Congenital Anomalies of the Heart 1 5 



§ VI. 



II. ANOMALIES OF THE HEART AS A WHOLE 

 A. Acardia 



Acardia or hemicardia indicates a pronounced disturbance of 

 the heart anlage. Stockard (191 5) has greatly added to the in- 

 terest of this subject by his work on Fundulus. He has shown 

 that the growth of the heart may be entirely arrested by the use 

 of the proper percentages of alcohols in the water in which they 

 are hatched. 



Of course these cases are not of clinical interest but valuable 

 in indicating the extreme degree in which factors affecting the 

 development of the heart may operate. The condition is gener- 

 ally found in monsters and is naturally incompatible with any 

 extended period of development. Early cases were reported by 

 Mery (1720) and Winslow (1740) and others studied by Nacke 

 & Benda (1907) and Kehrer (1908). 



Multiple hearts are probably due to an early division of the 

 heart anlage, then cessation of the malignant influences. An in- 

 teresting case of double heart has been reported by Collomb 

 (1798) in a human cyclops. 



B. Bifid Apex of the Heart 



In these cases the apices of both ventricles project below the 

 interventricular groove. The condition is usually present in a 

 heart which is otherwise normal. The first case which I have 

 found recorded was by Bartholinus (1654), who described it as 

 " Mucrone non acuto ut fieri solet, sed bifido." In explaining the 

 condition Mall (1912) showed that there is a tendency for the 

 divided apex to remain for some time, as in embryos of 11-25 

 mm. stage, after the adult form should be assumed; this agrees 

 with a like observation made by Paget (1831), p. 282. Mall 

 considered that the bifid apex is due to arrest of development. 

 The condition is normal for the dugong. The condition is rare, 

 constituting 2.3 per cent, in Abbott's series. 



Bartholin (1654), Meckel (1805), Parise (1837), Schattuck (1891), 

 Rolleston (1891), Hare (1902), Carpenter (igo8). Mall (1912) 



