Frederick Parsons, John Broadbent and Edmund Owen

“ The valves of the left side of the heart, the aortic and mitral valves, are affected far more commonly than those of the right side. It is indeed comparatively rarely that the latter are attacked. In the process of healing of a damaged valve, scar tissue is formed which has a tendency to contract, so that in some cases the orifice of the valve becomes narrowed, and the resulting stenosis or narrowing gives rise to obstruction of the blood stream. ”

“ In addition to these the beginning of the ventral aorta is often thickened and expanded to form a bulbus arteriosus, which is non-contractile, and, strictly speaking, should rather be described with the arteries than with the heart. In relation to human embryology the smooth sinus venosus and reticulated auricle are interesting. Between the auricle and ventricle is the auriculo-ventricular valve, which primarily consists of two cusps, comparable to the two endocardial cushions of the human embryo, though in some forms they may be subdivided. ”

“ Temporary over-distension or dilatation of the cavities of the heart occurs in violent and protracted exertion, but rapidly subsides and is in no wise harmful to the sound and vigorous heart of the young. It is otherwise if the heart is weak and flabby from a too sedentary life or degenerative changes in its walls or during convalescence from a severe illness, when the same circumstances which will not injure a healthy heart, may give rise to serious dilatation from which recovery may be very protracted. ”

“ The sinus venosus is still a separate chamber, and the conus arteriosus, which may contain many or few valves, is usually divided into two by a spiral fold. Structurally the amphibian heart closely resembles the dipnoan, though the increased size of the left auricle is an advance. In the Anura (frogs and toads) the whole ventricle is filled with a spongy network which prevents the arterial and venous blood from the two auricles mixing to any great extent. ”

“ The mere existence of a valvular lesion does not call for any special treatment so long as compensation is efficient, and a large number of people with slight valvular lesions are living lives indistinguishable from those of their neighbours. ”

“ So far the heart is a single tubular organ expanded into various cavities and having the characteristic ∾–shaped form seen in the human embryo; it contains only venous blood which is forced through the gills to be oxidized on its way to the tissues. In the Dipnoi (mud fish) , in which rudimentary lungs, as well as gills, are developed, the auricle is divided into two, and the sinus venosus opens into the right auricle. ”

“ The degree of hypertrophy of the left or right ventricle is thus, up to a certain point, a measure of the extent of the lesion of the aortic or mitral valve respectively. When the effects of the valvular lesion are so neutralized by these structural changes in the heart that the circulation is equably maintained, “compensation” is said to be efficient. ”

“ In the Birds the auricular and ventricular septa are complete; the right ventricle is thin-walled and crescentic in section, as in Man, and the musculi papillares are developed. The left auriculo-ventricular valve has three membranous cusps with chordae tendineae attached to them, but the right auriculo-ventricular valve has a large fleshy cusp without chordae tendineae. The sinus venosus is largely included in the right auricle, but remains of the two venous valves are seen on each side of the orifice of the inferior vena cava. ”

“ Respiration as well as circulation is embarrassed, and there is a marked fulness and dulness of the front wall of the chest to the left of the breast-bone. In that region also pain and tenderness are complained of. By using the slender, hollow needle of an aspirator great relief may be afforded, but the tapping may have to be repeated from time to time. If the fluid drawn off is found to be purulent, it may be necessary to make a trap-door opening into the chest by cutting across the 4th and 5th ribs, incising and evacuating the pericardium and providing for drainage. ”

“ In the Cyclostomata (lamprey and hag) , and Fishes, the heart has the same arrangement which has been noticed in the human embryo. There is a smooth, thin-walled sinus venosus, a thin reticulate-walled auricle, produced laterally into two appendages, a thick-walled ventricle, and a conus arteriosus containing valves. ”

“ In the Reptiles the ventricular septum begins to appear; this in the lizards is quite incomplete, but in the crocodiles, which are usually regarded as the highest order of living reptiles, the partition has nearly reached the top of the ventricle, and the condition resembles that of the human embryo before the pars membranacea septi is formed. ”

“ Influenza is a common cause of cardiac dilatation, and is liable to be a source of trouble after the acute illness has subsided, if the patient goes about and resumes his ordinary avocations too soon. ”

“ In the Ungulates the moderator band in the right ventricle is especially well developed, and the central fibrous body at the base of the heart is often ossified, forming the os cordis so well known in the heart of the ox.
The position of the heart in the lower mammals is not so oblique as it is in Man. ”

“ When it is established the septum primum grows down and meets the endocardial cushions, and so the ostium primum is obliterated. The septum secundum grows down on the right of the septum primum and is never complete; it grows round and largely overlaps the foramen ovale and its edges form the annulus ovalis, so that, in the later months of foetal life, the foramen ovale is a valvular opening, the floor of which is formed by the septum primum and the margins by the septum secundum. ”

“ More severe types, which are apt to prove fatal from a form of blood poisoning, may result when the valves of the heart are attacked by certain micro-organisms, such as the pneumococcus, which is responsible for pneumonia, the streptococcus and the staphylococcus pyogenes, the gonococcus and the influenza bacillus. ”

“ It will, however, be readily understood that in the case of the more serious lesions certain precautions should be observed in regard to over-exertion, excitement, over-indulgence in tobacco or alcohol, &c., as the balance is more readily upset and any undue strain on the heart may cause a breakdown of compensation. ”

“ The pulmonary veins of the two sides at first join one another, dorsal to the left auricle, and open into that cavity by a single median trunk, but, as the auricle grows, this trunk and part of the right and left veins are absorbed into its cavity. ”

“ This soon shows four dilatations, which, from the tail towards the head end, are called the sinus venosus, the auricle, the ventricle and the truncus [2] arteriosus. As the tubular heart grows more rapidly than the pericardium which contains it, it becomes bent into the form of an S laid on its side (∾) , the ventral convexity being the ventricle and the dorsal the auricle. ”