DISEASES OF THE IIEArvT,— MYOCARDITIS, 275 



0. Inflammation. 



§ 240. Myocarditis is one of the most obscure chapters iu 

 general pathology, and morbid anatomy can only contribute very 

 insufficient data for its elucidation. Experience has shown that 

 the most trifling degree of inflammation affecting the striped 

 muscles of the trunk and limbs — e.g. even that slight intumes- 

 cence which we find associated with chronic rheumatism, and 

 with regard to which it is not yet settled whether it really is 

 more than a marked degree of hypera}mia — occasions the most 

 violent disturbances of function. The muscle rests in a state of 

 contraction. Any attempt to extend it is most strenuously 

 opposed by the patient on account of the intense pain to which 

 it gives rise. Now if we apply these results of our experience 

 to the heart, it is obvious from the first that even the most trifling 

 degree of diffuse inflammation ought immediately to be followed 

 by an arrest of the heart's action and the consequent death of 

 the patient, so that the inflammatory process could not attain 

 the later stages of its evolution unless when circumscribed and 

 partial. Some have even gone so far as to deny the possibility 

 of a diffuse myocarditis. Herein they were undoubtedly wrong. 

 I can positively affirm that an infkmmation uniformly involving 

 every portion of the heart may exist. A male patient, 54 years of 

 age, who had undergone a protracted course of treatment for con- 

 stitutional syphilis, and had subsequently passed through an attack 

 of double pneumonia, died suddenly a few days after his discharge 

 from the hospital ; his death was so sudden as to rouse suspicions 

 of apoplexy. At the post-mortem examination, 2c\^2iYt from some 

 syphilitic lesions, I discovered a condition of the heart which I 

 feel myself justified in unhesitatingly describing as a diff'use 

 parenchymatous inflammation of its muscular substance. 



The heart was partially contracted; its walls were so stiff" 

 that it could only be compressed by the application of a very 

 laro'G amount of force. Even after the customary incisions had 

 been made into its cavities, its walls did not collapse. At the 

 same time a singular and unusual condition of the muscular 

 tissue excited my attention. It had lost its bright red colour 

 which was dashed with violet ; the cut surface was iridescent, its 

 edges nearly transparent ; in consistency it resembled caoutchouc ; 



