PATHOLOGY, 
250 
the Tides of tl is ventricle become thicker than in the na¬ 
tural or healthy ftate. “I have fometimes,” fays Laen- 
r.ec, “found the thicknefs to be full an inch at the bafe 
of the ventricle, which is double that of the healthy 
Hate : this thicknefs in general diminilhes infenfibly from 
the bafe to the apex of the ventricle, where it becomes 
almoft nothing; but in other cafes the apex partakes in 
the affeftion, and I have fometimes found it from two 
to four lines in thicknefs, which may be eftimated at 
twice or four times its natural thicknefs.” The fleffiy 
columns and fupporters of the valves acquire a thicknefs 
proportioned to the degree of hypertrophy. The inter¬ 
ventricular partition, which in the prefent cafe feems to 
appertain to the left ventricle much more than to the 
right, participates greatly in the difeafe, though it never 
acquires a thicknefs equal to that of the reft of the lides 
of the ventricle. The mufcular fubftance of the difeafed 
ventricle becomes fometimes twice as hard as in the na¬ 
tural ftate, and of a more intenfe red colour. The ca¬ 
vity of the ventricle appears to have loft in capacity what 
the fides have gained in thicknefs. In a heart twice as 
large as the patient’s fill, this cavity has been fo fmall, 
that an almond with its fhell could fcarcely be fqueezed 
into it. The right ventricle, now diminifhecl in propor¬ 
tion as the left is enlarged, lies flat along the interven¬ 
tricular partition, and does not reach fo low as the point 
of the heart: in thefe fevere cafes, it feems as it were 
imbedded in the fubftance of the Tides of the left ventricle. 
The following'are the anatomical chara&ers of hyper¬ 
trophy of the right ventricle. The Tides of this ventricle 
are thicker and harder than in the natural ftate: they 
fink or give way but little under the knife ; their thick¬ 
nefs is more uniform than that of the left ventricle, being 
indeed nearly the fame throughout the whole length of 
the ventricle ; it is, however, always rather more marked 
about the triglochin valve, and in that portion of the 
ventricle which forms the origin of the pulmonary ar¬ 
tery. The flefliy columns and pillars are confiderably 
increafed in dimenfions; and this circumftance, which is 
more evident than in hypertrophy of the left ventricle, 
is, together with the extraordinary hardnefs of the fub¬ 
ftance of the heart, moft remarkable and decifive of an 
hypertrophy of the right ventricle, and moft eafy to de¬ 
tect on a firft examination ; for the abfolute thicknefs of 
the Tides of this ventricle is never very confiderable; 
never, fays Laennec, more than four or five lines. 
Hypertrophy of the Left Ventricle .—This is the affec¬ 
tion which appears to be defcribed by M. Corvifart under 
the name of “active aneurifm of the heart.” The fymp- 
toms arifing from a thickening of the left ventricle, be- 
fides thofe of difeafes of the heart in general, are—a 
ftrong pulfe, the beats being very perceptible to the pa¬ 
tient, as well as to phyfician, by applying his hand over 
the region of the heart; the abfence or diminution of the 
found arifing from percuflion on the region of the heart; 
and the red, rather than blue, colour in the face. But 
thefe fymptoms are not conftant; and it is not uncom¬ 
mon for a confiderable hypertrophy of the left ventricle 
to exift where fcarcely any of them are prefent. The 
pulfe, in particular, is a very deceitful guide; and it is 
perhaps as common to find it weak as ftrong, even in pa¬ 
tients affli&ed with a high degree of hypertrophy. Per- 
cuffion, and the application of the hand over the region 
of the heart, are alfo fruitlefs modes of examination if 
the patient happens to be fat or dropfical. The ufe of 
the ftethofcope, however, is here of more decided import¬ 
ance. The inftrument being fixed between the cartilages 
of the fifth and fixth ribs of the fternum, the contraction 
of the left ventricle will produce a ftrong impulfe, and a 
found duller than ordinary ; and the more confiderable 
the difeafe, the more this found is prolonged. The con¬ 
traction of the auricle is very Ihort, little fonorous, and 
therefore fcarcely fenfible in fevere cafes. The beatings 
of the heart are heard through a fmall extent only ; moft 
frequently they are fcarcely audible under the left cla¬ 
vicle and the top of the fternum; fometimes they are 
heard only where they may be felt, namely, between the 
cartilages of the fifth and feventh ribs. In this diforder, 
more than any other, the patient feels the beating of the 
heart almoft continually; but he is not very fubjeCI to 
violent attacks of palpitation, unlefs from fome extrinfic 
caufes, as difturbance of the mind or violent exercife. 
Irregularities and intermittences of the palpitation are 
not common ; and they are characterized by an increafe 
in the impulfe of the ventricles rather than by the noife 
they make. 
Hypertrophy of the Right Ventricle.- —The fymptoms in 
this cafe, according to M. Corvifart, differ from thofe of 
the preceding feCtion chiefly by a greater difficulty of 
breathing and a darker colour of the face. He adds, 
“the beating of the heart being more evident on the 
right fide of the bread may be confidered as a fymptom 
of the dilatation of the right ventricle ; but this fymp¬ 
tom, unlefs accompanied by others, is not much to be 
depended upon.” 
Lancifi had noted as a fymptom of the aneurifm of 
the right ventricle, the fwelling of the external jugular 
veins, accompanied with pulfations analogous and ifo- 
chronous to thofe of an artery. M. Corvifart rejeCts this 
fymptom, relying upon what has, he fays, “ been ob- 
ferved in cafes where the left cavities have been found 
dilated ;” and moreover, “ becaufe fuch pulfation may 
be confounded with that of the carotids.” But the 
obfervation of M. Laennec gave him a refult which 
does not agree with the opinion of M. Corvifart. 
He fays, “ I conftantly found this fymptom in all the 
cafes of hypertrophy of the right ventricle which came 
under my notice; and I never obferved it in perfons at¬ 
tacked with hypertrophy of the left ventricle, unlefs the 
fame perfons had a fimilar affedfion in the right alfo ; and 
I think that perfon mult have been a carelefs obferver, 
or one who had never met with thefe jugular pulfations, 
who could confound them with the rifing produced by 
the beatings of the carotids. Thefe pulfations, more¬ 
over, are confined to the lower part of the jugular veins ; 
and are fcarcely fenfible, or much lefs fo, towards the 
middle of the neck, where the external jugular vein ap¬ 
proaches the carotid, from which indeed it is feparated 
only by the fterno-maftoid mufcle. Sometimes, however, 
the reflux of the blood extends farther, and even beyond 
the jugular veins: Hunaldus had found it to extend, 
moft decidedly, to the fuperficial veins of the arm. We 
may therefore confider this fymptom, whenever it is pre¬ 
fent, as a good reafon to fufpedt at leaft an hypertrophy 
of the right ventricle.” 
The contractions of the heart in hypertrophy of the 
right, as heard through the ftethofcope, are of the fame 
kind as in hypertrophy of the left ventricle, except that 
the found from the contractions of the affeCted ventricle 
is lefs dull. But in hypertrophy of the right ventricle, 
the heart gives a ftronger impulfion under the lower 
part of the fternum than between the cartilages of the 
fifth and feventh ribs; while the contrary takes place, 
as we have feen, when the left ventricle is affeCted. In 
the generality of perfons, the pulfations of the heart are 
equally audible in each of thofe places; but in others, 
who however have no appearance of difeafe of the heart, 
they are heard more clearly under the fternum than be¬ 
tween the cartilages of the ribs; “ and it has appeared to 
me,” fays Laennec, “ that fuch a fymptom has always co¬ 
incided with, or denoted, a decided predifpofition to hy¬ 
pertrophy or dilatation of the right ventricle.” 
Hypertrophy of both Ventricles. —When both ventricles 
are at once attacked with hypertrophy, they both defcend 
to the point of the heart; and the fymptoms confift of an 
union of thofe proper to the hypertrophy of each ven¬ 
tricle, but with almoft-conftant predominance of thofe 
which indicate the hypertrophy of the right ventricle. 
Dilatation of the Ventricles. —A dilatation of the ven¬ 
tricles of the heart, which M. Corvifart denominates 
“paffive 
