Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 2: Dia-Ins
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit25760/645/
637 
ABNORMAL CONDITIONS OF THE HEART, 
- 
eases of the Heart,* an abstract of several cases 
in which pus was found in the substance of the 
heart. Those quoted from Corvisart, Raikem, 
and Simonet, and probably that from Dr. 
Graves,f may be regarded as examples of puru¬ 
lent formation following carditis, general or 
partial. So likewise is Laennec’s case, in 
which, however, the carditis was consequent 
upon pericarditis. There is no anatomical cha¬ 
racter which will enable us to distinguish whe¬ 
ther a simple purulent deposit, surrounded by 
natural muscular texture, be inflammatory or 
not, for there is no reason why the heart should 
be exempt from that which we know often 
occurs in other muscles, namely, non-inflam- 
matory deposits. 
Ulceration.—As true carditis seems to be 
generally admitted to be rare, so we may con¬ 
clude that ulceration is equally so. It is by 
the ulcerative process that some of the perfora¬ 
tions or ruptures of the parietes of the heart 
take place ; it is probable, however, that the 
great majority of the ulcerations we meet 
with commence from the surface, and result 
from membranous inflammation rather than 
from that of the muscular substance; the ulcer 
commences on the surfaces, either in or imme¬ 
diately subjacent to the internal or external 
membrane ; and as it burrows deeply, it may 
perforate the muscular wall, and so destroy the 
membrane on the side opposite to that on which 
the ulceration had commenced. Sometimes an 
ulceration of this kind gives rise to aneurismal 
tumours or sacs, very variable in size, projecting 
from that part of the cavity which corresponds 
to the artery. It seems evident that these 
tumours are produced by the pressure of the 
contained blood distending the thinned and 
yielding wall of the heart. We shall return to 
this subject further on in treating of aneurisms 
of the heart. 
Induration.—This condition of the muscular 
structure of the heart seems most probably to 
be a result of inflammation, especially of the 
chronic kind. It is generally found in small 
circumscribed portions ; it may occur in any 
part of the heart, and may even co-exist with 
softening : the hardened portion has become 
particularly firm, is cut with difficulty, and when 
struck with the scalpel sounds, as Laennec 
says, like a leather dice-box. It is harder, 
denser, less elastic, and as regards colour is 
paler than the hypertrophied muscular tissue. 
Cartilaginous and osseous transformations.— 
Induration of the subserous cellular tissue of 
the heart is in general the precursor of many of 
these transformations. This indurated portion 
increasing in thickness gradually assumes the 
appearance of cartilage—in this cartilage the 
calcareous particles are deposited. I have not 
been able to ascertain whether this so-called 
ossification exhibits, on examination by the mi¬ 
croscope, the lamellar arrangement of true bone, 
as osseous transformations of certain permanent 
cartilages do, those of the thyroid cartilage for 
example. These calcareous or osseous patches 
* Diet, of Medicine, part iv. p. 191. 
t Lond. Med. and Surg. Journal, vol. vii. 
or tumours compress the subjacent muscular 
tissue, and produce atrophy of them, and ac¬ 
cording to Andral, sometimes are connected by 
prolongations of the same material with other 
calcareous deposits formed round the orifices. 
Many pathologists believe that these transfor¬ 
mations are the result of inflammation. I sup¬ 
pose there can be no doubt that they follow an 
increased afflux of blood, and so they may be 
considered, although not an immediate, at least 
a remote effect of inflammation, or rather of the 
altered nutrition and secretion to which inflam¬ 
mation gave rise. 
In a case recorded by my friend Mr. Robert 
Smith, of Dublin, the apex of the left ventricle 
was converted into a dense, white, firm, car¬ 
tilaginous structure, the division of which with 
a scissors required the employment of con¬ 
siderable force ; the alteration of structure had 
extended to some of the carneæ columnæ.* 
Tubercles.—These productions are very 
rarely if ever met with in the heart. No re¬ 
liance can be placed on most of the instances 
recorded, in consequence of the imperfect and 
unsatisfactory descriptions accompanying them; 
what appears to one person to be tubercular 
may present a totally different aspect to another. 
Laennec says vaguely, “ only three or four 
times have I met with tubercles in the muscular 
substance of the heart.” And Andral states, 
that they are never met with in the heart, 
except when they likewise occur in other 
muscles. Otto says, “ although I have dis¬ 
sected a great number of scrofulous men and 
animals, I have never found a tubercle on the 
heart, and therefore consider them very rare.” 
Dr. Elliotson-f mentions a case in which there 
were scrofulous deposits in the walls of the 
left ventricle, surrounded by white and almost 
cartilaginous induration. In a case wrhich came 
under my own observation, in a woman be¬ 
tween 50 and 60 years of age, there were several 
white tumours in the parietes of the right 
ventricle, each about a quarter of an inch in 
diameter, of uniform consistence throughout, 
nor showing any disposition to softening in the 
centre. 
Scirrhus.—Equally unsatisfactory are the 
reports of anatomists respecting this alteration. 
Rullierand Billard relate cases in which scirrhus 
had developed itself on the heart. Rullier’sJ 
case was an instance of degeneration of the 
whole substance of the heart into a scirrhous 
mass, which formed irregular knobs on the ex¬ 
ternal and internal surfaces of the heart. Bil¬ 
lard found three scirrhous tumours embedded in 
the heart of an infant only three days old.§ 
Medullary fungus, or encephaloid tumours.— 
Of these, several instances are quoted by Andral 
from others, and he describes two which he 
saw himself.|| In the first of Andral’s cases the 
whole of the walls of the right auricle and 
ventricle were converted into a hard, dirty 
white substance, traversed by a number of 
* Dub. Journal, vol. ix. p. 418. 
f Luraleyan Lectures, p. 32. 
$ Bull, de la Faculté, 1813. 
S Malad, des Enfans. 
|| Loc. cit. vol. ii. p. 346,
        

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