ABNORMAL CONDITIONS OF THE HEART. 



647 



was, I believe, first pointed out by Dr. 

 Watson. 



Ossification most commonly manifests itself 

 in the fibrous zones which surround the heart's 

 orifices, and therefore it is chiefly to be found 

 at the bases of the valves ; but it likewise ex- 

 tends towards their free margin ; and it too is 

 apt to be developed in the double crescentic 

 form in the aortic valves. Sometimes the ossi- 

 fication appears to involve principally the mar- 

 gin of the valve in whole or in part, and this 

 occurs much more frequently in the semilunar 

 than in the auriculo-ventricular valves. Osseous 

 deposits in the valves are either in the form of 

 thin calcareous laminae or spiculae, small round- 

 ed points, or large masses more or less rounded, 

 and often projecting to a considerable extent 

 beyond the surface of the valve. 



The effect which the developement of these 

 new deposits on or in the valves has upon their 

 size and form, as well as upon the size and form 

 of the openings which the valves surround, is 

 very various and very interesting to the patho- 

 logist. The almost invariable alteration which 

 they produce in the size of the valve is to 

 shorten it or diminish it in depth ; the valve 

 becomes corrugated, its free margin thickened, 

 or folded in the direction of the current, or in 

 an opposite direction, the whole valve present- 

 ing a curled appearance. The orifices are 

 always more or less diminished in size when 

 one or more valves have acquired this rigid, 

 inelastic, and contracted form ; the diminution 

 is produced by the valve or valves always pro- 

 jecting more or less into the orifice; but the 

 greatest degree of narrowing of the aperture is 

 occasioned by the adhesion of two or more 

 valves at their free margins ; and in this way, 

 as may be readily conceived, an orifice be- 

 comes sometimes almost completely obliterated. 

 The same causes change the shape of the orifi- 

 ces, and consequently we find altered size and 

 shape constantly going together. It is in the 

 left auriculo-ventricular opening that these 

 changes are most commonly seen ; they rarely 

 occur to so great an extent in the aortic orifice, 

 and seldom at all in the apertures of the right 

 heart. My friend, Mr. Adams, has made some 

 most valuable remarks upon the contracted au- 

 riculo-ventricular orifice of the left side, in his 

 very valuable paper on diseases of the heart in 

 the Dublin Hospital Reports. His description 

 of the anatomical characters of the disease cor- 

 responds so exactly with what I have many 

 limes witnessed, that I cannot refrain from 

 quoting it. " When the dilated (left) auricle 

 is cut into and cleared of the blood it contains, 

 at its lowest part, instead of the mitral valve, a 

 concave membranous septum of a yellow colour 

 is seen, which is perforated by an oblong 

 fissure, about half an inch in length, and one or 

 two lines broad ; this fissure I have observed 

 to be always obliquely situated, and to run 

 parallel to the septum of the ventricles ; it ge- 

 nerally is of a semilunar form, the concavity of 

 the curve looking towards the root of the aorta, 

 the convexity backwards ; the first formed by 

 the larger portion of the mitral valve, the latter 

 by the smaller ; the edges of this oblong fissure 



are generally studded with long depositions ; 

 viewed from the left ventricle, the membranous 

 septum is convex, and the angles of the fissure 

 are connected by shortened chordse tendineae, 

 with two very thick fleshy columns, the one in 

 front, the other behind." 



Dilatation of the valves. We sometimes 

 find the valves of the heart in a dilated or aneu- 

 rismal state. Laennec has placed on record an 

 example of this affecting the mitral valve :* " A 

 little pouch, half an inch long and more than 

 four lines in diameter, projected on the supe- 

 rior surface of this valve," i. e. into the left 

 auricle. Mr. Tlmrnam has appended the 

 detail of several cases to his memoir already 

 quoted on Aneurisms of the Heart.f He de- 

 scribes a specimen, preserved in the Hunterian 

 Museum, affording an example of four aneuris- 

 mal pouches of the tricuspid valve. The same 

 writer likewise records a case in which there 

 was congenital absence of one aortic valve ; the 

 two, which were present, were thick and fleshy, 

 and rough on their ventricular surfaces. The 

 edge of the one was smooth, that of the other 

 rugged ; there was a deposit of ossific matter at 

 their points of attachment. From the ventricu- 

 lar surface of the valve with the smooth border, 

 there projected a little bag that would hold a 

 swan-shot, and which opened by a little round 

 mouth on the aortic surface of the valve. It 

 had two little slits in its most depending por- 

 tion, and was evidently formed by a dilatation 

 of the valve itself." 



Atrophy of the valves. We have a familiar 

 instance of atrophy of valves in the case of the 

 Eustachian valve, which undergoes as it were a 

 sort of natural atrophy from the commencement 

 of extra-uterine life. The valve becomes cri- 

 briform, and the holes by which it is pierced 

 gradually enlarge and coalesce, and in this way 

 the valve is worn away. We often find one or 

 more of the semilunar valves perforated by 

 openings of a similar kind, without the co-ex- 

 istence of any other disease ; the margin of the 

 opening is always smooth, and the valve itself 

 thinner and more flaccid than is natural. Ac- 

 cording to Dr. Williams, the wasting affects the 

 posterior portion of the mitral valve, " the 

 membrane of which is often annihilated by it, 

 the cords being inserted directly into the auri- 

 cular ring." The anterior lamina is also occa- 

 sionally found much shortened, and without 

 those fine thin expansions of membrane which 

 commonly unite the cords to each other, below 

 their insertion into the thicker part of the 

 valve. 



Entozoa in the heart. The occurrence of 

 entozoa in the human heart must be considered 

 to be extremely rare, at least the cases on record 

 which may be depended on are very few. 

 Andral states that he found the cysticercus 

 once in the human heart, but has seen it fre- 

 quently in the hearts of measly pigs. Many 

 examples are mentioned by various authors of 

 ascarides, filariae, cercariae, and other entozoa 

 in the hearts of dogs and many other of the in- 



* Quoted in Bouillaud's work, t. ii. p. 510. 

 t Loc. cit. 



