HEART (DISEASES OF THE) 565 evils which have already ensued being greatly relieved. This latter statement has reference especially to dropsy and suffering from a sense of the want of breath. Life may be often pro- longed and the tolerance of the lesion pro- moted by appropriate management. Atrophy of the Heart. This is a lesion the reverse of enlargement, the term denoting a morbid dim- inution of the size of the organ. The heart is greatly diminished in size, and in some cases of great emaciation its weight may be reduced to 4| oz. Under these circumstances the atrophy is in accordance with the general con- dition, and gives rise to no special morbid ef- fects. Atrophy may be produced by the ad- hesions which result from pericarditis, and the diminished muscular power thus induced may give rise to morbid effects dependent on fee- bleness of the circulation. As the size of the icart can be determined with much precision }y physical signs, the diagnosis of atrophy is practicable. From its infrequency, however, and the very small proportion of cases in which it has pathological significance, it is not a le- sion of much importance. Fatty Degenera- m. This term is not applied to the deposit of fat upon the heart or between the muscular fibres of its walls. The organ is sometimes )verloaded with fat in these situations, and is loubtless thereby burdened ; but serious con- sequences never follow. Fatty degeneration of the heart means a substitution of fat for the proper muscular substance, and this takes place without as well as with an increase of the adi- pose tissue of the organ, and is a lesion of seri- ous import. It is evident that in proportion as fat is substituted for the muscular substance, the power of the heart's action must be weak- ened. If the structural change be consider- able and extensive, morbid effects and danger arise from the enfeebled circulation. The pulse is small, compressible, irregular, and sometimes notably slow ; there is breathlessness on exer- tion; the patient readily faints, and there is danger of death from over distention of the cavities of the heart. The lesion involves softening of the muscular structure, sometimes resulting in rupture. There are no special physical signs which denote this lesion, but auscultation and palpation show persistent weakness of the heart's action. The apex im- pulse is feeble or not appreciable, and the first sound of the heart is feeble, short, and valvular over the apex. The lesion may exist alone, or it may coexist with valvular lesions and en- largement ; in the latter case its existence is not easily determined. "When it exists alone the diagnosis may be made with much positive- ness, taking the symptoms and signs which have been mentioned in conjunction with the following facts: Fatty degeneration occurs rarely before middle age ; it exists more fre- quently, but by no means invariably, in con- nection with general obesity ; and it is often accompanied by the fatty change in the cornea known as the arcus senilis. The treatment consists of a highly nutritious diet, into which fatty articles should enter sparingly, together with the employment of hygienic measures and remedies designed to give tone to and to invigorate the heart. The lesion is irremedi- able ; that is, the fibres which have under- gone degeneration are never restored to their normal condition. All that is to be hoped for from treatment relates to the tolerance of the affection for an indefinite period, and the re- lief of symptoms. Miscellaneous Lesions. Soft- ening of the muscular structure of the heart, irrespective of fatty degeneration, may occur in connection with the continued and eruptive fevers, scorbutus, pyaemia, and other diseases. It is due to disturbed nutrition, and is accom- panied by great feebleness of the circulation. Softening as thus produced is not irremedi- able ; restoration takes place on recovery from the diseases to which it is secondary. Rup- ture of the heart has been mentioned as an ac- cident occurring in connection with fatty de- generation. It may occur also as a result of circumscribed suppurative inflammation in the muscular walls, and of aneurismal dilatation. It is one of the causes of sudden death. If the rupture be of sufficient size to admit of the free escape of blood into the pericardial sac, the loss of blood and the compression of the heart by the blood accumulating in the sac, prove immediately or quickly fatal. Some- times, however, the opening is so small that death is slowly produced, and cases have been reported in which the orifice has been tem- porarily closed by a coagulum of blood, and the escape of blood in sufficient quantity to cause death has been delayed from one to two days. Cicatrization and recovery are perhaps not beyond the limits of possibility, but it may be doubted whether there is an authentic case on record. Cancer, hydatid cysts, fibrous growths, calcareous deposits, and other affec- tions involving serious lesions, are very rarely seated in the heart ; and when they are, their existence cannot be determined during life. Wounds of the heart with perforation of the walls are of necessity fatal, death taking place as in cases of rupture. Foreign bodies, how- ever, may remain imbedded in the muscular sub- stance without giving rise to any serious incon- venience for an indefinite period. The writer has seen a specimen in which a pistol ball was found in the walls of the right ventricle, the pa- tient having received the wound 20 years before his death, and the cause of death being an attack of pneumonia. III. FUNCTIONAL DISOEDEB OF THE HEART. Under this name are embraced all kinds of disturbed action occurring irrespective of either inflammation or any structural lesion. The forms of functional disorder are various. A frequent form is that commonly known by the name palpitation, consisting of violent or tumultuous action, of which the patient is dis- tressingly conscious, occurring in paroxysms very variable as regards their duration and their recurrence. In severe cases patients o
