A study of the various changes which occur in the tissues in acute diphtheritic toxaemia : more especially in reference to 'acute cardiac failure' / by Leonard S. Dudgeon.

  • Leonard Dudgeon
Date:
1906
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Licence: In copyright

Credit: A study of the various changes which occur in the tissues in acute diphtheritic toxaemia : more especially in reference to 'acute cardiac failure' / by Leonard S. Dudgeon. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    change present throughout the cardiac muscle resembling the most acute example of diphtheritic toxaemia. Fat drop- lets were present, chiefly of the fine type. The muscle fibres appeared to be in good condition, but, in a few instances, the nuclei stained poorly, and the transverse striation was lost. A few cells were completely degenerated. Well-marked inflammatory reaction of the heart muscle has been noted by tbe large majority of investigators on this subject, as previously stated. Romberg [16] drew special attention to this feature, but considering that in five out of eight cases pericarditis was found at the autopsy, and in the remainder endocarditis, we must look for some cause other than the diphtheritic toxin for the production of the inflammatory lesions which occurred in his cases. It is a matter of common knowledge that inflammation of the heart muscle is found, without exception, in all cases of pericarditis and endocarditis, but in diphtheria inflamma- tion of the serous membranes is uncommon. Hesse [8] also draws special attention to the interstitial myocarditis which he found in his cases. Flexner [7] is one of the few observers who failed to find any evidence of inflammation of the heart muscle in diph- theritic toxaemia. In the large majority of my own cases, both the experi- mental and those in the human subject, there was complete absence of inflammatory processes. In a few instances, however, very slight inflammatory changes were noted. We must be fully alive to the fact that, while the earlier observers considered that diphtheria was a true toxaemia, more recent experience tends to show that in the very acute cases this disease must often be classed as a septicaemia. In such instances the presence of phagocytes in the diseased tissues in which the bacilli are present is only what takes place in every bacterial infection, but in all my experimental cases bacterial free toxins were employed, and there was com- plete absence of inflammatory reaction—as already men- tioned—except at the seat of inoculation. In conclusion, it may be justly said that there are two typical forms of fatty change of the cardiac muscle in acute
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