Lectures on nutrition, hypertrophy, and atrophy : delivered in the Theatre of the Royal College of Surgeons, May 1847 / by James Paget ; reported by William S. Kirkes.

  • James Paget
Date:
1847
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Credit: Lectures on nutrition, hypertrophy, and atrophy : delivered in the Theatre of the Royal College of Surgeons, May 1847 / by James Paget ; reported by William S. Kirkes. 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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    recovery of strength was speedy and com- plete ; more so, 1 think, than if, in the paralysed condition, the muscles had been left to the progress of the atrophy. The hindered action of muscles is not the only condition from which their atrophy may ensue. They waste, together with all the rest of the body, in most emaciating diseases ; as, for example, in phthisis. And, this specimen of an excessively fat mutton chop* shews that they may degenerate into fat, in concert with other tissues, in a general defective nutrition j such as, I believe, is not very uncommon in sheep, but such as I have never seen in man. But, besides this general fatty degenera- tion of muscles, we find it sometimes appa- rently as a primary or spontaneous affec- tion of one or more muscles. Thus I believe it may occur in a voluntary muscle. We find sometimes one of the muscles of an extremity or of the back thoroughly atrophied, while the others are healthy ; and no account can be given of its failure. Perhaps its history would have been like that of a case to which Rokitanskyf briefly refers as a spontaneous fatty degeneration of the muscles of the calf with extreme pain. Mr. MayoJ has recorded two cases of, ap- parently spontaneous, atrophy of the muscles of the shoulder, in which, in a few weeks after severe pain, but no other sign of acute inflammation, all the muscles about the shoulder became simply, but exceedingly, atrophied. It is not unfrequent to find a portion of the lower and posterior part of the recti abdominis muscles in a state of fatty degene- ration. I can give no account or explana- tion of it, more than by saying that I have seen four or five cases in which about as much of the back part of each of these muscles as corresponded with the pyrami- dales in front, was in complete fatty degene- ration. A similar change also is mentioned by Dr. Budd§ and Rokitansky||, as occurring in the gall-bladder. Something of the kind may also be found in the urinary bladder of old people. But most of all, the fatty de- generation appears both frequent and im- portant in the heart; and, with your leave, I will enter into some detail respecting the atrophy of this organ. Atrophy of the heart may appear in either wasting or degeneration. Of the former I shewed examples in the last lec- ture, in the heart of a cancerous man, 50 years old, which weighed only five ounces * Prep. 10, Pathological Museum of the Col- lege of Surgeons, t Patholog. Anat. B. 2. S. 348. i Outlines of Human Pathology, 1830, p. 117. § Diseases of the Liver, 1845, page 191. I Patholog. Anat. B. 3 S. 368. four drachms; and that of a diabetic woman, 25 years old, which weighed only five ounces one drachm. Both these had deviated from the general rule of enlarge- ment of the heart with advancing years, in adaptation to the diminished quantity of blood, and the general diminution of the body. In these cases there is a uniform decrease of the heart: its cavities become small, and its walls proportionally thin. In other in- stances the cavities are dilated, without pro- portionate thickening, or, it may be, even with thinning of their walls. This may be considered as occurring in cases of such in- creased obstacle to the circulation as might in other persons, or in other conditions, en- gender hypertrophy of the heart. Or, more probably, the dilatation is the consequence of wasting in a heart that had once been large and strong. But I wish to speak particularly of that form of atrophy of the heart which consists in fatty degeneration ; and of examples of it which in their early stages might be called granular degeneration, though later the fatty degeneration may be manifest. Extreme instances of fatty degeneration of the heart have been long known and well described. The whole, or the greater part of the heart, in such cases, may seem le- duced to fat,—the fat which occupies the place of its proper tissue having coalesced with that which lies on its surface, and the degeneration being accompanied by thinning and softening of its walls. In like manner, the cases have been well known and described, in which fat accumu- lates in unusual quantity in those parts of the exterior of the heart in which it natu- rally exists and is found, though often emaciated and very soft, even in the thin- nest people ; viz. along its transverse furrow, the furrows in which the coronary vessels run, and others. From these positions, the fat dipping more and more deeply may nearly displace the fibres, and lead, it may be, to a secondary degeneration of them. But these conditions, and their frequent combinations, are too well known to need that I should describe them, or refer par- ticularly to any of the specimens of them, except to this, which is a heart from a sheep.* It exhibits a great accumulation of fat on its surface ; its walls are thin, and particularly fatty; and the greater parts of the cavities of the ventricles and of the left auricle are occupied by large lobulated growths of suet-like fat. The weight of the fat here added to the heart is 25 ounces, and it is said that there was besides a large accu- mulation of fat about the kidneys. But no other history of the case is extant than that * College Museum.
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