CHAPTER XX. OF THE PARTICULAR DISEASES OF THE HEART. A Classification of the Diseases of the Heart. THAT desire to arrange and classify the multiplied objects with which man is surrounded, and which may be easily traced from the first dawn of civilisation, may also be found in the earliest works on physic. The resemblance which some diseases have with one another in their general character, in the regions of the body, and in the particular organs which are affected by them, must have led to something like a rational mode of their classification. It was long, however, before anything like a methodical system of nosology was formed; and whilst medical science remained fettered and encumbered with false theories and hypotheses, many diseases were grouped together and arranged in the same class, order, and genus, from erroneous notions of their nature, of the causes which were supposed to produce them, or of the system of the economy in which they were conceived to be situated. In classifying the diseases of the heart, those arrangements which have hitherto been made, are, in many respects, extremely complicated; so that in place of rendering the disorders of this important organ readily understood, and a knowledge of them more easily acquired, the primary objects of nosology, they tend rather to embarrass and confuse medical science. To me, it appears, that the diseases of the heart may with propriety be classed according to the same general principles on which the diseases of other organs have been so clearly and simply arranged I allude to their division into the functional and organic. However advantageous it may be for practical purposes,and in no organ can such a classification be more legitimately made, it must nevertheless be considered arbitrary; for it is quite impossible to draw a definite line of demarcation between the two classes, or to affix a precise boundary to each of them; and it is clear that there must be many different phases of a Nosographie Philosophique. disease, from the first functional disturbance, to the formation of morbid changes in any of the heart's tissues. The distinctive characters of the two classes is sufficiently apparent by the examination of diseased parts after death; although in those organs which the naked eye can reach, changes during life become invisible after death. If a limb, where a sanguineous congestion which has been produced by the application of a ligature around it, be macerated in water, it loses every vestige of disease. Whereas, if an extremity which had suffered from inflammation be treated in the same manner, its form remains unchanged-a seroalbuminous fluid having been deposited in its tissues. And functional disorders of the heart, like those of other organs, such as the alimentary canal and skin, exhibit, on dissection, no vestige of disease; whereas, in the organic diseases, some morbid alterations are detected after death; although, at the same time, changes in the tissue that existed during life, may after death have completely disappeared. The functional disorders of the heart, include those wherein. there is a disturbance of the circulation, either from changes in the quantity of blood within the cavities of the heart; from an interruption to the entrance, or to the exit of the blood, or from changes in the quality of the blood. They arise likewise from vital causes, or from that sympathy which subsists between the heart and the other systems of the economy; and they may also be produced by changes in the functions of both, or of only one of the hearts. The organic diseases comprehend all those wherein there is an appreciable change in the structure of any of the heart's component tissues; an arrangement formed according to those physiological Lessons Pa principles which were first adopted in classifying the organic diseases of other organs of the body by the ingenious Pinel and Bichât. thologique. Besides being divided into those affecting particular tissues, I have subdivided the organic diseases of the heart into the idiopathic and the specific, and into those of the systemic and of the pulmonic heart; for diseases are not only limited to one tissue, but they are also limited to one, and seldom affect both hearts. Diseases cannot be legitimately divided into the acute and chronic; these terms signifying merely different stages of the same malady. detailed classification of the diseases of the heart. 400 General ob CHAPTER XXI. ON THE CONGESTION OF THE HEART. General observations on the heart's functional diseases; this subject neglected ; its extent and importance; peculiarity of the heart's functional discases; these are derived from the peculiarity of its natural functions; the phenomena, causes, symptoms and diagonosis of cardiac congestion; congestion of the coronary vessels; systemic and pulmonic congestion; pulmo-cardiac congestion; treatment of congestion. BEFORE entering upon the subject of congestion, I may remark, on functional as regards functional diseases of the heart in general, that in servations diseases. the works which have professedly treated of the diseases of this important organ, little notice has been taken, far less have any minute researches been made, into the nature of its functional disorders; and this is the more surprising, as such affections are both numerous and of frequent occurrence, and most of them are remediable by medical treatment. Indeed, there can be no more satisfactory evidence of the frequency of the heart's functional disorders, than the frequency in the changes of the arterial pulse, these always indicating some corresponding change in the function of the heart. But it is not on all occasions easy to draw a distinct line of line of demarcation between the natural and the diseased functions of any organ; for the same functions are performed both in health and in disease. A person vomits in order to empty the stomach of deleterious food; and he also vomits as an act of the See page 77. economy, to assist in restoring the circulation during a fit of syncope. He respires to oxygenate the blood; and he breathes quickly to relieve a congested state of the thoracic viscera. See page 80. The morbid changes of the different tissues which compose the heart, present the same characters as those of similar tissues in other organs; but the disorders of the heart which are functional, are peculiar to the central organ of the circulation; for like other vital organs, the heart has its own particular functional diseases. The circumstance of the heart being neither an organ of secretion nor of excretion, but merely a receptacle for receiving, its muscular parietes propelling the blood into the proper vessels, produces a particular assemblage of symptoms wherever its functions are deranged; and, besides, the circumstance of the heart's action being unremitting is a peculiarity in its function which must essentially modify its various diseases. 1.- General Observations on Congestion of the Heart. HAVING fully explained, when considering "the phenomena. and causes of the diseases of the heart in general," the nature of cardiac congestion, and the various phenomena with which it is accompanied, these observations will serve as an introduction to what now remains to be said on this important subject. It has already been observed, that the heart, in its natural and healthy condition, neither expels during each contraction the whole of its contents, nor does it receive during each dilatation, all the blood which its cavities could contain. It has been likewise shown, that differences in the quantity of the heart's blood are almost constantly taking place during the performance of the natural functions of the body; and that, in order to regulate the quantity of blood in the cavities of the heart, the economy itself possesses certain means. I have also endeavoured to point out that, when any superabundant blood cannot be removed from the heart by these instinctive processes which are possessed by the economy, the congestion then becomes permanent; a condition which is by far one of the most frequent causes of disorders of the heart; and a condition, too, which, in place of having been hitherto considered as a primary affection of the heart, or described as a distinct disease, has only been cursorily alluded to amongst the diseases either of the pulmonary, or of the nervous systems, some authors having considered it as belonging to the former class, because of the cough, dyspnoea, and haemoptysis, by which it is usually accompanied; and others to the latter class, from its being attended by disturbances of one or more portions of the cerebro-spinal system. Besides cardiac congestion, properly so called, there may also be a congestion of the coronary, or of the pulmonary vessels. See p. 11. See page 104. See page 8. Their imper fect classifi cation. |