Vol. 60, 1909 - University of North Carolina at Chapel Hill

ABSTRACTS. 263
sat up ill bed on the second day; forty rose Malformations ol the Heart.-Keith in
on the third day; thirty-five rose on the the London Lancet, savs that our kiiowlfourth
day; twenty-five rose on the fifth ed^e of the heart has advanced since Peaday.
Of the one hundred cases, forty- cock's time, who in 1866 published his last
seven were pnmaparee and fifty-three mul- edition of Malformations of the Human
tiparae. Each was carefully examined be- Heart, still the standard English work on
fore leaving the hospital, and as many as this subject. One of the greatest discoverpossible
six weeks later. The morbidity in ies since that time is now only dawing, but
these cases— that is, a temperature over every year increases our assurances of its
100 F. or pulse o\'er 90 for twelve consec- truth— viz., that there is a fourth part or
utive hours—was represented by three chamber in the mammalian heart which
cases. In two infective temperatures de- hitherto we have taken no cognizance of.
veloped on the third day. One of these pa- The three parts of the mammalian heart at
tients left the hospital well on the sixteenth, present recognized are ( 1 ) the sinus venothe
other on the twenty-eighth day. Pel- sus, (2) the auricles, and (3 ) the ventricles.
vie examination on the day of leaving the The fourth part is thebulbus cordis, which
hospital (tenth or twelfth day) showed the is so well seen in the shark's heart. It is
pelvic organs to be normal, except in two usually supposed that the bulbus cordis
cases, where a slight retroversion of the has completely disappeared from the mamuterus
was present. In one there was con- malian heart, but now we have good reason
siderable varicosity of the veins of the legs, for believing that, in the same manner as
but the woman remarked that it was not the sinus venosus has become incorporated
nearly so bad as after previous confine- in the right auricle, the bulbus has become
ments— this being her seventh. All the pa- included in the right ventricle, forming
tients examined six weeks and more after that part loosely termed its infundibulum.
confinement showed involution to be thor- The credit for this discovery belongs to
ough, and the position of the uterus nor- Alfred Griel, prosector in the University
mal, with the exception of two, being of Innsbruck. He traced the fate of the
those previously noted as having retrover- bulbys by a prolonged study of the hearts
sion. It was most interesting to hear the of developing vertebrates. Independently
uniformly eulogistic terms in which, with- of him Keith has reached the same concluout
exception, the women described their sion from an investigation of malformed
so-called convalescence while the favorable human hearts and of the hearts of vertecomparisons
made by multipara; with their brate animals. Professor Peter Thompson
former confinements was most convincing, has recently identified and described the
Many voluntarily expressed the opinion development of the bulbus in an early huthat
they had never felt so well previously, man embryo. A large number of the very
and from the others when asked there was commonest malformations of the human
no dissentient voice. He says that it is heart are due to an arrest of the process
difficult to understand why woman has which ends in the incorporation of bulbus
been condemned for thousands of years to cordis in the right vetricle. The great maso
much enforced idleness. In consulting jority of cases of congenital stenosis of the
ancient literature there is no evidence that pulmonary artery are of this nature. Our
the prescription was founded on a physio- author makes 270 specimens of malformed
logical or even a physical basis. In primi- hearts the subject of his lecture in reference
tJve races immediate exercise was the usual to the bulbus cordis, and says that applycustom,
the woman, to cleanse herself, at ing our presence knowledge of the developonce
after the birth of the child plunged ment and comparative anatomy of the
into the lake or stream near which the con- htart to the explanation of these abnorfinements
were usually conducted. In malities, we find ourselves hampered at the
what might be termed "the religious very outset by a complete ignorance of the
epoch," when priests assigned to them- functional nature of the bulbus cordis. It
selves the position of obstetrical specialists, is especially large in the shark tribe, and
this practice seems to have been discontin- is often lined with valves and thickened
ued, and woman sujl)ected to the ordeal of endocardium throughout. Its musculature
purification, which varied in detail amongst is striated but the fibres are more fusiform
different authorities, but mainly consisted and less branched than in the other chamin
enforced solitude for from fen days to bers. The nerve supply is abundant. Systhree
weeks, which was chiefly spent in the tole occurs in it subsequent to contraction
recumbent posture, ; doubtless from want of in the ventricles. Somehow its function is
anything better to do. I-'rom this probably connected with the gill of respiratory sys-
arises the term "confinement," so generally tem; it is with the respiratory system that
used for the act of child bearing, it is correlated. When the gills become