though in the Urodela (tailed amphibians) the auricular septum
is often fenestrated. 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. (For the
anatomy and physiology of the frog’s heart, see The Frog,
by Milnes Marshall.)
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. The conus arteriosus becomes included in the ventricular cavity, but the sinus venosus still remains distinct, and its opening into the right ventricle is guarded by two valves which closely resemble the two venous valves in the auricle of the human embryo already referred to.
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.
In the Mammals the structure of the heart corresponds closely with the description of that of Man already given. In the Ornithorynchus, among the Monotremes, the right auriculo-ventricular valve has two fleshy and two membranous cusps, thus showing a resemblance to that of the bird. In the Echidna, the other member of the order, however, both auriculo-ventricular valves are membranous. In the Edentates the remains of the venous valves at the opening of the inferior vena cava are better marked than in other orders. 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.
For further details, see C. Rose, Beitr. z. vergl. Anal. des Herzens der Wirbelthiere Morph. Jahrb., Bd. xvi. (1890); R. Wiedersheim, Vergleichende Anatomie der Wirbelthiere (Jena, 1902) (for literature); also Parker and Haswell’s Zoology (London, 1897). (F. G. P.)
Heart Disease.—In the early ages of medicine, the absence of correct anatomical, physiological and pathological knowledge prevented diseases of the heart from being recognized with any certainty during life, and almost entirely precluded them from becoming the object of medical treatment. But no sooner did Harvey (1628) publish his discovery of the circulation of the blood, and its dependence on the heart as its central organ, than derangements of the circulation began to be recognized as signs of disease of that central organ. (See also under Vascular System.)
Among the earliest to profit by this discovery and to make important contributions to the literature of diseases of the heart and circulation were, R. Lower (1631–1691), R. Vieussens (1641–1716). H. Boerhave (1668–1738) and the great pathologists at the beginning of the 18th century, G. M. Lancisi (1654–1720), G. B. Morgagni (1682–1771) and J. B. Senac (1693–1770). The works of these writers form very interesting reading, and it is remarkable how careful were the observations made, and how sound the conclusions drawn, by these pioneers of scientific medicine. J. N. Corvisart (1755–1821) was one of the earliest to make practical use of R. T. Auenbrugger’s (1722–1809) invention of percussion to determine the size of the heart. R. T. H. Laennec (1781–1826) was the first to make a scientific application of mediate auscultation to the diagnosis of disease of the chest, by the invention of the stethoscope. J. Bouillaud (1796–1881) extended its use to the diagnosis of disease of the heart. To James Hope (1801–1841) we owe much of the precision we have now attained in diagnosis of valvular disease from abnormalities in the sounds produced during cardiac movements. This short list by no means exhausts the earlier literature on the subject, but each of these names marks an era in the progress of the diagnosis of cardiac disease. In later years the literature on this subject has become very copious.
The heart and great vessels occupy a position immediately to the left of the centre of the thoracic cavity. The anterior surface of the heart is projected against the chest wall and is surrounded on either side by the lungs, which are resonant organs, so that any increase in the size of the heart, “dilatation,” can be detected by percussion. By placing the hand on the chest, palpation, the impulse of the left ventricle, or apex beat, can normally be felt just below and internal to the nipple. Deviations from the normal in the position or force of the apex beat will afford important information as to the nature of the pathological changes in the heart. Thus, displacement downwards and outwards of the apex beat, with a forcible thrusting impulse, will indicate hypertrophy, or increase of the muscular wall and increased driving power of the left ventricle, whereas a similar displacement with a feeble diffuse impulse will indicate dilatation, or over-distension of its cavity from stretching of the walls.
By auscultation, or listening with a suitable instrument named a stethoscope over appropriate areas, we can detect any abnormality in the sounds of the heart, and the presence of murmurs indicative of disease of one or other of the valves of the heart.
The pericardium is a fibro-serous sac which loosely envelops the heart and the origin of the great vessels. Inflammation of this sac, or pericarditis, is apt to occur as a result of rheumatism, more especially in children. It may also occur as a complication of pneumonia. It is a serious affection associated with pain over the heart, fever, shortness of breath, rapid pulse and dilatation of the heart. As a result of the inflammation, fluid may accumulate in the pericardial sac, or the walls of the sac may become adherent to the heart and tend to embarrass its action. In favourable cases, however, recovery may take place without any untoward sequelae.
Diseases of the heart may be classified in two main groups, (1) Disease of the valves, and (2) Disease of the walls of the heart.
1. Valvular Disease.—Inflammation of the valves of the heart, or endocarditis, is one of the most common complications of rheumatism in children and young adults. 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.
As a result of endocarditis, one or more of the valves may be seriously damaged, so that it leaks or becomes incompetent. 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. We may thus have incompetence or stenosis of a valve or both combined.
Valvular lesions are detected on auscultation over appropriate areas by the blowing sounds or murmurs to which they give rise, which modify or replace the normal heart sounds. Thus, lesions of the mitral valve give rise to murmurs which are heard at the apex beat of the heart, and lesions of the aortic valves to murmurs which are heard over the aortic area, in the second right intercostal space. Accurate timing of the murmurs in relation to the heart sounds enables us to judge whether the murmur is due to stenosis or incompetence of the valve affected.
