6 C. W. M. Poynter 



§11. SYMPTOMS 



Cyanosis. — One of the subjects inseparably linked with con- 

 genital cardiac disease is cyanosis congenita or morbus coeruleus. 

 Its cause has been the subject of debate over a long period. 

 Paracelsus (1500) mentioned Icteritia Coelestena, and later Cham- 

 seau (1789) speaks of Ictere violet, but I believe Senac (1749) 

 was the first to definitely connect cyanosis with anomalies of the 

 heart. 



Morgagni (1761) declared that cyanosis was caused by stasis 

 of the blood in the venous system. This theory has been ac- 

 cepted by a large number of investigators, notably, Louis, Bouil- 

 laud, Farre, Haase, Peacock and Rokitansky. The idea that 

 cyanosis is due to admixture of arterial and venous blood is 

 probably older than the theory just mentioned and has been very 

 generally accepted ; even now it seems to be quite firmly estab- 

 lished, notwithstanding the fact that Stille (1841) showed that 

 admixture of blood may occur without cyanosis and that cyanosis 

 may occur without any admixture. Other theories relating to 

 changes in the blood and tissues extend beyond the scope of this 

 paper and may be consulted elsewhere. The question is not as 

 yet entirely settled ; certainly more than half of the cases of con- 

 genital cardiac disease do not exhibit cyanosis except for a very 

 short period pro exitu. It is most frequently associated with 

 obstruction of the pulmonary circulation but may be absent in 

 these cases, Mazaroff (1895), ^'^d, since it is observed under 

 other conditions than congenital cardiac disease, it would seem 

 that the simple circulatory disturbance due to the lack of a normal 

 functioning heart should not be considered as anything more than 

 a contributing factor in any case. 



Clubbed fingers have been observed in many cases of congenital 

 cardiac disease, but are by no means a constant finding even in 

 the cases which have lived past the first decade. The condition 

 is probably due to congestion and toxaemia. Carpenter (1909). 



§111. CLASSIFICATION 



Classification of congenital cardiac abnormalities presents many 

 difficulties. A review of the various essays on the subject shows 



