously. This fact 

 is further confirmed by Dr. Budd, who sup- 

 ports the views of Cruveilhier in an interesting 

 paper in the last volume of the Medico-Chirur- 

 gical Transactions. In one of Dr. Budd's cases 

 the thickness of the parietes of the left ventricle 

 eighteen hours after death varied from an inch 

 to an inch and a half, on a transverse section 

 made at a distance from the apex of one-third 

 of its length, and the cavity was not large 

 enough to hold the second phalanx of the 

 thumb, and was almost filled by the carneae 

 columnae. This heart, in its open state, was 

 put to macerate ; no force was applied to extend 

 it. At the end of some days, on being folded 

 up, it was found to have dilated very conside- 

 rably, so that the left ventricle could not then 

 be said to be smaller than natural. Dr. Budd 

 argues against the existence of the diminished 

 cavity from the fact that of eight cases collected 

 by him, no one afforded signs, either during 

 life or after death, of any obstacle to the circu- 

 lation through the heart. There were no irre- 

 gularity of pulse, no dropsy during life, no di- 

 latation of the right cavities after death, pheno- 

 mena which, it may be said, must of necessity 

 be present if there be an obstacle to the circu- 



* Diet, de Med. et Chir. Prat. art. Hypertrophie. 

 f Mr. Jackson and Dr. Budd have observed this 

 state of the heart in persons who died of cholera. 



lation in the heart. It is impossible, as he 

 states, to conceive that a left ventricle, which 

 could scarcely hold an almond, should offer no 

 obstacle to the circulation through the heart. 

 Yet Laennec has recorded a case in which the 

 parietes of the left ventricle had acquired the 

 thickness of from an inch to an inch and a half, 

 and the cavity seemed capable at most of con- 

 taining an almond stripped of its shell. Yet 

 the day before the patient's death his pulse was 

 natural, the breathing perfectly free, " and 

 nothing," says Laennec, " led me to suppose 

 that this man had a disease of his heart." 



Hypertrophy with dilatation. It is in this 

 morbid condition that the heart acquires the 

 greatest increase of size as well as the most 

 striking alteration of form. The cor bovinum 

 of some authors, so called from its enormous 

 size, affords an instance of an extreme develope- 

 ment of this form of disease. The extent to 

 which the heart may become enlarged in this 

 way is quite extraordinary. Of certain cases 

 recorded by Bouillaud, in one the right ventri- 

 cle was large enough to contain a goose's egg, 

 and the left, still larger, the closed hand of a 

 female; in another, the left ventricle was simi- 

 larly increased in capacity. In a third, the 

 right auricle of a child, aged seven years, was 

 so dilated as to contain a coagulum as large as 

 the closed hand of an adult. The thickness of 

 the left ventricle in Bouillaud's cases varied 

 from 7 to 14 lines, that of the right 3 to 5 lines; 

 but in some instances it was as considerable as 

 from 8 to 10 lines or 11 to 16 lines. The weight 

 of the heart, in some instances, trebled the na- 

 tural ; thus in one case of general hypertrophy 

 the weight was 22 ounces, and others weighed 

 from 13 to 20 ounces. The circumference of 

 the heart was often increased to twelve inches, 

 the longitudinal diameter five inches, and the 

 transverse eight inches. In a patient who died 

 at the Hotel Dieu in 1834, the heart measured 

 fifteen inches and a half at its base. Hypertro- 

 phy seldom occurs in the auricles, except when 

 accompanied by dilatation : the musculi pecti- 

 nati are generally the seat of the increased mus- 

 cular developement, and as the number and 

 developement of these muscular columns is 

 greater in the right auricle than in the left in 

 the normal state, (in the left they are only found 

 in the auricular appendage,) the remark of Dr. 

 Hope follows almost as a matter of course, 

 namely, that in the right auricle hypertrophy 

 proceeds to the greatest extent, its walls being 

 sometimes rendered nearly equal in thickness 

 to those of the right ventricle in the normal 

 state. 



In the vast majority of cases of this kind the 

 products of inflammatory states of the pericar- 

 dium or endocardium, or its appendages, are 

 present; in short, a diseased state of the valves 

 constantly co-exists with hypertrophy and dila- 

 tation. These conditions of the cavities are very 

 frequently traceable to some obstacle to the cir- 

 culation through the heart, and sometimes it 

 would seem that the valvular disease preceded 

 and gave rise to the hypertrophous and dilated 

 cavity; but it is not impossible nor unlikely 

 that the valvular disease may follow the hyper- 



