inflammation. The former are diseases which tend to widen the valvular apertures, and to dilate the right side of the heart; the latter are diseases which tend to contract the valvular apertures, and to increase the size and bulk of the left side of the heart.
Disease of the right side of the heart is essentially passive and secondary in its character; disease of the left side of the heart is essentially active and primary in its character. I speak now of disease when it occurs, not when it has existed for some time. Active inflammation of the left chambers of the heart arises; it progresses to a certain extent; treatment subdues it; the patient recovers; but a certain amount of damage is left behind. Years pass on; the patient during this time appears none the worse for his previous illness; but at length pulmonary symptoms suddenly manifest themselves, and then it is that the physician discovers that the left side of the heart is permanently damaged, and that the present condition of the lungs is traceable to this cause.
In this instance the mischief in the heart inducing this condition of the lungs is not, strictly speaking, active. The first step of the cardiac disease was active; but the second step was chronic. Bit by bit—increment by increment—after the patient's apparent recovery from the primary attack, is the valvular lesion left by such attack added to, not perhaps constantly, but intermittingly, until at length the aggregate increments of addition so hamper, oppress, obstruct, and distort the mitral, or the mitral and aortic valves, that secondary consequences begin to follow.
Why are the affections of the two sides of the heart essentially different in their nature? Why do those of the left side of the heart point to an inflammatory origin; those of the right side of the heart, with but few exceptions, to a non-inflammatory origin? There must be some cause for this difference. What is it? The reason is found in the difference which exists between the constitution of the blood which reaches the left side of the heart from the lungs, and that which reaches the right side of the heart from the general system. The blood reaching the left side of the heart from the lungs has been replenished with all the elements necessary for the growth of the tissues; it has been purified, renovated, and vivified by its oxygenation in the lungs, and it is thus rendered in the highest degree stimulating to the left heart. The blood reaching the right side of the heart from the general system has been deprived, by the requirements of growth, of the chief portion of its nutrient materials; it has been fouled by the débris of tissue-waste; it has been further poisoned by its impregnation with carbonic-acid gas: it is therefore a depressant, rather than a healthy excitant, to the right heart. True, it brings with it to the chambers of the right heart the products of the digestion of food; but what are they, either as nutrients or excitants, when they reach that point? They are no more than inert, unusable, passive elements. Not
