. Medical diagnosis for the student and practitioner. Fig. 307.—Stomach of patient whose heart is shown in Fig. 302. They also serve to explain the puzzling orthodiagraphic contours whichhave been presented, for example, by Adler and Krehbiel.* A dilated or a dilated and hypertrophied drop heart may produce suchoutlines; a fundamentally normal heart, never. The so-called usmall-heart will be found almost invariably in suggestiveassociation with the visceroptosis of congenitally asthenic individuals andin most instances represents a dilated or hypertrophied drop heart. * Archiv. Int. Med., Chic
. Medical diagnosis for the student and practitioner. Fig. 307.—Stomach of patient whose heart is shown in Fig. 302. They also serve to explain the puzzling orthodiagraphic contours whichhave been presented, for example, by Adler and Krehbiel.* A dilated or a dilated and hypertrophied drop heart may produce suchoutlines; a fundamentally normal heart, never. The so-called usmall-heart will be found almost invariably in suggestiveassociation with the visceroptosis of congenitally asthenic individuals andin most instances represents a dilated or hypertrophied drop heart. * Archiv. Int. Med., Chicago, vol. ix, p. 346-361, 1912. 6o2 MEDICAL DIAGNOSIS The drop heart is extremely common in the female; common in the male,and, probably, the effect of environment and mode of life in childhood has agreat effect in determining its strict adherence or relative nonadherence tothe type in development. In many if not most instances these individuals attain a degree of myo-cardial adequacy which enables them to lead an active Fig. 308.—Modified drop heart. Case showing distinct impairment of cardiacreserve, although heart measures but 9 cm. in total transverse diameter: Mr., 3 cm.; ML, 6cm. A soft localized systolic murmur was present at the apex. Right ventricle is enlarged,left also probably. To what extent the almost universally present roentgenographic signs ofobsolete, latent or, more rarely, active tuberculous infection, affects the devel-opment of this type of heart is a question of interest. Such infections almostwholly, no doubt, date from childhood; for the asthenic tissues afford afavorable locus for the tubercle bacillus. Misleading Bruits.—Murmurs when present over these hearts are systolicand may be maximal in the mitral, tricuspid or pulmonic auscultation areas. THE DROP-HEART 603 The last are usually ascribed to anemia alone, but in such cases they may andoften do occur in its absence or tend to persist or recur after any existing initialanemia is reliev
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