IN this text Austin Flint discusses Heteromorphous Productions, and enlargement of the heart. The text selected is from his book, A Practical treatise on the diagnosis, pathology, and treatment of diseases of the Heart. Second Edition. (Philadelphia 1870).
Heteromorphous Productions.—The various morbid productions which, from their being foreign to the structure of the part in which they are seated, are distinguished as heteromorphous, occur very rarely in the walls of the heart. They are, however, sometimes observed. Specimens of morbid growths or tumors, belonging to the classes lipoma or fatty, fibroma or fibrous, myoma or fleshy, and syphiloma or gummy, are occasionally met with. As stated by Raynaud, from their infrequency these are interesting chiefly as pathological curiosities. They are unattended by distinctive symptoms or signs, and they accordingly defy diagnosis. In a practical point of view, therefore, they have but little importance. Few organs in the body are more exempt from these, and other heteromorphous productions, than the heart. So slight is the probability of their existence in any individual case, that they arc scarcely to be taken into account in the investigation of cardiac affections which are evidently anomalous. This statement will apply to tubercles. Miliary tubercles are sometimes observed upon the surface of the heart; but collections of the product known as yellow or cheesy tuberculous matter are amongst the rarest of pathological curiosities. (Page 123)
ENLARGEMENT OF THE HEART.
Definition and varieties of hypertrophy and dilatation—Normal dimensions and weight of the heart—Enlargement by hypertrophy—Concentrio hypertrophy—Symptoms and pathological effects of hypertrophy—Physical signs and diagnosis of enlargement and hypertrophy—Situation and anatomical relations of the heart in health—Alterations in degree and extent of dulness on percussion in hypertrophy—Altered situation and extent of the apex-beat, and abnormal force of impulse in hypertrophy, as determined by palpation—Abnormal modifications of the heart-sounds—Diminished extent and degree of the respiratory murmur and vocal resonance within the prsecordia in hypertrophy, as determined by auscultation—Results of the clinical study of the heartsounds in health—Enlargement of the prsecordia and abnormal movements in hypertrophy, as determined by inspection—Increased size of the chest, as determined by mensuration—Summary of the physical signs of enlargement of the heart—Summary of the physical Bigns distinctive of enlargement by hypertrophy—Treatment of hypertrophy—Enlargement by dilatation—Symptoms and pathological effects of dilatation— Physical signs and diagnosis of dilatation—Summary of the physical signs distinctive of enlargement by dilatation—Treatment of dilatation.
Enlargement Of Tiie Heart is a term which embraces abnormal increase of this organ, as regards either volume or weight, or, as is commonly the case, increase both in weight and volume. Increase of the volume of the heart, and increase of its weight, are different forms of enlargement, either of which, although they are usually associated, may exist independently of the other. The heart may exceed the limit of health, as regards weight, from an increased thickness of its walls, the normal volume being retained. This is a condition sometimes found after death, although, in the vast majority of the cases in which the weight is augmented, the volume exceeds the healthy limit. On the other hand, the volume of the heart may be abnormally great, the cavities being enlarged, while the thickness of the walls is so far diminished that the normal weight is retained. (Page 17)