case of interventricular opening, and the existence of the aneurism, which must be exceedingly rare if it ever occurs as a complication of interventricular opening, and which would therefore predispose one to look upon this case as not one of common interventricular opening. The rupture of the aneurism, of course, occurred a day or two before death. The question must have been between a congenital opening and rupture ; for there was no appearance of disease at the opening, though there was the aneurism quite near to it.
In May, 1869, the case was submitted to Dr. Thomas B. Peacock, of London, who has written a very full and ex- cellent work upon Malformations of the Heart ; and his answer was that he " should feel disposed to think that the opening must have resulted from disease or accident, and this mainly in consequence of the absence of any evidence of congenital defect of the pulmonary artery." See Med. Jour. Vol. LXIX. p. 273, and Vol. LXXII. p. 209. 1863. Dr. Thomas H. Gage, of Worcester.
1707. Rupture of a diseased mitral valve and of the cordse ten- dineae.
From a physician, set. thirty-five. (Hospital, 228, 90.) Two months previously, and being then as well as usual, he had rheumatism, which in two weeks left him, and car- diac symptoms then came on, that obliged him to give up his business. There was dyspnosa, but scarcely any palpi- tation ; a systolic bellows murmur over the mitral valve, and a slight aortic souffle after the second sound. Death very sudden on the third day after admission.
The heart weighed 17 oz. and was universally thick- ened and dilated. Aortic valves thickened and retracted ; with a soft, whitish deposit upon the under surface of one, and also upon the mitral valve and the inner surface of the left auricle. The laceration in the valve would admit the last joint of the little finger, when recent. There was also a large serous effusion in the cavities of the pericaz'diuni and right pleura; with disease of the spleen. (Series XL.)
In the preparation the mitral and aortic valves are shown. 1860. Dr. C. Ellis.
�� �
