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.