Studies in fat necrosis / by H. Gideon Wells.

  • Harry Gideon Wells
Date:
1903
Catalogue details

Licence: In copyright

Credit: Studies in fat necrosis / by H. Gideon Wells. 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.

    5/30 (page 199)
    STUDIES IN FAT NECROSIS H. Gideon Wells Langekhans1 made the first actual attempt to learn the cause of the changes of fat necrosis in 1890. Before that time Balser (1882),2 who first called attention to the condition, and Chiari (1883)3 had attempted to reach conclusions by study of the histology of the lesions. The former decided that overgrowth of fat tissue was at the bottom of the trouble, thinking that the new fat cells which he described as growing about the periphery shut off the blood supply of the center of the focus. Chiari took an exactly opposite view. Observing fat necrosis in the bodies of marantic patients, he considered that lack of nutrition during cachexia was the cause. From his histologic studies he concluded that the process was not at all different from retro- gressive changes seen in other organs and there designated as simple necrosis and fatty degeneration. Langerhans’s first studies were of a histologic and micro-chemic nature. He observed that the necrotic masses did not float like masses of stearin, but sank quickly to the bottom. On teasing out they were seen to consist of characteristic needles of fatty acids, a few small oil droplets, and many flakes of varying size, the last being responsible for the high specific gravity. Further evidence of the change from the normal fat that had previously occupied the affected area was furnished by staining with osmic acid, which merely yielded a dirty, grayish-brown coloration. Addition of concentrated sulphuric acid to sections from which the fat had been removed with alco- hol and ether caused complete solution of the heavy flakes. If this treatment was followed by the addition of water, and the specimen allowed to stand until the follow- ing day, numerous characteristic crystals of calcium sulphate settled out. From these observations he concluded that, since both calcium and fatty acids existed in the necrotic areas, they were probably combined. Further evidence was furnished by the insolubility of the calcium salts in hydrochloric acid, which showed that they were not carbonates or phosphates, and the insolubility of the fatty acids in boiling ether, which showed that they were not free. At the time Langerhans wrote the knowledge of the history of fat in metabolism was less advanced than now, and he sought support for his assumption of the formation of calcium soaps in the observations on this process as it occurs in adipocere. With this exception the chief illustration of such a process was the description of retrogressive metamorphosis in lipomas by Virchow,4 who said that in these tumors the fat is occasionally saponified, combines with calcium and mag- nesium, and together with earthy phosphates forms a crumbling, mortar-like mass. By 1 Virchow's Archiv, Vol. CXXII (1890), p. 252. zibid., Vol. XC (1882), p. 520. 3 Prager medicinische Wochenschrift (1883), No. 30, p. 285; No. 31, p. 299. 4 Krankhafte Geschwiilste, Vol. I, p. 393.