278 CIRCULATOlir APPARATUS. 



tricuspid, the left flap of tlie piilinoiiaiy and the right flap of the 

 aortic valves ; the result of course being insufficiency of the cor- 

 responding valvular apparatus (cf. incompetence and stenosis of 

 the valvular apertures of the heart, § 255). 



§ 245. Appendix. The term " abscess of the heart," besides 

 being applied to the large solitary lesion described above, is also 

 employed to denote those small and scattered foci of softening, 

 not exceeding a pin's head in size, which are occasionally found 

 in connexion with pyemic, puerperal, glanderous and other 

 forms of blood-poisoning, and which are always multiple. Some 

 of them are usually situated immediately beneath the en do- or 

 pericardium. They make their first appearance as greyish specks 

 in the muscular tissue ; later, as minute cavities filled with a 

 diffluent pulp. No true pus-corpuscles can be detected under 

 the microscope, nothing indeed but vibrios {see § 24). At first, 

 these vibrios are found packed closely between the muscular 

 fasciculi \ they subsequently penetrate into their interior, the 

 muscular fibres simultaneously undergoing disintegration ; in 

 fact, transverse sections give one the impression that the con- 

 tractile substance is actually breaking up into vibrios, since the 

 substitution of a mass of vibrios for the muscular fibre takes 

 place without any increase in its volume. The alterations do not 

 admit of being traced beyond the formation of little abscess-like 

 foci of softening, inasmuch as the affection occurs exclusively 

 in the most violent and quickly fatal forms of the said toxasmic 

 disorders* 



t:; Heteroplastic Tumours of the Heart. 



§ 246. When we come to consider the morbid anatomy of 

 serous membranes we shall become acquainted with a primary 

 sarcoma of the pericardium. Apart from this, all cancerous, tuber- 

 culouSj and sarcomatous affections of the heart are of metastatic 

 origin. But even these are rare. The occurrence of milianj 

 tubercles in the heart has only been known within the last few 

 years. Recklinghausen discovered them in the muscular tissue of | 

 that organ; indeed it is a general rule that all heteroplastic 

 growths are principally met with in the connective tissue of the 

 myocardium. I have recently met twice with mihary tubercles 

 in the endocardium, near the free border of the mitral valve. 



