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There is much to suggest that in rheumatism we have to deal only with a further stage in those catarrhal infections to which so much infantile ill-health is to be attributed, and that endocarditis and arthritis, when they arise, signalise the entry of these catarrhal, non-pyogenic organisms into the blood stream, overcoming at last the barrier of lymphoid tissue which has hypertrophied to oppose their passage.
On the other hand, a high systolic pressure without a high diastolic pressure should not be rapidly lowered, else depression will be caused. In hypertension, as long as the heart, which is probably hypertrophied, remains perfectly competent, there are few symptoms, and the person does not seek advice until he notices one or more of several possible conditions.
According to my theory there are two hormone actions, the centripetal from the hypertrophied tissue to the corresponding factor in the gametocytes, and the centrifugal from the testis to the tissue of the antler or other organ concerned.
When the heart is hypertrophied sufficiently and compensation is perfect, a reserve power must be developed by such exercise as represented by the Nauheim, Oertel or Schott methods. Anything that increases the peripheral resistance causes the left ventricle to hypertrophy. Anything that increases the resistance in the lungs causes the right ventricle to hypertrophy.
The ulcers and sinuses persist indefinitely, or they heal and then break out again; sometimes the skin becomes infected, and a condition like lupus spreads over a considerable area. Spontaneous healing finally takes place after the caseous tubercle has been extruded; the resulting scars are extremely unsightly, being puckered or bridled, or hypertrophied like keloid.
The only satisfactory method of getting rid of the coloration is to excise the scar; the edges are brought together by sutures, or the raw surface is covered with skin-grafts according to the size of the gap. Hypertrophied Scars.
If the left ventricle is the most hypertrophied, the apex is also to the left, but the impact is very decided and the aortic closure is accentuated. The term "simple dilatation" may be applied to the dilatation of one or both ventricles when there is no valvular lesion and when the condition may not be called broken compensation. The compensation has been sufficiently discussed.
When the heart is hypertrophied in disease, the cavities of the ventricles are probably also generally enlarged, and therefore they propel more blood at each contraction than in normal persons and thus increase the blood pressure. The blood pressure is raised not only by intestinal toxemia and uremia, but also by lead poisoning and the conditions generally present in gout.
On the hypothesis of Natural Selection itself, we must assume that up to that time the race had been well adapted to the surrounding conditions; the temporary and accidental trial and change of conditions, which caused the so-sucking young one to be the "fittest to survive" under the supposed circumstances, would soon cease to act, and then the progeny of the mother, with the accidentally hypertrophied, sebaceous glands, would have no tendency to survive the far outnumbering descendants of the normal ancestral form.
Sometimes it is more persistent, as in the enlargement that is associated with adenoids, hypertrophied tonsils, carious teeth, eczema of the scalp, and otorrhœa; and it is possible that this indolent enlargement predisposes to tuberculous infection.
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