BIRMINGHAM EYE INFIRMARY

Abstract

the endocardium was so extensively affected, there had been at some period of their history pericardial inflammation; though it was subordinate to the other affection, and much of the effusion into the serous sac was the result of post mortem change. The state in which the heart was found had either been brought about by intense inflammation with an injected condition of the cellular substances, followed by serous infiltration pressing on the muscular fibres, and thus directly weakening them, or diminishing their consistence. Or, this weakness might have been secondary, there being first the common condition of inflammation of a tissue in close connexion with muscle; viz., excitement, followed to undue extent in these cases by depressed vitality of the contiguous muscular fibre, which persisted. The weakened contractile force of the heart would cause smallness, irregularity, and feebleness of the pulse; but not necessarily slowness. This might or might not depend wholly upon "nervous paralysis of the heart's cavities," from the morbid changes extending to the cardiac ganglia; but I think a mechanical reason may be given to account in some measure for it. From the congested state of every organ after death, we may infer that the same condition was present to a great extent during life; and the heart must have partaken in this repletion. With weakened, atrophied muscular fibre, and inelastic lining membrane, the organ refused to be stimulated by the normal influx of blood into the systemic ventricle; but a gorged condition arising, the blood slowly oozed into the aorta, and was conveyed at a sluggish pace over the body. We may explain the changes in the nutrition of the muscle and its atrophy, by adopting Dr. Hodgkin's idea of defective nourishment, from partial blocking up of the coronary arteries by this fibroid deposit. Unfortunately, these vessels were not examined. I regret, also, that percussion was not employed for the purpose of testing the undue sonorousness of the chest, by which, according to M. lavirotte (Rev. Med. Chir., tom. xviii, p. 229), we may diagnose fibrinous concretions of the heart. If polypus obstructs the circulation, causing the lungs to receive less blood, and thus rendering them less dense, thickened endocardium, bulging into and diminishing the calibre of the ventricles, would act in the same manner. We may have hyperemis and anmmia each producing cerebral symptoms, such as were witnessed in these cases ; but there can be little doubt that here a defective supply of blood to the brain was the cause of them. Yet there probably was at times a state of passive congestion, causing hebetude and headache; and the second patient told me that he had been much troubled with epistaxis for a week or two before admission.