Some writers (Thurnam) have applied this designation to a morbid condition of the valves, which has indeed some affinity with aneurism, more especially if we adopt Scarpa's theory of spurious Aneurism (the mixed Aneurism of others).

From our own observations, we should be led to divide aneurism of the valves into two forms, and to compare them with the two forms of aneurism of the heart we have already described, although they do not indeed strictly correspond to one another, since only one (namely the acute) form of the disease in the valves corresponds with acute aneurism of the wall of the heart, while we have observed no form of aneurism of the valves corresponding to chronic aneurism of the heart. We would, however, include under this head consolidated (cured) aneurism of the acute form, affecting a valve, whose continuity is still undestroyed, although it may present unimportant sinuosities, such as are sometimes observed at the mitral valve near the free edge. We have found these structures in only one case, together with the residua of endocarditis, at the aortic valves, and, if they were not consolidated aneurisms of the acute form, they must have been produced by a hernia of one of the lamellae of endocardium, through the fibrous layer of the valve. - This class would necessarily include the three cases described by Thurnam (one of which affected the mitral, one the tricuspid, and the third one of the aortic valves), since he regards them as dependent on gradual extension of the valves.

The following is the mode of origin of acute aneurism of the valves, according to the observations made by ourselves and others. In the course of intense inflammation of the valves, a lossio continui is produced in the valve, affecting only one of the laminae of endocardium, and a layer of the contiguous fibrous tissue.

1. This loesio continui appears either as a separation or fissure of the structure, and may occur, a. As the consequence of the condition of loosening and lacerability induced by inflammation, b. Or it may arise from the loosened condition of the tissue, observed in the neighborhood of an abscess, in the parenchyma of the valve.

2. A loesio continui may also be the result of an abscess proceeding from the lowest part of the valve, and penetrating towards or even through its endocardium, or in other words it may be owing to a final suppuration of the endocardium. (In one specimen in our collection, a sinus even passes from an abscess in the substance of the heart towards the aortic portion of the mitral valve; above this the valve is torn from the ventricle, and the whole sinus thus converted into an aneurismal sac.) It is however very questionable whether the endocardium is actually in a state of suppuration in such cases, or whether it may not rather be lacerated above the adjoining abscess, in which case the whole process would essentially belong to that which has been considered under b.

When there is a tendency to laceration of the valve, this will occur with a frequency proportional to the extension of the aneurism in the direction towards which the blood flows to the valve, - the auriculo-ventricular valves being lacerated in the direction of the auricle and the arterial valves in that of the ventricle, - and especially when the lo3sio continui affects the surface of the valve against which the blood is propelled.

Thus where the valve has been perforated to a greater or less extent, the blood which impinges on it, penetrates into its parenchyma, and causes more or less extensive infiltration. By this means the yet uninjured portion of the valve assumes the appearance of a projecting tumor on the corresponding surface; and becoming, as it were, inflated, constitutes valvular aneurism, in the form in which we have observed it, and to which the following remarks apply.

This tumor is usually about the size of a pea or a bean, although, after continued attenuation of the layer of the valvular tissue of which it consists, it becomes as large as a hazel-nut, or even a pigeon's egg. The tumor is especially capable of such an enlargement at the auriculo-ven-tricular valves, in consequence of the more abundant mass of the fibrous tissue occurring in them.

Its form is round and hemispherical, or frequently so far irregular that it presents various sinuosities in the circumference of its base, as well as in its arched portion. It generally extends over a considerable space, in consequence of the widely diffused infiltration of the blood into the parenchyma of the valve.

Its aperture although originally a fissure-like rent, is generally round, and has fringed margins, which, together with the circumference of the valve, are covered with luxuriant vegetations.

Its cavity is filled with a variously discolored bluish-red, reddish-gray, yellow-reddish, dirty white, solid, or more frequently loose, soft coagulum, which very often becomes disintegrated like the globular vegetations.

Aneurism of the valves is, therefore, as may be seen from what has been already stated, an acute formation occasioned by a considerable degree of inflammation of the valves.

These tumors in general terminate somewhat speedily in lacerations. This usually occurs in the more intense aneurisms of the auriculo-ventri-cular valve at the highest point of the aneurism, or at the summit of one of its various pouches, in the form of a small fissure-like rent, inclining from its circumference towards the opening, and having its margins speedily covered with vegetations.

Death does not follow from this mode of termination of the disease, but results from the endocarditic process and the corresponding disease, to which the latter gives rise in the blood. - In the rare cases in which this aneurism is consolidated (that is to say, where it has its opening and the walls of the cavity covered with membrane), it constitutes a chronic aneurism, and, like simple or hernial sinuosities, continues longer (see the cases recorded by Thurnam and others), and may become fatal through consecutive diseases in connection with other coexisting heart-affections. It may be observed, in reference to the size of such aneurismal pouches of the valves, that in one case seen by Thurnam the tumor had attained the unusual dimensions of a large walnut.

Our own experience coincides with that of most foreign observers, in having discovered this aneurism on the valves of the left side only, - a circumstance that corresponds with the relation of endocarditis to the same side of the heart. It is probably always more extensive at the auriculo-ventricular valve, on account of the greater development of the parenchyma in that structure whilst it is lacerated in the arterial valves soon after its formation, and may thus terminate in a large fissure. - Thurnam, as has been already observed, found aneurism of the tricuspid valve in a heart in which there was a communication between both ventricles. In this case there were four aneurismal pouches on the valve.

From the above observations it will easily be seen, that although aneurism of the valves possesses a scientific interest, it is not of much practical importance when considered either on its own account or in reference to the intense disease from which it arises.