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
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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![Millard and Regaud [12], from a series of experimental investigations on diphtheritic toxaemia in animals, found that leucocytes are present in large numbers in the inter- stitial tissue of the various viscera; that the foci of fatty degen- eration which occur are composed of leucocytes ; that the leucocytes absorb the muscular debris and especially the exudates, and that the muscular lesion provokes the leucocytosis. Andrewes [1] states that: “ The muscular tissue of the heart may be in a condition of fatty degeneration which varies to a greater or less degree, but is frequently absent.” He also mentions that the cardiac muscle may present advanced fatty change affecting all the fibres, or it may be patchy in character. He considers that the diphtheritic toxins are especially nerve poisons. It should be stated, however, that Andrewes maintains that, in cases of cardiac syncope, the cause of the condition is due to a direct action of the toxin on the cardiac muscle. Gee [1], in his clinical description of diphtheria in Allbutt's Medicine, says: “The cause of the heart failure is interstitial myocarditis with granular and hyaline degen- eration of the muscular fibres.” Mott [1], referring to fatty degeneration, says: “From a large experience in the examination of hearts, I am certain that fatty degeneration may be overlooked unless a micro- scopical examination be made after staining writh osmic acid. Thus, in a case of fatal syncope occurring in diphtheritic paralysis, I found the organ extremely degenerated ; yet the heart had been passed as normal on macroscopical examin- ation.” “ I have observed intense fatty degeneration of the heart in a case of diphtheritic paralysis, but I could find no degeneration of the nerve trunks.” Romberg [16] examined the heart muscle in eight fatal cases of diphtheria, in five of which there was 'pericarditis, and in three endocarditis. Patchy change was found scat- tered throughout the cardiac muscle. Central vacuolation of the individual fibre was also noted. The most marked fatty change was noticed in the fibres beneath the endo- atid peri-cardium. Interstitial inflammation was constantly present.](https://iiif.wellcomecollection.org/image/b22428483_0009.jp2/full/800%2C/0/default.jpg)
