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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    pulp and follicles, and states that it is found to be most abundant in the neighbourhood of the necrotic foci met with in this viscus. He also refers to invasion of the tissues with polynuclear leucocytes. Bezan9on [2] refers to the cloudy swelling, parenchy- matous degeneration and fatty change which have been found in the liver, especially in septic cases. Stanley [17], in an interesting paper published in the British Medical Journal in 1903, states that in his opinion the prime factor for the cause of death in diphtheria and beri-beri is the cardiac muscle. He is most emphatic on this point. He says, “ To attribute heart failure in beri-beri and diphtheria to a necrosis of the vagus is alike unneces- sary, inadequate, and unproved.” He, however, concludes this very important statement with some interesting remarks, to which I will refer again later. “ In beri-beri and diphtheria the cardiac change is parenchymatous degeneration of the heart muscle.” “ Sometimes fatty degeneration only is seen and appears to be a later stage of the granular albuminous degeneration.” “ While the granular degeneration is usually general, the fatty degen- eration is more often patchy.” He also adds that, “ The heart muscle degeneration takes place as a rule before skeletal muscle degeneration, and is the result probably of direct action of the toxin, and not a secondary result of nerve change.” Hamilton Wright [20], however, adopts quite a different view to explain the cause of rapid death which occurs in acute beri-beri. He says : “ In acute pernicious beri-beri the vagal cardiac terminations bear the brunt of the poison, and this, together with poisoning of the accelerator termina- tion, soon leads to cardiac exhaustion and death.” He, however, mentions that the muscle fibres of the heart in acute beri-beri are found to be extremely fatty, especially on the right side and in the papillary muscle. Poynton [i5] investigated the heart muscle in eighteen cases of rheumatic cardiac disease, four cases of diphtheria, one of chorea, and the heart muscle of a rabbit in which septicaemia had been produced by means of “staphylococci.”
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