Boston Medical and Surgical Journal
Physician to Out-Patients at the Massachusetts General Hospital. Cardiac displacement, while not a subject of distinctly practical importance, nevertheless is one which has aroused considerable interest during the past decade, especially in France, where there have appeared a number of excellent papers calling attention to the general erroneous ideas which have been held regarding the subject. As most of what has been said by the members of the Lyons school is also applicable to much of the
... to much of the teaching hereabouts, it has seemed worth while to review tito subject and to add my observations, which arc based on the study of more than nine cases of permanent cardiac displacement, in addition to a number of cases seen in the ordinary course of acute pleurisy and pneumothorax. Besides Sir R. Douglas Powell very few other observers have reported more than two or three personal observations, and the total number confirmed by autopsy or X-ray examinations is remarkably small. The most recent and complete résumé of the subject is to be found in the Thesis of Alaux, a student of Professor Pic of Lyons, and doubtless reflects accurately the teaching of that school. It is unfortunate that in his desire to give credit to Professors Bard, Pitres and Pic, he has neglected to quote the correcto bservations of Sir Douglas Powell, made in 1869 and 187G. Powell's results were obtained from the study of a goodly number of cases, not only clinically but also at the autopsy table. And to these accurate observations are atlded experimental studies serving to explain the conditions found. Not only has Powell's work not been quoted by the French writers, but it has also been forgotten by recent English clinicians, who have speculated much regarding the position of the displaced hearts they had observed, when a reference to these papers would have answered all their questions. Symes of Dublin in 1892 disputed Powell's statement as made in his book on the" Diseases of the Heart," evidently without looking up the work on which Powell based his assertions. The subject, of displacements of the heart naturally divides itself into two general divisions, the congenital displacements of the heart, and the acquired or pathological displacements. About the former probably there has arisen the greater amount of dispute, while the latter has given rise to the greater amount of erroneous teacliing. The question at issue is, does such a condition as congenital dcxtrocardia without an accompanying transposition of all the viscera in the body exist unless accompanied by other malformations of the heart? Cases of transposition of all the organs of the body have been reported from time to time since the first observation by 1 Read at a meeting of the Boston Society for Medical Improvement, Nov. 16, 1903. Petrus Servius was made in Rome in 1643. (Collection of cases by Gruber.) As a part of this process the heart is involved in the general transposition and points towards the right, the aorta also arching to the right instead of the left, with the valves of the heart changed to meet the new condition of things; that is, the mitral valves arc found in tho right ventricle, which is thick-walled and of course communicates with the aorta, while the left ventricle is thin-walled and has trieuspid valves, and communicates with the pulmonary artery. In every way the hearts in the transposed cases are reversed from the ordinary conditions, that is, they are mirror hearts. It has been supposed that in a number of cases where the heart either actually or apparently pointed to the right, without any transposition of the other viscera, there was present a congenital dextrocardia. It has been assumed that I here was a mirror heart, also present, the con-Fig. 1. -Mirror heart. (litions holding as in cases of complete transposition of all the organs. The reported cases of dextrocardia are few in number, and the autopsies when dextrocardia has been suspected are very few indeed. Of the authentic cases, first of all come a small group where the condition has been noted at the Flu, 2. -Inverted heart. Aorta archoe to Hie left.