2. The first stage of actual relaxation. This is divided into an acute, a Subacute, and an intermittent form; such cases are often labeled as cardiac neurasthenia.
3. This class enibraces the ordinary cases of actual dilatation, on which so much has been written.
The early stages should be especially sought for. The early stages of cardiac dilatation should be recognized, just as much as the early stages of pulmonary tuberculosis, so that the condition may be opposed in time. Concordance with Gerhardt and Friintzel that palpation is more important than percussion for esti mating the size of a relaxed heart. One must feel in the intercostal spaces for the left ventricle several times and with the patient in different positions, but especially in the leaning-forward posi tion made use of by Gumprecht. Whit wieki and Seeligmtiller have observed a marked difference in respiration accord ingly as the patient lies on his left or his right side. This may be an impor tant symptom of dilatation of the left ventricle. In one case was noted on re peated occasions an increase of twelve to twenty inspirations in the minute when tbe patient turned from his right on to his left side. L. Feilchenfeld (Brit. Med. Jour., from Berl. klin. Woch., Feb. 2S, '9S).
Case in a bicyclist who had been in the ha.bit of taking prolonged rides and who had accomplished several century-runs. Marked hypertrophy and dilatation of the heart, the latter being predominant. ln addition a systolic murtnur was audi ble over the cardiac area, with its great est intensity at the apex. The patient readily becomes dyspnceic; the heart-beat is ordinarily 38 to 40, but under the influence of the slightest excitement or exertion it increases to SO or DO. J. M. Taylor (Phila. Med. Jour., Apr. 16, '98).
Several cases of acute dilatation of the heart from bicycling witnessed. Ex planation referred to the lack of the aspiratory action of the heart during the ride, and the excessive pumping ac tion of the muscles of the extremities exerted on the veins and lymphatics,— both of which lead to a distension of the right heart. F. A. Packard (Phila. Med. Jour., Apr. 16, '9S).
In the etiology of cardiac dilatation the two essential factors are: (1) the element of increased mechanical strain and (2) myocardial weakness, primary or secondary. H. A. Caley (Lancet, June 3, '99).
Active dilatation of the heart, or hyperdiastole, is frequently met with. Normally the heart-muscle dilates act ively within certain limits in order to receive the incoming blood-stream. Under some circumstances this hyper diastole is increased beyond the nonnal. It then amounts to an active dilatation of the heart. The conditions that cause this may be nervous, or alteration in the blood, but particularly those condi tions in which, as in anmrnia, there is a demand by the tissues for a larger quan tity of blood. This demand cannot be met by merely increasing the number of pulsations, as the blood would not re main sufficiently long in contact with the tissues. It can be met only by in creasing the amount of blood driven out at each stroke. Hyperdiastole may be seen under physiological circumstances at times, as in normal persons, after climbing mountains. It is often seen after hot baths, during digestion, and, at times, during pregnancy. H. Herz (Deutsche med. Woch., Feb. 22, 1900).
Other causes are acute nephritis, as after scarlet fever, rheumatic pericarditis and' myocarditis, pneumonia, and ty phoid fever. Influenza certainly may precipitate dilatation, if it does not act ually cause it.
Defective development of thorax im portant in the etiology of pseudohyper trophies of adolescence. Thorax elon gated and constricted; heart forced downward, apex sometimes as low as fifth intercostal space. Huchard (La Semaine Wd., Nov. 3, '94).
Connection between kidney disease and cardiac hypertrophy attributed to pri mary toxicity of the blood. De Domini cis (Wiener med. Woch., Nov. 17 to Dec. 1, '94).
Ingestion of a pint of water causes blood-pressure to return to normal in one hour; after ingestion of pint of wine or beer blood-pressure becomes normal only after two hours. Great beer-drink ers nearly all suffer in a few years from dilatation of the heart. Bollinger Pied. Press and Circular, Aug. 2S, '95).