520 Howrah Hospital Report for 1846. 



tient ; in one dysentery and hepatitis ; in one delirium tremens ; 

 in another case of extensive endocarditis^ complicated with 

 dropsy into the large cavities and bronchitis^ death is attribut- 

 able to the sum total of the diseases taken as a whole. In 

 two other cases., not fatal; rheumatism was associated. 



The forms of the heart disease met with have been pericar- 

 ditis and endocarditis,, hypertrophy and dilatation; placing 

 in juxtaposition the ordinary physical signs and those by aus- 

 cultation, with the post mortem appearances — 



I find that in case 1st, (death by Dysentery) the heart symptoms 

 were pain and oppression of chest, and difficulty of breathing, coming 

 on in paroxysms ; also occasional momentary shooting pain through 

 the heart. By auscultation, a bruit heard over the heart, with in- 

 creased natural sound heard on the right side of the heart. On 

 examination there were found within all the cavities of the heart clots 

 of black blood, and leathery, colourless, coagula adherent to all the 

 valves ; a granular condensation of the mitral valve at its edge and 

 throughout it; left ventricle very much thickened and contracted 

 in calibre ; of the right ventricle the walls much attenuated. 



Case 2nd. — (death by Delirium Tremens). The man's restless 

 state did not admit of auscultation, he complained of palpitation ; 

 any other symptoms were masked by the delirium. 



There was found hypertrophy of the left ventricle ; the lining 

 membrane of the ascending aorta and of its arch was found much 

 thickened, atheromatous, with spiculse and plates of bone embedded 

 in it ; the calibre of the aorta at the part dilated. 



Case 3rd. — Heart disease with bronchitis, followed by dropsy into 

 the pericardium and all the cavities ; the chief symptoms referable 

 to the heart were distressing paroxysms of difficult breathing and of 

 palpitation ; rapid small pulse. By auscultation, the sound of the heart 

 loud and of great extent ; the action of the heart tumultuous, not 

 of increased impetus, attended at first with splashing noise ; a rough, 

 somewhat rasping, sound of the heart heard a good deal to the 

 left and under left arm ; the sound of the heart beneath the left breast 

 of a ringing metallic character also, in connection with the systole ; 

 impulse of the heart increased at times ; both sound and impulse 



