Congenital Malformations of the Heart.

Abstract

Paget on Congenital Malformations nated, was supposed so completely to set at defiance all the ordinary laws of nature, that not only could no elucidation of these laws be derived from such anomalies, but the very causes on which their formation depended, were thought to be entirely distinct.The falsity of such a doctrine is now sufficiently established. " L'ordre est dans le desordre," are the words of M. Serres, concisely expressing the important truth, that the same laws preside alike over formation and malformation, and that it is only in the more perfect knowledge of these laws, that we can look for a full explanation of such appearances.The German anatomists seem to have been the first, to attempt the study of monsters on anything like philosophical principles. Soemmering, Walter, Meckel, and Tiedemann, have enlisted their talents in the cause, and the French, with St Hilaire, Serres, Breschet, Andral fils, amidst a host of others, have of the Heart. 26*5After disproving this fallacy, however, as well by observation on man as by the most conclusive experiments on eggs, M. Geoffroy * demands an equal universality of influence for external and corporeal injuries. These, he says, occurring during fetation, produce adhesions between the placenta and embryo, whereby the circulation to a particular part or parts is affected, and the growth modified accordingly. This we might imagine to operate as far as regards the malformation of an extremity, or some part to which the effect of the adhesion might extend; but how it can act in producing an imperfect septum ven~ triculorum, or an open foramen ovale, we must confess we can scarcely see, and cannot therefore allow it, as the general ex^ citing cause of congenital malformation.M. Serres-f* has imagined that he has discovered, if not the cause, at least the manner, in which malformation is produced. He conceives that every artery has its own specific function, and that the developement of every part depends immediately on the presence of the artery proper to that part; as, for instance, that of the cerebrum on the internal carotid; or that of the cerebellum on the vertebral; and consequently, that when any artery fails, the part which it ought to supply is also deficient.When, on the contrary, there are additional parts formed, as supernumerary arms or legs ; these, he says, must be supplied by branches corresponding to the arteries natural to the part.In proof of this, he adduces the case J of a monstrous kitten, in which there was an additional upper extremity protruding from under the chin, and an axillary artery was found creeping under the skin of the neck to supply its nutriment, and account for its existence.It is for this reason, according to the same author, that a certain relation is observed in tke formation of supernumerary parts, for which it would be otherwise difficult to account. We never see, says he, an additional head or arm protruding from