From  the  general  pathological  effects  of  hypertrophy  of  the  heart
you  may  infer  the  prevailing  character  of  its  symptoms.  A  forcible,
at  the  same  time  often  not  a  very  effective,  state  of  the  circulation,
with  its  phenomena,  palpitation  and  throbbing,  occasional  flushing,
and  a  strong  hard  pulse,  manifesting  its  effects  on  particular  organs,
as  by  giddiness,  palsy,  or  apoplexy  in  the  brain  ;  dyspnoea,  asthma,
with  (hin  mucous  secretion,  or  occasionally  hemorrhage  in  the
pulmonary  tissues  ;  gastric  dyspepsia,  gastrodynia,  sickness,  dis-
coloured alvine  secretions,  and  other  symptoms  of  disorder  in  the
stomach,  liver,  and  bowels  ;  albuminous,  high-coloured,  and  often
scanty  urine,  with  accompanying  gouty  or  dropsical  symptoms,
referrible  to  disordered  functions  of  the  kidneys  ;  more  or  fewer  of
these  may  be  variously  grouped  together  in  different  cases,  as  frequent
effects  or  symptoms  of  the  more  sthenic  forms  of  hypertrophy  of
the  heart.  Some  of  these  secondary  effects  may  occur  and  be  the
subjects  of  complaint,  when  those  of  the  immediate  action  of  the
organ,  the  <;ause  of  them  all,  are  not  sufficiently  marked  to  attract
attention.  When  dilatation  is  joined  with  it,  there  will  be  more
weakness  of  the  circulation,  with  consequent  torpidity  of  the  functions
of  the  extreme  vessels,  manifesting  itself  in  venous  or  visceral
congestions,  oedema,  and  coldness  of  the  extremities,  pains  in  the
back  and  limbs,  and  the  incapacity  of  the  organ,  will  be  greater  j
whence  a  pulse,  unequal  in  force  and  often  irregular  in  rhythm,
severe  attacks  of  palpitation  and  dyspnoea,  may  then  present  them-
selves, the  disease  is  more  manifestly  one  of  the  heart  itself.
The  physical  signs  of  hypertrophy  are  intelligible  and  character-
istic. The  increased  mass  of  the  muscular  fibres  renders  their  act
of  contraction  stronger  than  usual  ;  hence  the  impulse  is  also  strong.
