636 
ABNORMAL CONDITIONS OF THE HEART. 
from external violence. The patient was 
crushed between a water-wheel and the em¬ 
bankment on which the axle was supported. 
Several ribs were broken, as well as the right 
clavicle and humerus. The heart, which, ac¬ 
cording to the statement of the patient, had 
always occupied its natural situation, was now 
found beating at the right side.* 
MORBID ALTERATIONS OF THE MUSCULAR 
SUBSTANCE OF THE HEART. 
1. Inflammation of the muscular structure of 
the heart, or carditis (the carditis proper of some 
pathologists).—The same anatomical characters 
which would lead us to pronounce any muscu¬ 
lar tissue in a state of acute inflammation, 
would justify a similar conclusion respecting the 
heart. But from the sparing deposition of cel¬ 
lular tissue around this organ and between its 
fibres, the anatomical phenomena which denote 
the previous existence of inflammation are not so 
marked in it as in the muscles of animal life ; and 
judging from the rarity of these organic signs, as 
well as from the unfrequent occurrence of those 
symptoms which so great a morbid process could 
scarcely fail to produce, we may reasonably 
conclude that active inflammation deeply im¬ 
plicating the carneous fibres of the heart, and 
originating in them, is very seldom met with. 
The anatomical characters indicative of car¬ 
ditis are a dark, almost black, colour of the 
muscular substance, the fibres of which have 
lost in a great measure their cohesive power ; 
they are very compressible and readily torn, 
and consequently cannot be easily isolated to 
any great extent, although easily separable en 
masse. When the muscular wall of either ven¬ 
tricle is pressed, the blood oozes out from the 
divided vessels on the cut surface in much 
greater quantity than usual. In Mr. Stanley’s 
case, as in all cases, the dark colour of the 
fibres “ evidently depended on the nutrient 
vessels being loaded with venous blood.” When 
in addition to these signs we find purulent de¬ 
posits in various parts of the muscular struc¬ 
ture, and moreover, when it is manifest that the 
internal and external membranes are implica¬ 
ted, from the effusion of coagulable lymph on 
them to a greater or less extent, no doubt can 
be entertained respecting the exact nature of 
the lesion. In Mr. Stanley’s case, “ upon 
looking to the cut surface exposed in the section 
of either ventricle, numerous small collections 
of dark-coloured pus were visible in distinct 
situations among the muscular fasciculi.” t A 
similar case has been recorded by Dr. P. M. 
Latham, the anatomical characters of which ac¬ 
corded with those above mentioned. “ The 
whole heart was found deeply tinged with dark- 
coloured blood, and its substance softened ; and 
here and there, upon the section of both ven¬ 
tricles, innumerable small points of pus oozed 
from among the muscular fibres.” J 
Every anatomist must have noticed how 
variable is the colour and the consistence of the 
muscular structure of the heart, even indepen¬ 
* Med. Gazette, vol. viii. 
t Med. Chir. Trans, vol. vii. 
X Med. Gazette, vol. iii. 
dent of disease of the lining tissues. The pale, 
soft, compressible, flexible, and, to use a com¬ 
mon word, flabby heart, strongly contrasts with 
the firm, plump, fresh-looking elastic one; in 
the former, the flaccid parietes fall together im¬ 
mediately the cavities are emptied ; in the lat¬ 
ter, the surfaces retain their convexity, although 
the contents of the cavities have been com¬ 
pletely removed. Between these two extremes 
there are various grades of colour and consis¬ 
tence, of which Bouillaud particularises three 
as being the result of inflammation, the red 
softening, the white or grey, and the yellow. 
The first is probably that which may be said 
unequivocally to follow primary inflammation 
of the muscular texture ; the other two, how¬ 
ever, as Bouillaud admits, occur most fre¬ 
quently in connection with pericarditis : they 
occur, too, as Dr. Copland observes, where no 
sign of inflammation is manifest, and where 
during life there had been no evidence of car¬ 
diac disease ; in cases of general cachexia and 
of constitutional disease, attended by discolora¬ 
tion of the surface of the body, arising, in fact, 
as Dr. Williams explains, from an altered state 
of the nutrition of the organ, owing perhaps to 
partial obstructions in the coronary vessels ra¬ 
ther than to the immediate influence of inflam¬ 
mation. This last excellent observer makes the 
following judicious remarks in reference to this 
matter.* “ To judge that the tissue of the 
heart is especially diseased, we must see that it 
differs much in appearance from the other 
muscles of the same subject. You will find, 
on comparing the same muscles in different 
subjects, a remarkable variety of colour; and 
in some there is no freshness in any of the 
muscles, but all are pale, and verging on a 
pinkish drab or dingy brick colour.” Perhaps 
the most correct arrangement of the various cir¬ 
cumstances under which softening of the heart 
may take place is that given by Andral. 1st, 
Softening connected with active hyperæmia of 
the heart ; 2d, softening connected with anaemia 
of the heart ; 3d, softening connected with 
atrophy of the heart; 4th, softening connected 
with an acute alteration in the general nutritive 
process (as in typhus) ; 5th, softening connected 
with a chronic alteration in the general nutritive 
process (as in a variety of chronic diseases) ; 
6th, softening which we are not yet enabled to 
refer to any morbid condition of the heart itself 
or of the rest of the system.f 
Suppuration.— The occurrence of an abscess 
uncomplicated with any other lesion in the 
walls of the heart, does not unequivocally de¬ 
note the previous existence of carditis, although 
it may afford strong presumptive evidence of 
the fact : when, however, we find abscess, with 
lymph or adhesions of recent date, we may rea¬ 
sonably infer its inflammatory nature. Dr. 
Copland has introduced in a note to his inva¬ 
luable and profoundly learned article on Dis- 
* Lectures on Diseases of the Chest, Med. Gaz. 
vol. xvi. 
t Otto says that violent exertion appears as in 
other muscles to render the heart easily broken 
down ; thus, for instance, it is found very weak in 
hunted deer.