DISEASES OF THE HEART. — ABSCESS. 277 



fibres, albuminoid molecules, and oil-globules; it also contains 

 larger shreds of the contractile tissue, in which, however, the 

 transverse striation is no longer to be recognised. The affected 

 part is, in the main, of oval form ; but sinuses bmTowing far into 

 the muscular layer are also occasionally met with. The boundary 

 of the deposit sometimes consists of a very soft layer of red- 

 dish-grey material — granidation -tissue, according to Rohitanski 

 Should the abscess approach the endocardium, it may peel it off; 

 sometimes too, it forces its way between the lamellae of the 

 cuspid valves. 



§ 244. This condition may terminate in various ways. In 

 very rare cases, the purulent pulp may become inspissated into 

 a cheesy mass, and surround itself with a capsule of connective 

 tissue ; the cheesy nodule ultimately becoming calcareous and 

 establishing a toleration of its presence. More commonly the 

 abscess bui'sts, and its contents escape. According as it ap- 

 proaches the outer or the inner surface of the myocardium, it 

 bm'sts either into the pericardial sac, setting up a rapidly fatal 

 pericarditis, or into one of the cavities of the heai't itself In the 

 latter event the bm'sting of the abscess is immediately followed 

 by a rush of blood into its cavity which washes out the contained 

 debris. This opens out wide contingencies of embolism, mainly 

 in the region of the systemic circulation, inasmuch as the abscess 

 is usually situated in the wall of the left ventricle. The abscess- 

 cavity becomes a diverticulum, or an aneurism of the heart's 

 cavities, if the name be preferred. (Acute aneurism of the heart.) 

 How long this state of things may last, depends entirely on the 

 thickness of the hitherto unaffected portion of the wall of the 

 heart. For it is this alone, together with the visceral layer of 

 the pericardium, which delays the inevitable ruptm-e of the heart 

 and the fatal extravasation of blood into the pericardial sac. 

 When the abscess, as often happens, is situated in the septum 

 ventriculorum, the result is somewhat different. A communica- 

 tion between the ventricidar cavities by a small opening does not 

 seem to have any marked influence upon the circulation ; should 

 the suppurative change however have extended upwards from 

 the septum, should the pus have burrowed into the lax connec- 

 tive tissue between the lamella) of the tricuspid valve, the burst- 

 ing of the abscess may cause detachment of all the three flaps 

 which are attached to the septum, sc. the inner curtain of the 



