14 C. W. M. Poynter 



was that the heart developed in an abnormal position and so pre- 

 vented the closure of the body wall ; this is not consistent with 

 what we know oT development. It has been suggested that an 

 over-distended heart from increased blood pressure prevented 

 early closing of the sternal bars. Adhesions have been blamed 

 for this as for many other anomalies. The condition has been 

 repeatedly produced in experimental teratology in chicks and 

 seems to have to do with disturbance of the body wall as well as 

 the heart ; probably separate factors affect each part, for cases 

 are encountered in which the heart is in position and the sternum 

 is defective. 



Breschet recognized three forms: (a) cervical, in which the 

 heart is beneath the chin; (b) pectoral, in which the heart pro- 

 trudes through a defect in the sternum; and (c) abdominal, in 

 which the cleft extends to the abdominal wall and in which ab- 

 dominal viscera as well as the heart are protruded. The heart 

 in these cases of ectopia may show maldevelopment intrinsically 

 or, more rarely, may be normal ; the condition is incompatible 

 with life, the average age for all cases being but a few hours. 



Cases of Ectopia Cordis. 



(a) Cervical: Vaubonnis (1712), de Torres (1741), Breschet (1826). 



(b) Pectoral: Walter (1745), Biittner (1768), Wiedemann (1794), 

 Chaussier (1814), Weese (1818) Walter's case, Haan (1825), Breschet 

 (1826), Pecchioli (1839), Wittstock (1839), Cruveilhier (1841), Jones 

 (1854), Brown (1855), Jones (1855), Frickhoffer (1856), Dotzauer (1857), 

 Gross u. Heim (1859), March (1859), Marchal (1850), Daniel (i860), 

 Forster (1861), Rezek (1868), Obermeier (1869), Scblesenger (1870), 

 Jahn (1875), Deserte (1876), Hodgen (1878), Fischer (1879), Hofmeier 

 (1880), Charpentier (1883), Grant (1896), Barnado (1897) Grant's case, 

 Goode (1904), Ellis (1905), Fox (1909). 



(c( Abdominal: Martinez (1723), Prochaska (1734), Schultz (1763), 

 Wahlbom (1764), Sandifort (1772), Herold (1787), Fleischmann (1810), 

 Barret (1835), Becker (1839), Mitchel (1844), Follin (1850), Francois- 

 Franck (1877). Total 46 cases. 



