ABNORMAL CONDITIONS OF THE HEART. 



645 



maintains this opinion exclusively, and Dr. 

 Hod^kin states his belief that in by far the 

 greater number of cases these patches depend 

 on a deposit on the attached surface. This 

 writer adds " From the circumstance of their 

 being often found immediately under the ster- 

 num, and from their being occasionally met 

 with on other parts of the heart, to which a firm 

 and resisting body has been unusually opposed ; 

 as for example, when a bony deposit has taken 

 place beneath the reflected pericardium, or 

 when an uneven and remarkably indurated 

 liver has, even through the diaphragm, presented 

 an unequal pressure against a particular part of 

 the heart, I have thought it probable that such 

 pressure, aided by the movements of the heart 

 itself, may have led to the production of these 

 spots. These formations may certainly take 

 place at a very early period of life. I have 

 met with one rather loose and thick, but in 

 other respects perfectly resembling those found 

 in the adult, on the right ventricle of a child 

 only ten weeks old. Similar thickening of the 

 close pericardium sometimes marks the course 

 of the coronary arteries and their branches ; and 

 this circumstance amongst others tends to con- 

 firm the idea which I entertain as to its mode 

 of formation."* 



Mr. T. \V. King, in an Essay on this subject 

 in the sixth number of Guy's Hospital Reports, 

 records a very remarkable example of the opa- 

 city. The patch, " a uniform whitish thicken- 

 ing of the close pericardium," nearly equalled 

 in extent the anterior surface of the right ven- 

 tricle, and was extended over the anterior sur- 

 face of the pulmonary artery as far as its bifur- 

 cation. Two similar patches were found on 

 the under surface of the ventricle. Mr. King 

 inclines to the opinion that this deposit is 

 seated in the proper tissue of the serous mem- 

 brane, and considers it always inflammatory 

 and pretty constantly the effect of friction and 

 irritation. " The situation of these patches," 

 observes Mr. King," whenever they occur, im- 

 plies to my mind a egree of attrition at the 

 part more than belongs to the pericardium ge- 

 nerally. They are found on the surface of the 

 right auricle almost as frequently as on the ven- 

 tricle, but not in so morbid a form ; and much 

 more divided, even minute, and often clustered 

 like the rippling of the sand at ebb-tide. One 

 is not unfrequently seen along the anterior 

 face of the great pulmonary artery. All these 

 relate to the right side of the heart, which all 

 pathologists are aware is often, and more than 

 the left, the subject of distensions. The 

 patches may occasionally, perhaps, be seen on 

 any part of the close pericardium. I have 

 seen them behind the left pulmonary veins; 

 but, omitting this instance, the next most com- 

 mon appearance of the kind is that of length- 

 ened, narrow, winding, and even branching 

 lines immediately over the great vessels of the 

 ventricles whenever they are the subject of con- 

 siderable dilatation. Here, also, we have evi- 

 dence of a disproportionate space of attrition, 

 resulting from undue prominence." 



Lect. on Morb. Anat. of serous membranes, p. 98. 



I am not aware of any well-authenticated 

 instance of ulceration or gangrene of the peri- 

 cardium. In cases of ulcerative perforation of 

 the heart, it may be said, however, that the pe- 

 ricardium ulcerates as the other parts do. 



Tubercular formations. Tubercles, whether 

 cancerous, me'lanotic, or scrofulous, are formed 

 subjacent to either serous layer of the pericar- 

 dium ; sometimes, and most frequently they 

 are deposited between the visceral layer and the 

 heart, or they may be found between the fibrous 

 pericardium and the parietal aspect of the se- 

 rous layer. 



Cysts. The serous cysts which are described 

 as occurring in the heart are sometimes formed 

 immediately subjacent to the serous membrane, 

 and project into the pericardial sac. Accord- 

 ing to Andral they occur most frequently in 

 this situation. Similar cysts have been found 

 between the fibrous pericardium and its serous 

 lining. 



Hy drops pericardii or hy draper icardium. 

 This disease consists in an undue accumulation 

 of fluid in the sac of the pericardium. The 

 fluid is either simply serous, of yellowish cha- 

 racter, or it may be of a brownish or reddish 

 hue. In quantity it rarely exceeds two pints. 

 The effusion is not generally attended with any 

 evident morbid change either of the heart or its 

 membranes, excepting that in cases of some 

 standing, the heart seems somewhat atrophied, 

 and the pericardium has lost its perfect trans- 

 parency. 



Pneumopericardium. The presence of air in 

 the pericardium, as the effect of morbid action 

 during life, must be very rare. Laennec, how- 

 ever, speaks very confidently of its existence. 

 " Sometimes," he says, " the air is combined 

 with a liquid, and this is by much the most 

 frequent case ; at other times the pericardium 

 is distended by air alone." Could the cases of 

 dry pericardium related by Baillie have been 

 produced by the developement of air in its cavity ? 



Morbid states of the endocardium. 1. En- 

 docarditis. The lining membrane of the heart 

 is so similar in its structure and properties to 

 the pericardium, that their morbid states are 

 very similar likewise. The constant contact of 

 the blood with the former membrane serves, 

 however, to modify considerably the anatomical 

 characters of disease in it. \Ve want, I think, 

 satisfactory proofs of the changes induced by 

 endocarditis in its earliest stage; these changes 

 are described to be, redness of the membrane, 

 with a more or less thickened or swollen condi- 

 tion of it; but the redness is not the result of 

 capillary injection, but seems to be a stain on 

 the membrane, the result of contact with the 

 blood. The stain is not merely superficial, but 

 has sunk into the substance of the tissue, and 

 it cannot consequently be washed off. 



The lining membrane of the heart is often 

 found stained of a red colour as a post-mortem 

 result ; and this is invariably the case in hearts 

 examined after putrefaction has commenced. 

 The blood contained in the heart has begun to 

 alter, various gases are given out, and the inter- 

 nal membrane more readily imbibes the colour- 

 ing matter that is brought in contact with it. 



