Part 44

The Heart.--The heart is the central organ of the entire system and consists of a hollow muscle; by its contraction the blood is pumped to all parts of the body through a complicated series of tubes, termed arteries. The arteries undergo enormous ramifications (branchings) in their course throughout the body and end in very minute vessels, called arterioles, which in their turn open into a close meshed network of microscopic (very minute) vessels, termed capillaries. After the blood has passed through the capillaries it is collected into a series of larger vessels called veins by which it is returned to the heart. The passage of the blood through the heart and blood vessels constitutes what is termed the circulation of the blood. The human heart is divided by a septum (partition) into two halves, right and left, each half being further constricted into, two cavities, the upper of the two being termed the auricle and the lower the ventricle. The heart consists of four chambers or cavities, two forming the right half, the right auricle and right ventricle, and two forming the left half, the left auricle and left ventricle. The right half of the heart contains the venous or impure blood; the left the arterial or pure blood. From the cavity of the left ventricle the pure blood is carried into a large artery, the aorta, through the numerous branches of which it is distributed to all parts of the body, with the exception of the lungs. In its passage through the capillaries of the body the blood gives up to the tissues the material necessary for their growth and nourishment and at the same time receives from the tissues the waste products resulting from their metabolism, that is, the building up and tearing down of the tissues, and in so doing becomes changed from arterial or pure blood into venous or impure blood, which is collected by the veins and through them returned to the right auricle of the heart.

From this cavity the impure blood passes into the right ventricle from which it is conveyed through the pulmonary (lung) arteries to the lungs. In the capillaries of the lungs it again becomes arterialized by the air that fills the lungs and is then carried to the left auricle by the pulmonary veins. From this cavity it passes into that of the left ventricle, from which the cycle once more begins. The heart, then, is a hollow muscular organ of a conical form, placed between the lungs and enclosed in the cavity of the pericardium. It is placed obliquely in the chest. The broad attached end or base is directed upwards, backwards and to the right and extends up to the right as high as the second rib and the center of the base lies near the surface underneath the breast bone. The apex (point) is directed downwards, forward and to the left and corresponds to the space between the cartilage of the fifth and sixth ribs, three-fourths of an inch to the inner side, and one and one-half inches below the nipple, or about three and one-half inches from the middle line of the breast bone. The heart is placed behind the lower two- thirds of the breast bone and extends from the median line three inches to the left half of the cavity of the chest and one and one-half inches to the right half of the cavity of the chest.

Size: In adults it is five inches long, three and one-half inches in breadth at its broadest part and two and one-half inches in thickness. Weight in the male ten to twelve ounces; in the female eight to ten. It increases up to an advanced period of life. The tricuspid valve (three segments) closes the opening between the right auricle and right ventricle. Pulmonary semilunar valves guard the orifice of the pulmonary artery, keeping the blood from flowing back into the right ventricle. The mitral valve guards the opening to the left ventricle from the left auricle. The semilunar valves surround the opening from the left ventricle into the aorta and keep the blood from flowing back. If any one of these valves becomes diseased it may not thoroughly close the opening it is placed to guard and then we have a train of important symptoms.

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PERICARDITIS.--This is an inflammation of the pericardium, the sac containing the heart.

Primary or First Causes.--They refer in this disease to a peculiar constitution. Children that have a tuberculous constitution are more liable to this disease. Acute rheumatism or tonsilitis are the causes and this trouble follows or goes with them. Infectious diseases also cause it.

Symptoms.--Slight pain in the heart region, fever moderate. These subside or effusion may set in and this usually occurs with acute rheumatism, tuberculosis and septicemia. Sometimes these symptoms are absent.

Treatment of Pericarditis.--The patient must rest quietly in bed and a doctor should be in attendance. An ice bag placed over the heart frequently gives relief and quiets the distress and pain. There is apt to be liquid in the sac (pericardium) and to lessen the tendency to this there should not be much drink or liquid food taken. There should be what is called a dry diet. (See Nursing Department for this.)

ENDOCARDITIS.--Inflammation of the lining of the heart chiefly confined to the valves; it may be acute or chronic.

Simple Kind, Cause.--Occurs at all ages, but most often in children and young adults. It most frequently comes with acute rheumatism, chorea, tonsilitis, scarlet fever, and pneumonia. The valves in the left heart are most often affected, the mitral simply swollen or bearing small growths.

Symptoms.--If it is caused by acute rheumatism, there may be higher temperature, without increase of joint symptoms. Heart beats faster and is irregular. It may run into chronic valvular disease.

Treatment of Endocarditis.--Preventive.--Much can be done to prevent this disease by closely watching the patient having the disease that causes it. The heart should be closely watched. Acute inflammatory rheumatism is a frequent cause and the heart must be watched continually in this disease. When the patient has this disease he must be quiet and in bed. This is essential. A doctor must be called, for the disease is serious and dangerous.

Diet.--Should be liquid. Milk or preparations made with it is the usual diet. Care must be taken that the stomach and bowels be not disordered. Gas collecting in the stomach causes much distress to one who has endocarditis or valvular disease.

Caution.--Avoid early exertion after getting well.

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CHRONIC ENDOCARDITIS.--Usually occurs in persons under middle age. Generally follows acute endocarditis. It may be caused by syphilis, alcoholism, gout, and prolonged over-exertion. The edges of the valve become thickened and then the thickened parts separate and cannot meet exactly and therefore fail to close the opening they are set to guard.

CHRONIC VALVULAR DISEASE.--Results of valve lesions. Narrowing of a valve causes increased difficulty in emptying the chamber of the heart behind it. Insufficiency of a valve allows the return of the blood through the valve during the dilation of a chamber, thus increasing the amount of blood entering the chamber beyond the normal. Either trouble causes dilation of the chamber and compensatory hypertrophy. Enlargement of its wall must take place in order to perform the extra work demanded constantly, for the normal reserve force of the heart muscles can accomplish the extra task only temporarily. This enlargement increases the working power of the heart to above normal, but the organ is relatively less efficient than the normal heart, as its reserve force is less and sudden or unusual exertion may cause disturbance or failure of the compensation acquired by the enlargement. If this loss of reserve force is temporary, compensation is restored by further enlargement and by diminution, by rest, of the work demanded of the heart. Any valvular lesion, whether a stenosis (narrowing) of the outlet or insufficiency from the moment of its origin, leads to certain alterations in the distribution of pressure upon each side of the affected valve. If the body of the heart itself did not possess a series of powerful compensatory aids, that is, the power of making good a defect or loss, or restoring a lost balance, to improve this relation of altered pressure, then every serious lesion at its very beginning would not only cause serious general disturbances of circulation, but very soon prove fatal. Without compensation of the power of making good the defect or loss, the blood in every valvular disease or lesion would be collected behind the diseased valve. The heart's reserve power prevents to a certain extent such a dangerous condition; the sections of the heart lying behind the diseased valve work harder, diminish the blood stoppage and furnish enough blood to the peripheral arteries. The reserve force is used in stenosis to overcome the obstacle, whereas in insufficiency it must force more blood forward during the succeeding phase through the diseased valve. To effect this increased work permanently, anatomic changes in the heart are bound to follow. The changes consist in hypertrophy (enlargement of the heart muscle) and dilatation of the different chambers. Under this head, compensation, is included the increased filling and increased work of certain heart chambers with their resulting dilatation and hypertrophy. But this compensation cannot last forever. It fails sometimes and certain symptoms follow as hereafter related. Therefore persons who have valvular disease and who have been informed that the heart has adapted itself to the condition by enlarging of its walls and chambers and thus forming the condition called compensation, should be very careful of their mode of living and not put any undue or sudden strain upon the heart that might destroy the conditions that make compensation continue. In the following pages symptoms are given showing what happens when compensation continues and when it fails.

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AORTIC INSUFFICIENCY OR INCOMPETENCY.--The valves are not doing their work thoroughly.

Symptoms.--They are often long absent; headache, dizziness, faintness, flashes of light, difficult breathing, and palpitation on exertion, and pain in the heart region may occur early. The pain may be dull and localized, or sharp and radiating to the neck or left arm. When compensation fails, we have difficult breathing, which is worse at night, swelling of the eyes and feet, cough, anemia. Sudden death is more common in this than with any other valvular disease. You can hear a soft blowing sound by listening with your ear.

NARROWING (Aortic Stenosis).--Caused by chronic endocarditis, etc. Their valve segments are usually adherent to each other by their margins and are thickened and distorted.

Symptoms.--When compensation is gone, diminished blood in the brain causes dizziness and faintness.

MITRAL INSUFFICIENCY OR INCOMPETENCY.--This is the most common valvular disease. The segments of the valve may be shortened and deformed. There is often stenosis (narrowing) caused by this deformity. The effects are regurgitation, flowing back of blood from the left ventricle into the left auricle, which is also receiving blood from the lungs, causing dilatation of the auricle and its enlargement to expel the extra blood; dilatation and other enlargement of the left ventricle occurs on account of the large quantity of blood forced in by the auricle; obstruction to flow of blood from pulmonary veins due to extra blood in left auricle, hence dilatation and enlargement of right ventricle which forces blood through the lungs; dilatation and enlargement of right auricle.

Symptoms.--If compensation is slightly disturbed we have blueness (cyanosis), clubbing of the fingers, hard breathing on exertion, and attacks of bronchitis and bleeding from the lungs. If compensation is seriously disturbed we are likely to have the blueness (cyanosis) more marked, heart beat feeble and irregular, constant hard breathing, with cough and water or bloody sputum, dropsy in the feet first and going up and involving the abdomen and chest cavities.

MITRAL STENOSIS.--This is the narrowing of the valve opening. It is most common in young persons, chiefly females. The narrowing of the valve opening may be due to thickening or hardening of the valve segments, adhesion of their edges, thickening and contraction of the tendinous cords of the valve ring.

Symptoms.--Similar to mitral insufficiency, but they develop slower and those symptoms of venous congestion of the lungs, liver, etc., are more marked; bleeding from the lungs is more common.

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TRICUSPID (VALVE) INSUFFICIENCY.--Cause.--Usually due to dilatation of the right ventricle in mitral disease or with lung emphysema or other obstruction to the lungs' circulation.

TRICUSPID STENOSIS (NARROWING).--Rare except in cases from the time of birth.

Recovery from the valvular disease, depends upon the degree of compensation maintained and is best when this is acquired spontaneously. This is to be judged by the heart action. The prognosis is poor in children. It is better in women than in men.

Treatment (a) While Compensated.--Medicine is not necessary at this period. The patient should lead a quiet, regulated, orderly life, free from excitement and worry; and the risk of certain death makes it necessary that those suffering from a disease of the aorta should be especially warned against over-exertion and hurry. An ordinary healthy diet in moderate quantities should be taken, tobacco and stimulants not allowed at all.

The feelings of the patient must control the amount of exercise; so long as no heart distress or palpitation follows, moderate exercise will be of great help. A daily bath is good. No hot baths should be taken and a Turkish bath absolutely prohibited. For the full-blooded, fleshy patient an occasional dose of salts should be taken. Patients with a valvular trouble should not go into any very high altitudes; over-exertion, mental worry and poor digestion are harmful.

(b) The stage of broken compensation. Rest. Disturbed compensation may be completely restored by rest of the body. In many cases with swelling of the ankles, moderate dilatation of the heart and irregularity of the pulse, the rest in bed, a few doses of the compound tincture of cardamon and a saline purge suffice within a week or ten days to restore the compensation. For medicine a doctor must be consulted as each individual case must be treated according to its peculiar symptoms.

FATTY HEART.--This occurs often in old age, prolonged, infectious, wasting disease, anemia, alcoholism, poisoning by phosphorus and arsenic.

ANGINA PECTORIS.--True angina, which is a rare disease, is characterized by paroxysms of agonizing pain in the region of the heart, extending into the arms and neck. In violent attacks there is the sensation of impending death. Usually during the exertion and excitement, sudden onset of agonizing pain in the region of the heart and a sense of constriction, as if the heart had been seized in a vise. The pains radiate up the neck and down the arm. The fingers may be numb. The patient remains motionless and silent, the face usually pale or ashy with profuse perspiration. Lasts for several seconds or a minute or two.

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Treatment.--Live an absolutely quiet life, avoid excitement and sudden muscular exertion. During the attack, break a pearl of amylnitrite in a handkerchief and inhale the fumes. These should always be carried. If no relief is had in a minute or two chloroform should be given at once. It is dangerous and you must look to your physician for advice and treatment.

ARTERIOSCLEROSIS.--A localized or diffused thickness of the inner coat and then of the other coats of the arteries. Arteries look lumpy and are crooked, dilated with stiff, thin or calcified walls. All coats, especially the middle, show degeneration. It usually comes in later life.

Treatment.--Regulate the mode of life, avoid alcohol, excess of eating, drinking, exertion, excitement and worry. Keep the bowels and kidneys acting regularly. There is no medicine for it.

ANEURISM.--This is a local dilatation of an artery. A local tumor.

Treatment.--Absolute rest, restrict fluids. There is always danger from rupture.

MYOCARDITIS.--This is an inflammation of the muscle substance of the heart. It may be acute or chronic.

Causes.--Endocarditis and pericarditis in the course of rheumatism; acute fevers like typhoid, etc.; clots lodging in the heart arteries, coming from diseases such as septicemia and pyemia.

Symptoms.--The heart is weak. The pulse is rapid, small and irregular, palpitation and fainty sensations come on suddenly during the course of diseases mentioned. The outlook is serious and life may end suddenly.

Treatment.--The same as that given for endocarditis. Absolute rest is necessary. A good nourishing diet must be given and a doctor is always needed.

PHLEBITIS, INFLAMMATION OF THE VEINS.--Causes.--Some irritation of the vein, as a puncture or any other injury accompanied by infection.

Symptoms.--Pain and tenderness along the course of the vein with discolored skin and acute swelling (watery) below the obstruction. Pulse rapid, high temperature, chills, dry and brown tongue and pain.

Treatment.--Absolute quiet is necessary, with the affected limb elevated. Lead and laudanum wash should be applied, or hot antiseptic fomentations if an abscess is forming. An abscess should be opened, keep up the patient's strength.

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VARICOSE VEINS (Varix).--This term means an enlarged, elongated, tortuous, knotty condition of the veins. The term "varicose veins" is restricted in general use to the veins of the extremities, and especially those belonging to the lower extremity. The disease begins with a slow dilation of the vein, which gradually becomes thickened and tortuous. The inner lining membrane or coat of the vein is altered, the valves are shortened and thus rendered insufficient to support the column of blood. The outer coat becomes thickened. The varicose conditions affect chiefly the superficial veins.

Predisposing Causes.--They are most frequent in the female sex. The tendency increases as the age advances. Obstruction. Anything that obstructs the full return of blood in the veins, as tight garters below the knee, etc. Standing work may bring it on.

Exciting Causes.--Tumors in the pelvis; diseases of the heart and lungs; pregnancy. These all obstruct the full return of blood in the veins.

PHYSICIANS' TREATMENT FOR VARICOSE VEINS.--Palliative.--Remove the cause if possible. Treat the heart and lung troubles. Remove the pelvic tumors. In pregnancy, the woman afflicted with this trouble should not be much on her feet, but should remain lying down in bed as much as possible. This position removes the weight of the pregnant womb from the veins and allows a free return of the venous blood. An elastic bandage, or a perfectly fitting elastic stocking, supports the veins, equalizes the circulation and turns the flow to the deeper veins, which do not, as a rule, become varicose. This silk stocking should be made to order. This treatment gives much comfort in chronic varicose veins.

DISEASES OF THE EYE AND EAR

The first thing we notice in looking at the eye may be the lids and at each edge are the eyelashes. When this edge becomes inflamed it is called Blenharitis Marginalis or inflammation of the margin of the eyelids. It is called thus from the name of the eyelid "Blepharon;" It is always means inflammation.

If we turn down the lower lid and turn up the upper, we see a red membrane called the conjunctiva (connecting). This is the mucous membrane of the eye. It lines the inner surface of both lids and is reflected over the fore part of the Sclerotic and Cornea--two other coats of the eye, The palpebral or eyelid portion of the conjunctiva is thick, opaque, highly vascular (filled with blood vessels) and covered with numerous papillae. It turns back (reflects) over the Cornea, but it consists only of a very thin structure (epithelium) forming the anterior layer of the cornea and is, in health, perfectly transparent. Upon the sclerotic it is loosely attached to the globe. When the conjunctiva becomes inflamed it is called (Conjunctiv(a)itis) conjunctivitis. The sclerotic-cornea forms the external tunic (coat) of the eyeball, the sclerotic being opaque and forming the posterior five-sixths of the globe; the cornea, which forms the remaining sixth (the front white part that is plainly seen) being transparent. The sclerotic (means dense and hard) serves to maintain the form of the globe, the eyeball.

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The cornea.--This is almost circular in shape. It is convex anteriorly and projects forward from the sclerotic in the same manner that a watch glass does from its case. This layer covers what we call the pupil.

The second tunic or coat (membrane) is formed from behind forward by the Choroid, the ciliary body and the Iris. The choroid is the vascular and dark coat covering the posterior five-sixths of the globe. The ciliary body connects the choroid to the circumference of the iris. The iris is the circular muscular septum (division) which hangs vertically behind the cornea, presenting in its center a large rounded opening, the pupil.

The choroid is a thin highly vascular membrane of a dark brown or chocolate color and is pierced behind by the optic nerve and in this situation is firmly adherent to the sclerotic.

The ciliary body comprises three muscles for its make-up and connects the choroid to the circumference of the iris.

The Iris (rainbow) has received its name from its various colors in different individuals. It is a thin, circular shaped, contractile curtain, suspended in the aqueous (watery) humor behind the cornea and in front of the lens, being perforated a little to the nasal (nose) side of its centre by a circular opening, the pupil, for the transmission of light. By its circumference it is continuous with the ciliary body, and its inner or free edge forms the margin of the pupil. The anterior surface of the iris is variously colored in different individuals and marked by lines which converge toward the pupil.

The Retina.--This is a delicate membrane, upon the surface of which the images of external objects are received. Its outer surface is in contact with the choroid; its inner, with the vitreous (glass) body. Behind it is continuous with the optic nerve; it gradually diminishes in thickness from behind forward. The retina is soft, semi-transparent and of a purple tint in the fresh state. Exactly in the centre of the posterior part of the retina corresponding to the axis of the eye, and at a point in which the sense of vision is most perfect, is an oval yellowish spot, called after its discoverer, the yellow spot or Macula lutea of Sommering.

Refracting Media.--The aqueous humor completely fills the anterior and posterior chambers of the eyeball. The anterior chamber is the space bounded in front by the cornea; behind by the front of the iris. The posterior chamber is a narrow chink between the peripheral part of the iris, the "suspensory ligament" of the lens and the "ciliary processes."

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The vitreous body forms about four-fifths of the entire globe, It fills the concavity of the retina and is hollowed in front, forming a deep cavity, for the reception of the lens. It is perfectly transparent and of the consistency of thin jelly. The fluid from the vitreous body resembles nearly pure water. The crystalline lens enclosed in its capsule is situated immediately behind the pupil, in front of the vitreous body. The lens is a transparent, double-convex body. It is more convex on the posterior than on the anterior surface. The rays of light go through this body and converge to a point at the back of the retina.