PATHOLOGY. 
252 
tation of the heart, it may perhaps be more dark, in dila¬ 
tation of the right than of the left cavities, and the fame 
thing may be faid of the lividity of the extremities; but 
I have often feen the countenance very pale and yellow- 
iffi, and even the lips difcoloured, in patients attacked 
with dilatation of the heart; and, on the other hand, 
hypertrophy with dilatation of the right cavities, has ap¬ 
peared to me to be the difeafe molt frequently attended 
by intenfe lividity of the face and of the extremities, 
great (luffing, frequent or confiderable hasmoptyfis, and 
a very confiderable pouring-out of ferous matter.” 
The only conftant pathognomonic fymptom of dilata¬ 
tion of the right ventricle, is the ruffiing noife of the 
heart to be heard under the lower part of the fternum, 
or in the fpace between the cartilages of the fifth and 
feventh ribs on the right fide. The degree of dilatation 
is meafured by the extent of the heart along which the 
found can be heard, and according to a kind of progref- 
five fcale for which we mull refer to Laennec, § 599. 
The palpitations, in dilatation of the heart, confift 
chiefly in the frequency and noife of the contractions, 
not in the increafe of their force, which indeed is often 
lefs than when the patient is in health. The irregulari¬ 
ties of llrength and of frequency, and the intermittences 
of the pulfe, are not very common, though perhaps ra¬ 
ther more fo in thefe cafes than in hypertrophy. 
Dilatation combined with Hypertrophy of the Ventricles of 
the Heart. —The union of thefe affections is very com¬ 
mon. It may exift in one of the ventricles, or in both 
together. In the latter cafe, the heart may become pro- 
digioufly enlarged, even to thrice the fize of the patient’s 
fid. This increafe of fize arifes from the thickening of 
the parietes of the ventricles* together with a propor¬ 
tionable increafe of their cavities; their mufcular fub- 
llance alfo becomes harder. 
Thefymptoms of this affeCtion are, of courfe, a com¬ 
bination of thofe of hypertrophy and of dilatation. The 
contractions of the ventricles are attended with great 
force, and a confiderable noife; thofe of the auricles are 
fonorous alfo. The pulfations may be heard through a 
great extent; and fometimes, efpecially in thin people 
and in children, the impulfion is felt equally under the 
clavicles, in the ribs, and even a little in the left part of 
the back. “I once (fays Laennec) heard and felt the 
contraction of the ventricles in the lower and polterior 
right part of the bread of a woman attacked with this 
malady ; and, though the was a little woman, and not 
flrong, the impulfe and the found were more intenfe in 
that place than I have met with them in the precordial 
region of a'flout man.” 
The contractions of the ventricles, in this difeafe, 
may be readily felt on applying the hand over the region 
of the heart; for here, particularly during the moments 
of palpitation, the beats will be found quick, dry, flrong, 
and fenfibly refifling the hand. If we attentively notice 
the patient when he is mod calm and undiflurbed, it will 
be feen that his head, his limbs, and even the bed¬ 
clothes, are really fliaken at every contraction of the 
heart. The beatings of the carotids^of the radials, and 
other fuperficial arteries, are often vifible. If we prefs 
the region of the heart, that organ, according to the ex- 
preffion of M. Corvifart, “ feems to be angry at the pref- 
fure, and to re-aCt more violently.” Thefe violent 
beatings, fays he, when the diforder affeCts the left ven¬ 
tricle, are accompanied with a pulfe which is frequent, 
ftrong, hard, vibrating, and hard to be flopped. “ This 
character of the pulfe is obferved, indeed,” fays M. 
Laennec, “very frequently in hypertrophy with dilata¬ 
tion, as well as in Ample hypertrophy of the left ven¬ 
tricle : but I cannot agree with M. Corvifart in regard¬ 
ing it as a fymptom of aCtive aneurifm of the left ventri¬ 
cle ; for, as I have elfewhere obferved, we find very often 
a pulfe fmail and weak, though otherwife regular, in men 
wliofe heart is very large and habitually beats with great 
violence, and vice verfa. 
“The palpitations which take place in the difeafe we are 
treating of, when examined by the help of the ftethof- 
cope, prefent the fame characters with the habitual con¬ 
tractions defcribed above, but with greater intenfify; 
and they are feldom accompanied with irregularities, un- 
lefs when death is near, and they become weaker. In 
thefe palpitations we fometimes obferve, befides the im¬ 
pulfe which the heart feems to give through a large fur- 
face, a ftroke more dry, more fonorous, ffiorfer though 
ifochronous, and which appears to (trike the parietes of 
the bread along a much (mailer furface: this ftroke is 
evidently produced by a quick and flrong rifing of the 
apex of the heart.” 
If the beatings of the heart are examined alternately 
right and left, i. e. under the lower part of the fternum 
and between the cartilages of the fifth and feventh ribs, 
on the left fide, we may exaClly know which is the af- 
feCted ventricle, if only one, or whether both are affec¬ 
ted, as molt commonly happens. It will be ufelefs to 
repeat the fymptoms which have already been fufficiently 
detailed. Dilatation with hypertrophy of the ventricles 
of the heart being, of all affeCtions of the heart, that in 
which it attains the larged fize, it is alfo that wherein 
the abfence of found in the region of the heart is ob¬ 
ferved mod frequently and to the greateft extent. 
Dilatation of one ventricle with hypertrophy of the 
other, is a fpecies of complication not very uncommon, 
though more fo than the preceding. The fymptoms are 
(till a mixture of thofe of hypertrophy with thofe of di¬ 
latation, the one fet predominating over the other ac¬ 
cording as the former affeCtion is more or lefs intenfe 
than the latter. 
Dilatation of the Auricles of the Henri.—This variety of 
difeafe very rarely occurs, and we (hall therefore be 
brief in detailing the fymptoms. Laennec fays, that, 
whenever the auricles were confiderably enlarged, whe¬ 
ther from a&ual dilatation or from diftention arifing in 
extreme pain, he found that their contradlions, inftead of 
the brifk found they produce in the natural (late, which * 
has been compared to opening and (hutting of a valve, 
give out only a dull obtufe found like a bad pair of 
bellows. He never could clearly difcover that the con¬ 
tractions of the auricles gave any impulfe, even when 
the thicknefs of their parietes was greatly increafed. 
Here Laennec recalls our attention to a negative fymp¬ 
tom which he had already noticed in analyfing the beat¬ 
ings of the heart; namely, that, “in many cafes of hy¬ 
pertrophy of the ventricles, the contraction of the au¬ 
ricles can fcarcely be diftinguiffied by examination over 
the region of the heart; but if, inftead of this, the cy¬ 
linder be applied over the fternum or under the clavicles, 
the contractions may then be clearly diftinguiffied, and 
often the found is very confiderable. This fymptom, as 
I have before obferved, feems to point out, that the af¬ 
feCtions of the auricles and thofe of the ventricles are to¬ 
tally diftinCt from each other; i. e. that the auricles are 
not affeCted by the maladies of the ventricles.” 
Softening of the heart, fatty coverfions, atrophy, and 
cartilaginous and bony indurations, do not betray clear 
fymptoms of their exiftence during life; or at lead we are 
not fufficiently acquainted with thefe fymptoms. A ge¬ 
neral cacheCtic habit is ufually obferved in mod of thele 
morbid dates, which of courfe require the long continu¬ 
ance of diforder before they are ellabliffied. 
The treatment of hypertrophy or dilatation is feldom at¬ 
tended with fuccefs. The little that is to be done is com- 
prifed in a few words. The circulation mull be kept below 
par, by repeated fmail bleedings, when the fubftance of the 
heart is any-where thickened ; by a very low diet, when it 
is diminilhed or morbid. Wefiiould fomewhat modify the 
latter rule, becaufe it is often an objeCt to nouriffi and 
fupport the body in a (late of aCtual deprivation of fome 
of the fanguineous elements. Occafionally counter-irri¬ 
tants, and a regular ufe of medicines aCting mildly on 
the capillary fyftem, are alfo proper. Perhaps much of 
the 
