Such I believe to he the correct history of this state of the heart, of which most erroneous notions have been formed, owing in a great measure to the name under which the disease has been so often described. The description which I venture to offer has been drawn up from several cases of the disease in various grades of the deposit, which have come under my observation, and on comparing this description with some of the best detailed cases on record, it seems perfectly to con sist with the appearances described in them. In Mr. Adams' case,t for instance, " the right ventricle seemed composed of fat, of a deep yellow colour through most of its sub stance. The reticulated lining of the ventricle, which here and there allowed the fat to appear between its fibres, alone presented any ap pearance of muscular structure. The left ven tricle was very thin, and its whole surface was covered with a layer of fat. Beneath this the muscular structure was not a line in thickness, and was soft, easily torn, and like liver." Two cases, recorded by Mr. it. Smith,I presented the remarkable concomitant of an oily con dition of the blood ; in one " numerous glo bules of oil were found floating on the surface of the blood which escaped from the divided vessels ;" and in the other " the surface of the blood was thickly covered with globules of limpid oil." In this last case the condition of the heart's substance is described as follows : " the heart was remarkably soft, pale, and flaccid, its substance most easily broken, and its surface covered with a layer of fat a quarter of an inch in depth ; the parietes of the ven tricles were thin." The anatomical condition of the former case is not so precisely described as to admit of comparison. The subjects of both these eases were old women, one aged ninety, the other seventy ; and the former died of rupture of the left ventricle.
I am quite unable to account for the follow ing description of a case by Dr. Elliotson. lie says, " I once saw the muscular substance of the heart completely changed, except at the zetfurc, to fat. A mere layer of red muscular structure covered the internal and external parts of the heart and the columns: curlew : within every spot was fatty matter." Rupture of the heort.—A degenerate con dition of the muscular tissue is the most com mon cause of rupture of the heart : the states last described are those in which it most fre quently occurs; they correspond to the senile sof?ening of Bland the wall literally gives way at a certain point, and a laceration fre quently to a very trifling extent is found in that situation on examination after death : in some cases, moreover, several ruptures are found in the wall of the same cavity, and sometimes the rupture is very extensive, or it is large in ternally and small externally, or vice versa.
Any of the cavities may afford examples of this form of rupture, but the left ventricle is by far the most frequent seat of it, as may be understood from the following numerical state ment by 011ivier: " out of forty-nine cases the rupture was seated in the left ventricle in thirty four, in the right ventricle in eight, in the left auricle in three, and in two cases the ventricles presented several ruptures. In these cases the apex was the situation of the rupture in nine; in the rest the rupture took place near the base. Rupture, however, may occur in a healthy state of the organ, from violent bodily exertion ; of this a remarkable example was afforded in the case of one of NVhitbread's draymen, who in attempting to raise a butt of porter, fell dead, from a large laceration of the left ventricle, the structure of which was per fectly healthy. I had lately an opportunity of examining the preparation of this heart in the Museum of Guy's Ilospital.
Rupture is also found to ensue upon abscess in the heart, or upon ulceration and conse quent perforation ; it is sometimes caused by dilatation of it, and sometimes by contraction of one or more of the orifices.
Partial rupture may occur, i. e. the external fibres may be ruptured to a certain depth, without penetrating the cavity, or the internal ones may be similarly toni, the exterior being unaffected. A more remarkable kind of par tial rupture is that in which the carne co lumns or chords' tendinew are engaged. Cases of this form of rupture seem to have been detailed first by Corvisart, who attributed the rupture to violent efforts. Other cases have been subsequently recorded by Cheyne, Adams, and Townsend. In Dr. Cheyne's case, " the internal surface of the left ventricle was much inflamed, several irregular excrescences were attached to the mitral and semilunar valves. The chord tendinere, which connected the larger portion of the mitral valve to the wall of the left ventricle, were torn off just at the point of their insertion into the edge of the valve; four of these ruptured tendons hung loose into the ventricle."I