ficient intervals to render the circulation languid. The same purpose will be further obtained by the use of the tartrate of antimony, by a low diet, and by the recumbent posture. ImManiluvium. mersing the extremities, more especially the superior, into warm water, was strongly recommended by Morgagni; the increased heat of the cutaneous surface thus produced bringing an additional quantity of blood to them from the heart. Diminishing the force of the circulation by these means, not only is the growth of aneurismal swelling diminished, but the coats of the sac are thickened by the deposition of concentric lamina of fibrine, a process of the economy which is accelerated in proportion as the force of the current of the blood in the aneurism is diminished.

Rupture of the Heart.

Many examples of a rupture of the heart's parietes are recorded in medical writings; the walls of the heart being sometimes torn by a violent action of their muscles, in like manner as often happens to the uterus, during those violent contractions which take place during difficult parturition.

A rupture of the parietes of the heart usually takes place when some disease of the heart had previously existed; but it occurs also when there had been no evidence of any previous change of structure. The walls of all the different cavities have been found ruptured, but most frequently those of the left ventricle.

When the heart is ruptured, death is occasioned, as in an aneurismal artery, more or less suddenly, according to the size of the fissure; for sometimes the solution of continuity takes place gradually, the effusion of blood into the pericardium is slow; and in some cases the wound is completely filled up by coagulated blood, and ultimately by an effusion of fibrine.

When the parietes of the heart have been ruptured, it has usually happened in persons who had been exposed to some great muscular effort, or violent mental emotion. Running quickly, raising a heavy weight, crying loudly, playing on a wind instrument, falling from a great height, a paroxysm of

rage, or excessive grief, have all been known to cause a rupture of the heart.

Rupture of the Valvular Apparatus.

But the same cause which ruptures the parietes sometimes injures other portions of the heart. In some instances the fleshy and the tendinous columns are torn asunder, and sometimes the valves themselves are lacerated.

Injuries of this description happen not unfrequently. In all those cases where persons have been attacked suddenly with giddiness, reeling, and syncope, after having made some unaccustomed or violent exertion, and in whom the circulation is never afterwards perfectly natural, there is good reason to suspect that one or other portion of the systemic heart has been injured. The valve, torn and displaced, admits a retrograde stream of blood from the ventricle into the auricle; and when any such injury has occurred, the lacerated parts cannot adhere, as they are never in a state of rest; and all that the economy can accomplish is, to effuse fibrine sufficient to fill up, more or less perfectly, the aperture made by the laceration.

A courier, after having suffered much fatigue from riding on horseback, was attacked with difficulty of breathing and hæmoptoe. Repeated bloodlettings, and other means, afforded no relief. His pulse became very small and contracted, remarkably frequent and irregular; and besides the pulsations of the heart, there was a confused irregular beating, which had no resemblance to the heart's movements. He could not rest in any posture, and "he was in a state of anxiety and agitation impossible to describe." After death, it was discovered that one of the columnæ of the mitral valve was torn at its base, thus allowing the valve to float freely in the cavity of the ventricle.

case reCorvisart.

corded by

A young man made a violent effort to move a great weight, Case II. soon after which there came on a cough, palpitations, and sudden startings during sleep. He died twenty months after, having suffered from great anxiety and difficulty of breathing, and severe pains in the region of the heart.

On examining the tendinous columns of the mitral valve, two

Case re

corded by

of them were found torn, and all the cavities of the heart were considerably dilated.

"A youth received a sudden shock from the unexpected disBabington. charge of a pistol close to his ear. He felt conscious that something gave way in his heart, and from that time suffered from palpitation, occasional syncope, with the usual symptoms of obstructed circulation; and he died of general dropsy at the end of eighteen months. The mitral valve was found obstructed by a fringe of excrescences, originating from a rupture of the valve itself, which had taken place at the time of the surprise."

Rupture of the Aorta.-When, from any powerful muscular effort, there is a strong regurgitating stream of aortic blood, it has happened that either the semilunar valves are torn, or when they have been able to resist the retrograde stream, the coats of the aorta have given way.

A man fell from a window upwards of forty feet high, and in an hour after he expired. On opening the thorax, the madiastimum was filled with blood, and there were two fissures at the commencement of the descending aorta, through which the blood had escaped. This fig. represents the arch of the aorta, with its three branches, beyond which are two lacerations.

A youth, after a debauch, from which he experienced, on the case. following day, great weakness and derangement of the stomach, with a view of improving his condition, played at "tennis," which threw him into a profuse perspiration; and on making a violent exertion, he felt suddenly a giddiness and sense of swimming in the head, so that he could not stand or guide himself without difficulty. He was bled at the arm, and notwithstanding every means employed, the same feelings in the head continued, along with a difficulty in breathing and occasional syncope. These symptoms continued, varying in degree, for twelve years, and without any apparent cause he expired suddenly. On inspecting the body, an aneurism of the aorta, not larger than a walnut, had burst into the pericardium.

Differences in the size of the Heart.

The differences which are observed in the size of the heart may either depend on original organization, or they may be the effects of disease. "The bulk of the heart in the dead body varies according to the kind of death. There are cases in which the right heart is much contracted, as in those who die from hæmorrhage. In those who have been guillotined, the heart is found remarkably small; and the same is observed in syncope. It is also diminished in size in those who die of phthisis, in consequence of a less than usual quantity of blood. In asphyxia, on the contrary, the bulk of the heart is greatly augmented; and it is the same in the apoplectic. We find in these cases the heart double the size of those who die from hæmorrhage." There is considerable variety in the size of the heart at the thologique. different periods of life; in different persons of the same age, in those of different stature, and in the different sexes.

Neither is the size of the heart in proportion to the bulk of the body. Fat people, and those who have the least blood, have the smallest hearts; and in muscular men the heart is proportionally large. The heart increases in bulk during the whole period of life, which is contrary to what is observed of other muscles, all of which become enfeebled by age.

The comparison

that has been made of the heart being of the size of the fist,

Bichat,

Anat. Pa

Cases.

Lænnec.

though it may be applicable at some, cannot be so at all the different periods of life.

"In a woman fifty years of age, the heart was found about the size of a child's of twelve years old, and externally it presented the appearance of a withered apple."

Perhaps," observes John Bell, "the heart may be too small for the system to which it belongs; and this, I doubt not, had been the case with that boy in whom Kerkinguis found it so small, that though the boy was nine years old, the heart was no bigger than that of a child's born at the full time."