PATHOLOGY AND PRACTICE OF MEDICINE
Polypoid Growth of the Heart. (Reported by Mr. J. E. Nield, Resi-
dent Medical Officer.)—Christopher M--, aged forty-seven, an Irish-’
man, and a discharged soldier on pension; formerly served in India ;
was admitted as a home-patient of the Rochdale General Dispensary,
May 5,1852. I visited him the same day.
Symptoms.—Continuous vomiting of two days’ duration, the egesta
being streaked with blood; no pain, except during the act of emesis;
tongue coated with a dense white fur; pulse rapid and very compressible;
alvine functions normal. Ascertaining that a few days previously he
had received his pension, and on the strength of it he had been indulging
very freely in beer, I judged the case to be one of gastric derangement
occasioned by this just-named excess. I sent the following mixture:—
Epsom salts, two drachms; hydrocyanic acid, a drachm; camphor mix-
ture, six ounces; half an ounce every three hours. I sent also a small
dose of calomel and opium, to be taken when the vomiting should have
subsided, as I believed it would.
May 6th.—On visiting the man to-day, I was for the first time inform-
ed that on the 3d instant, during his debauch, he became involved in a
quarrel with another man, who, in the scuffle, kicked him over the region
of the liver. On making pressure over this organ, there was some in-
dication of tenderness, though not so considerable as to suggest serious-
lesion. There was no external evidence of injury. The vomiting still
continued as incessant as before; the pulse was more labored; some
dyspnoea had come on. There was no cough, nor other pulmonic symp-
tom beyond the dyspnoea, to draw attention to the condition of the
thoracic viscera. The face was much blanched, and the vital powers
apparently fast waning, as if from internal hemorrhage. All the pheno-
mena, in fact, pointed to the probability of rupture of the liver. I or-
dered the most perfect quietude to be observed, and sent a mixture con-
taining small doses of opium. I visited him again in the evening • the
pulse was fluttering; the respiration more oppressed; the vomiting per-
sistent ; the system merging on collapse. There was also some disturb-
ance of the intellectual powers. I ordered bottles of hot water to th©
feet and to the epigastrium.
7th.—Nine A. M.: Pulse a mere thread; extremities cold; breathing
much oppressed. He died an hour afterwards.
In connexion with Mr. J. E. Wood, one of the staff of this institution,
and with his kind and valuable assistance, I made the necropsy, seven
hours after death
No special external appearances, except a slight contusion on the arch
of the nose. The thorax and abdomen being opened, the heart was first
examined. The pericardium contained several ounces of serum; the
heart itself was somewhat hypertrophied. On being removed from its
attachments, a dense fibrinous mass was seen to hang from the severed
pulmonary artery; the right ventricle being opened, this body was found
to terminate in a lash of fibrinous threads, whose delicate extremities
were rather firmly connected to the parietes of this cavity, and to the
circumference of the auriculo-ventricular valve. In structure it was firm
and elastic, nearly resembling tendon; and to complete the likeness, it
was enveloped in a sort of theca, which was jagged and torn in places, as
if it had been lately separated from its adhesions to the endocardium.
Its length was ten inches; its weight 189 grains. At its superior ex-
tremity it was expanded into a leaf-like process. At about half its
length, a process was sent off of some thickness. The walls of the ven-
tricle were of more than normal thickness; the endocardium was hyper-
haematous; the valvular structures of the heart were natural; the pleurae
were almost throughout firmly adherent. The lungs were congested, but
otherwise healthy. The liver was enlarged, but in structure healthy.
There was no solution of continuity whatever in any part of this viscus.
The stomach was to all appearance healthy, its mucous coat being, if any-
thing, paler than usual; it contained several ounces of yellowish fluid,
that had the odor of malt liquor. The rest of the abdominal organs were
free from disease, with the exception of the kidneys, which were enlarged
and mottled. The blood was remarkably fluid.
Remarks.—It is evident that the whole of the phenomena were depend-
ent upon the adventitious formation within the heart. The peculiarity of
the symptoms, however, and the fact of previous violence having been ex-
perienced, tended altegether to put diagnosis at fault. It cannot be doubt-
ed that the polypoid growth had occupied for some time the position in
which it was found after death, but that its adhesions had prevented its
exercising much influence on the circulating current. Its detachment
may be accounted for in two ways—first, by the shock resulting from the
blows and falls encountered during the fight—or second, (supposing the
sickness to have been consequent on over-imbibition,) by the excessive
retching accompanying the vomiting. Perhaps both contributed to this
effect. I am less inclined to attribute the vomiting to sympathy with
the condition of the heart, inasmuch as when first I visited the patient,
I do not remember observing any pulmonic symptoms whatever.
The post-mortem examination was made in obedience to a coroner’s
order, and the man who had given the kick before spoken of had been
placed in custody. I fully believed that the inspection would have dis-
closed a ruptured liver; and it seemed highly probable that the inquest
would terminate in a verdict of manslaughter. The evidence given,
however, being of course in accordance with the facts already detailed,
the verdict was the usual one of il Died from natural causes.”—Lancet.