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Show 4, DISEASES ()I' THE HEART ANI) ITS MEMBRANES. the parenchyme of the heart. is the most obscure chapter of the whole pathology ot‘ the heart. and. untbrtunately. pathological anatomy can throw but. a feeble light on the subject. Experience has taught us that the voluntary nmscles ot' the body. even in the slightest state of inflammation (though there be no hypcrzemia. present‘). produces very grave functional disturbances in that tissue. The muscle rests in a state ot‘ contraction. and the slightest etl'ort at extension meets with the greatest resistance on the part of the patient. on account of the great sutl'ering it produces. ( Judging from analogy. it is easily conceivable that even the lowest grade ot‘ a general inflannuation ot' the myocardinm would bring the heart to a stand-still. and produce sudden death; that only in partial afl'ections could the latter stages ot‘ inflammation become possible. ',I,‘heorcti 'ally. ditl'use, myo 'arditis is impossible. yet not only a large portion ot' the muscles of the heart. bttt also the whole heart. may. under certain circumstances. undergo the ititlztltttttztt<_)1'y' process. ()1' course. death will always be the result. The following case will show it: A man. fifty years old, who was treated a long time for constitutional syphilis, and who was lately attacked with inflammation of both lungs. died suddenly. It was supposed that the sudden d lath was due to cerebral apoplexy. but a post-mortem examination rev -aled that. with the exception of some insignificant syphilitic pro- ductions. there was a condition of the heart which might well be considered as a general parencbymatous inllam- mation of its muscular tissue. The organ was cott- tracted. and its walls so rigid that it required consider- able force to compress it. Even after it was opened it did not collapse. The nmscttlar tissue had lost its fresh [ SECTION II. elongation of the l] xart. but also a widening and a thickening ot' the whole organ. Seen in front. it will have an almost quad'atic form. As it will tend to place the heart in a more verti 'al direction. it will be marked by all extension of the dull cardiac sound more to the right. and will reach the lower right border ot‘ the sternum. and even beyond it. In such a state. the apex will not only be formed conjointly by both ventricles. bttt in some instances the right ventricle alone will constitute it, and. as a consequence. instead of an apex heat (which will be mostly quite i111])(‘l'Ct‘lt‘tiblL‘iL there will be a basal shock. because the thickened and enlarged base will bring in innncdiate contact. the art/Awful. (WI/f" with the, inner wall of the heart. and ot‘ course the shock will be perceptible at the base during the systole. Each cardiac hypertrophy is produced by overworking of the heart. in its etl'ort to overcome mechanical impediments ot‘ circulation. The impediments increase the labor to be performed by the heart. by augmenting the pressure. which is directed ])ct‘peudicttlarly towards the inner wall of the ventricle during a systole. and which pressure is itselt‘ to be overcome by the contraction ot' the ventricle. I11 atheroma ot‘ the aorta. there is always formed a hyperIn valvular disease will be trophy ot' the lett ventricle. found the chiet‘ 'auses of such ltyperplasia; though difliculties ot' circulation. in other organs. do not a little, contribute towards t'orming such cardiac conditions. The histological changes ot' the muscular tissue. in hypertrophy. is ascribed to increase in size and density ot' each muscular fibre. Such enlargement of the fibres seems due to increase ot‘ cellular elements in the fibre by It is well known that the muscular fibres Hill r/ir/s/mI. ot' the heart bit'urcatc. and thus t‘orm net-works by the union ot' opposite bifurcations. leaving between them red color. and was of a violet tinge. The cut surface ot' a section had a glistening appearance. and its edges were almost transparent. and of the consistency ot‘ India rub- ber. The. fibres could readily be torn. but not st retchcd. Ben lath the peri 'ardium. as well as in the endocarditnn. were very numerous ecchymoses. which were probably caused by the grave disturbance of circulation in the myocardium («ten/w (Intent/u) All the vessels were empty. and the muscular tissue must have been in the highest degre‘ amemic. Microscopic examination showed a finely granular appearance ot‘ the interior of the mus- cular fibres. The granules were mostly distributed in the vicinity of the nuclei. The fibres were torn into short l'ragmcnts; a phenomena constant in pathological conditions ot' the striated nutscles. lt represented the In a muscular organ. like the heart. whose activity surpasses that of any other muscle ot' the body. a lack ot' nutrition is very soon and very sensibly t'clt. Not only does the heart speedily suli'er from atrophy in old age. when the process of nutrition naturally becomes les- most perfect type of Virchow‘s ]tarenchymatt>us, inflata- sened. but also mation. to all acute or a chronic state ot' disease. can becotne a [If/[H'l'f/‘U/I/lj/ of f/Ic [Ital/1. (‘ardiac hypertrophy is an increase of voltnne ot‘ the heart. caused by hyperplasia of the myocardium. It may bet‘all either ventricle. or both at the same time. The former is most l'requcntly the case. The hypertrophie condition of a ventricle is not only an increased quantity of its muscular tissue. which is manifested by an unusual thickness of the Ventricular wall. and a more or less changed t'orm. due to an augmented volume. but it becomes harder and more rigid. \Vhen such a hyper- trophied ventricle is cttt open and emptied of its blood. its walls will not collapse. nor can they readily be bent. either in or out. The increase of volume of the heart, in hypertrophy. is not only due to increased substance. but also to dilatation of its cavities. and the change ol‘ form of the organ will be characterized by a peculiarin proper to each ventricle. In hypertrophy ol‘ the let't ventricle. the heart will assume either an oblong-oVoid. or a cylindrical shape; the right ventricle will then appear as a mere appendix to the let't. The position ol. longitudinal fissures. These net-works can be reduced to small fragments with straight ends, which represent the cellular Each elements. of these have a central nucleus. I11 a hyperplastic nmscle ot' the heart. there are formed cells. with many neuclci. arranged in rows, one behind the other. .‘l/l'IIIIII'I/ of HIV .l/ll/m-HI'J/Hm. ‘zteh cachcxia. each anzcmia. be it due cause ot' cardia ' atrophy. which will be characterized by thinness and tlabbiness ot‘ its muscular tissttc. This would constitute general atrophy. Tllere exists ait'ophic conditions of only one layer of its muscle. or even of some localities or portion of the heart. These are partial atro- phies. The latter are due to local anzemia. In all those cases the muscular fibres become thinner. more slender, or partly obliterated. The histological character ot' atrophy oti'ers many modifications. They areas t'ollows: Brown atrophy. as the name indicates. is manit'cstcd by an increase ot' volume. and at the same time a discolora- tion ot' the tissue. and turning into a brown or brownish- yellow color. This is due to the titling up ot‘ the contractile portion of the muscular tissue. with yellow pigment granules. arranged in a variety ot' ways between the primitive tibres and around the nucleus. Brown atrophy is an alli-ctioll ot' the whole heart. It is [blind in senile marasmus. and in inauition. in tubercnlar and carcinomatous eachexia. Yr/lou‘ .ll‘z‘o/i/q/ or Fri/[.1] l)l'.I/('HI//‘II//ilu/ of HM» Hume/es of Mr //m//'/, the heart in the thorax will be almost horizontal (its base directed to the right. and its apex to the let't t. and In a measure. as the muscular tissue undergoes the will extend in that direction beyond the usual mammary fitttv' change. it becomes more discolored; turns at first vellow. then gradually whitish-yellow. and has the appearance ot' tallow. It lt),\(‘\ its consistency. and becomes l't'iable; can easily be reduced to a pulp between the lingers. and increases but little in \olume. line. It will be marked by displacement ot‘ the apex heat. which will be more to the let't. and the extension ot‘ the dull cardiac sound larther in that direction. In right Ventricular hypertrophy. there will be not only an |
