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Show DISEJ'\RE§ OF T1119 13190013 VESSELS. SECTon 1V. TABLE I. of an aneurismal sae. Ilvrnnriornv Axn DILATATon or LEFT Vizxrntema. Axrzt'nisn or 'rnr‘. 0111(th or an‘. -\on'r.\. Fins. l and 2 represent the heart and the aorta of an in- dividual who died suddenly. No previous history of the ease. Fig. l. the right ventricle (\l'. A. 1).). as eompared with the left. is exeeedingly redueed in size. while the left is enormously hypertrtqihied and very mueh dilated. The hase ofthe right ventriele passes forward as a funnel-shaped prolongation. and gives origin to the pulmonary artery. In the ascending portion of the arch of the aorta. heyond the origin of the innomiuate artery. there are three aneu- rismal enlargements (Nos. 1. 2. 3.). No. l is laid open. and presents the well-known stratitied disposition of the inside the interior of this vessel. Flo. 2 represents th mist-ending‘ portion ot'the aorta opened. No. I, shows the dilated portion of the vessel. ,No. 2 the yellowish-white. eal "are- ous amt selerotie plaques on its interior surface; No. 3 represents the origin of the aorta (0. oh). its healthy .semilunar valves ( l'. N. (1.). and the aortic sinus. In Fm. 2. the aneurismal saes 2. 3. are opened. Ko. ,1 eonnnunieates hy two orifices with the eavity of the aorta; Sac Ko. 2 is open hut. empty, No. it is widely opened and shows its eomunmieation with the artery hy three openings. indi- eated hy stillettes passing through them. [t o.\'r1x11:n Hum Paar, N, situl'lox [1.1 It'lrorl (rlr t/lNl'll. .trr'lo'r, for elf/i. JIM/fr. XXV/II) deserihes ln'mf- H. Ntr/elurr of the left ourim/lo-ruttrleillar opening. The following are its physieal symptoms: 1. Presto/(die murmur over the apex,whieh is often palpahl \ as a presystolie t'remitus. ()eeasionally, instead ofthe murmur. a par~ tial diastolic tone will he heard. The seeond aortic tone is verv systole of the ventrieles in a young woman. There was a tripartite apex-heat. a tripartite venous pulse and hut a single pulse 0t'the arteries. tie aserihes it to atheromatous condition of the arteries of the heart. Mallow/n- (deals-eh. .trrll._fnr rlln. filed/e.) eonsiders Dentist/stole as a eontraetion of only one ventriele. due to laek of force of the other. it constitutes a symptom indicating great danger, if there exists at the same time valvular trouhle. Frunrols Fran/c ( (tax. (in low.) tinds frustrated or incomplete systole of one ventriele to eause the following manifestations: when there is mitral regurgitation duringa ventriettlar eontraetion, whieh is insultieient to produce a. full arterial pulse, or when there is exeeeding high prr. sure in the aorta and the hlood regurgitates dur- ing ventrieular systole into the auriele; in either use there will he intermission in the arterial pulse. The next tollowing ventricular systole will he of an unusually great. strength, to compensate the t‘eehle. whilst the tirst ventrieular tone, over the apex. is very loud. 2. Dilatation oft/1e I'lij/lll rrntrirle will he produced hy the strieture in the left 11 tart. eausing enormous resistanee in the pulmonary eireulation, as stated ahove. i 3. Ill/prrlrop/o/ of tile rig/lit rentr/ele, the compensatory hypertrophy will increase the force of the seeond pulmonary sound. I. Struosls of the pulmonary owl/ire is eonneeted with the following changes: 1. Systolic murmur over the pulmonary artery. lt is very lottd and extensive,and is felt as a systolie fremitus: the second sound is low. 2. [lg/perlroplo/ of llm 't'ftlltl renlriele. due to eireulatory impediment. As a elinieal symptom ('j/U/HMlN 1's lure t't'l'l/ Nam/awn. 1C. Im-ompelmzeyoft/1epulmonaryrulrrs, l'hysiealsymptomsare: 1. Diastolic murmur over the pulmonary artery, sometimes pal- pahle as a t'remitus. The enlargementprotrudes into the pulmonary artery from without inward,just above the semi- lunar valves (: l'. X. I'. N), and then eomnnmi *at'es with former feehle one. amt a new aortie tension will follow, and of eours t a regurgitation and an intermittent arterial pulse. ete. I'omalurr' rrulrieular systole, when the ventriele eontraets hefol‘e its eavity is pert'eetly tilled, here an arterial pulse, hut. feehle one, will ensue. Ahortive or insultieient systole, when the mother pressure is no greater than the (lol'lll‘. .\n intermission, or a ve , t'eehle. alter- nating with a full pulse will follow. llemisystole is then either an inemnpletc eontraetion of the left ventricle or a total ahsenee of it, lt may spread to other oritiees of the heart. and even to the arteries of the. neck. 2. Dilatation oftlte rig/1t realrlrle hy overstilling it. 3. ID/perlropli‘t/ of the rig/lit reatrlele will arise from impediment and over-titling. .L. Slraosix of fllt‘ rlglzl (tur/calo-rratrleular orlfiee ‘annot he diagnosed. ill. J/tsuj/ieleaey of the Ira-uspltl rot/m otters the following at times. [termite/m (oa/ It‘eaou of Lyon eonside ‘ a long-standing condition of this kind a very dangerous symptom of alteration ot'the heart tissues. although not anatomieally demonstrahle. lit/rein (it rr/zlr. (lea. (1e llft'tl.) treats of functional or relative insuftieieney of the mitral 'alve as tollows: "There may be two innuediate causes for sueh disturlamees: 1. An aetual structural change ot'the papillary museles. 2. Dilatation ot‘ the ventricles. -ausing widening of the aurieulo-ventrieular opening to an excessive extent. The distant; eause may he. over-fatigue of the heart's tissue. Such eonditious exist in people who carry heavy hurdens up hill or up steps, ormal‘e long and foreihle marches. If not. of toolong standing, and not too severe, they are often eu 'ahle. The symp» toms in the early stages are: palpitation, shortness of hreath, pain in the chest, vertigo, sometimes hemisystole without tangihle anatomical lesion. in the second period of this malady there is permanent ventrieular dilatation, low position of the heart in the thorax, displaeement. ot' the apex-heat. and an extensive area of dull eardiae sound. tn the third stage, there is m/lral insutlr eiency; very seldom l/‘lt‘tlsllftl. The fourth and last stage is eharaeterized hy r-g/(Ino'is and (Iropsy. l'erteet insutlieieney may he eaused: 1. 3y disturhanee of cireulation, from aortie derangement. endoearditis, hypertrophy of the left ventriele or atrophy ofthe kidneys, emphysema, interstitial pneumonia, with dilatation of the right ventriele. 2. By paresis of the innseular tissue in endoearditis orperiearditis, in consequence of nervous derangement of the heart, hysterieal trouhle in the nervous eenters. typhoid, severe exanthematous and puerperal fevers, ea- symptoms: 1. Sj/xlullt‘ murmurorerlla'lriruxpid ralre. The pulmonary sounds are usually very feehle. 2. Dita/«Hon oft/2e I‘lglll (oo'fele produced hy over-titling with hlood from the \‘enie eavte, amt from the ventriele hy regurgitation during its systole. 23. Venous pulse and hepatie vein pulsation. ]"l'i\'(i"l‘[()i\r.lL DIL‘IMNGEJI/‘LV'l ()I'V THE HEART. The heart, as the central organ of eireulation, will heeome fitne- tionally deranged.not only when its own eireulation or nutrition is disturhed, hut. also. and most frequently, from disturhanees of eir- eulation andnutrition in any important organot' the hotly, especially when sueh disturhanee isof any eonsiderahle duration. Symptoms of t'uuetional derangement of the heart. ditl'er hut very little from such as are manifested in actual heart lesions, or tangihl -. anatomieal alterations in the tissues of the organ. The disturhanees may he either in the quantity of heart foree: systolie or d1astolie aetion, or in the quality: rhytlnn, sound. or in hoth at the same time. As lllttlltlt()ltllt‘ttl lesions only the physieal symptmnis are of any r ‘al elinieal value, so in funetional derangement of the heart, only the ohjeetive symptoms will he useful for diagnostie purposes. although, in either ease, the suhjeetive feeling ofthe patient. sueh as pain, feeling of uneasiness and nerve plnaionteita, may often he of suttieient signitieanee to elear tip a ‘ase of heart disease, When there is a general disturhanee of eireulation in the hotly, for instanee, in fevers, or in high-graded loeal intiammations. provided the nature of the disturhanee he of such a kind as to impair the eireulation or the nutrition of the heart, there will he symps ehexia. severe malarial trouhles.ehlorosis, ieterus of graver forms; ehronie and aeute poisoning. aleholism, ete. The (litterenee hetween relative and ahsolute insutlieieney is the amountofforee in the murmur, which is greater and more eon« slant in the latter than in the former. In relative insuttieituey the pulse is nearly always regular, in ahsoluteahnost ever irregular. in relative it is full: in ahsoltite small and feehle. tieneral disturtmnee ot'nutrition of the hotly takes plaee mueh sooner in ahsolute than in relative insutlieieney. .Vol/mIo/vl (tle'lllaell. .trelt/r, for rl/n. _l[ul_) speaks of Arythtnia as heing a deviation of the regularity of the heart pulse. and eontin- tied into the arteries as irregular arterial pulse. There are four toms showing a rednetion or temporary augmentation of the eon- traetionordilatation ofthe ventrielesortheaurieles. Theheart pulse and the apex-heat will he more or less moditied in intensity. duration or ealiher. Corres}mndingly the pulse of the large hlood vessel will show ehanges. indicative ot'the eardiae disturhanees. \Vhen there is insuttieient innervation in the tissues. or when there is too great irritahility of the highly-sensitive elnloeardial strueture, whether of inflammatory origin or not, the valvesheemne more or less ineompetent to elose the arterial or venousoritiees. and the sounds will at -onee show alteration in piteh and quality. The following synopsis of symptomatology will eonvey. in short. the physieal diagnosis of funrtional disturhanees of the heart. ditl'erent forms of it. 1. l'nlsus higeminusand alternans. 2. l'e- riodieal irregularities. that is. the duration of the pulse is variahle. 3;. lrr ilarity of frequency: »t. intermittent. or irregularity in the inlet val hetween the individual pulse'. The eauses of .\r_vthinia he eousiders to he disturhanees of funetion or lesions of the AlIIII/I‘I‘ t}. (1/: i/liI/re I‘ln‘ntrn. (Ira. .l/le/on) deserihes the light- heart ganglia. of theeardiae filaments of the iaa-tnno-gastrie rlireet- est forms of funetional insultieitaiey, found in young people. who develop too fast tip to puherty. and afterward heeome paralyzed. This insutlieietwy eeases after eomplete Inaturit" and total devel- opinent of the inuseular tissue. I'll/'1Itt'f/j/HHI/H/ls ills/urbane: after typhoid fevers, diphtheria, weakened heart and syphihtie diseases. lv. or hv retlex aetion from sensory tihres ofthe eardiae nerves: also disturlianee of the eenters of the pneunuigastrie. it is most pro- t t nonneed in general atony and anaemia. Join/m. [.1 who and l'o/«o'n deserihe duplieation or douhle pulse, t whieh they aserihe to general nerve derangements. 1 |