Studies in cardiac pathology . ) Although the earlier teaching, that the coronaries are end-arteries which practically do not anastomose, has been in a strictsense disproved by the researches of Hirsch and Spalteholtz, ^ Janninand Merkel;- and although cases have been reported in whichocclusion of large arteries, such as the right coronary, may occurwithout subsequent myocardial change (Marchiafava,^ Chiari);and although the last-named arterj^ has been ligated in man with-out subsequent muscular degeneration (Pagenstecher^), yet thesecases are exceptional, and must be explained as due to anoma
Studies in cardiac pathology . ) Although the earlier teaching, that the coronaries are end-arteries which practically do not anastomose, has been in a strictsense disproved by the researches of Hirsch and Spalteholtz, ^ Janninand Merkel;- and although cases have been reported in whichocclusion of large arteries, such as the right coronary, may occurwithout subsequent myocardial change (Marchiafava,^ Chiari);and although the last-named arterj^ has been ligated in man with-out subsequent muscular degeneration (Pagenstecher^), yet thesecases are exceptional, and must be explained as due to anomalousblood-supply or incomplete occlusion. Cases of the oppositesort have also been noted, as, for instance, that of F. T. Stewart,in which a human heart sutured some years before for trauma, Hirsch and Spalteholtz: Deut. med. Woch., 1907, p. 790. - Jannin and Merkel: Die Koronararterien des Mensehliohen Herzen, etc., Jena, 1907.^ Marchiafava: Revist. critica di olin. med., Pagenstecher: Deut. med. Woch., 1901, p. . Fid. 03.—C.\RDi.\c Aneurism and iiiusculatiiro of Iho left vontricle near the apex thinned and stretehed; its chamberis nearly filled with a large, dark, jiilisteninp;, adherent thrombus, which shows the Unes ofZahn. The mitral valve is moderately .sclerosed. (Photograph by Dr. Alfred R. Allen.) 182 STUDIES IN CARDIAC PATHOLOGY disclosed a fibroid myocarditis originating at the site of the originalligature. When the coronary arteries are ligated in animals, death mayoccur suddenly,^ preceded by fibrillation, or it ma}^ occur in thecourse of minutes,- hours,? or weeks. But we must bear in mind tiiat in animals we are dealing with healtliy lieartswliich we Ivnow are able to sustain a great deal of traumatic insult. Embolic orthrombotic manifestations, on the other hand, rarely occur in conjunction witha previously healthj^ myocardium. Based on original investigation and a review of the literature, Amenomiyadraws the following conclusions
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