Observations on the clinical history and pathology of one form of fatty degeneration of the heart : being the substance of a paper read before the Brighton and Sussex Medico-Chirurgical Society, Oct. 4, 1849 / by Edward Latham Ormerod.

  • Edward Ormerod
Date:
1849
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the clinical history and pathology of one form of fatty degeneration of the heart : being the substance of a paper read before the Brighton and Sussex Medico-Chirurgical Society, Oct. 4, 1849 / by Edward Latham Ormerod. 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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    have attracted even scrupulous attention. The condition of the heart was alike in all, and very characteristic, though, indeed, to an unpractised eye it might seem unimpor- tant. Before detailing the three remaining cases of this division there is one point to be guarded. They are not put here simply be- cause they died suddenly, and there was found fatty degeneration of their hearts; but because this sudden death was explica- ble on no other grounds, taking all things into consideration, than failure of the heart's action. And in their hearts was found what may go some way towards explaining that failure. From the nature of the cases, coagulation of the blood in the pulmonary arteries might appear a very possible cause of so sudden death. The mode of death, how- ever, was not exactly similar to what occurs under such circumstances, and, yet better evidence, no such coagula were found there after death. The point, however, is of such importance, of all the obscure causes of sudden d-ath to determine which has hap- pened in any particular case, that the fol- lowing details will not be irrelevant. The case selected is the one which displays the symptoms of death from coagulation of the blood in the pulmonary artery in a higher degree than any other which my collection affords. Paraplegia from disease of the vertebrae— Sudden death, from coagulation of the blood in the pulmonary arteries. Sarah Dillon, aged 20, Hope back ward, February 1847. A healthy-looking girl, of a fair complexion, who had been in the hospital a few weeks before with some ano- malous symptoms which were not exactly made out at the time, was re-admitted with the same symptoms, and with great weak- ness of the lower extremities. She had complained at first of a feeling as if a ban- dage were drawn tightly round the lower part of the chest, and when, on her re-ad- mission, her weakness drew particular atten- tion to her spine, it was found that the middle dorsal vertebrae projected posteriorly, and were tender on pressure. The notes of her case, extending from Dec. 18, 1847, to March 6, 1848, speak of little but constantly increasing weakness. By the end of January she had lost all power over her legs. On Feb. 9 she had very little, if any, sensibility of the feet, though pinching of the foot was immediately followed by retraction of the legs. Indeed, it was a great trouble to her that her legs were always doubling themselves up, and that she had to ask the nurse to come and straighten them. She had great difficulty in evacuating her bladder, or controlling the action of the bowels. On Feb. 19 it is noted that all her evacuations passed away unconsciously; she dreads being moved, and all her appearance of cheerfulness and health has passed away. March 6.—She has been steadily getting worse, though she always says she is better ; but her face is dusky, and her expression anxious. Last night she had a profuse per- spiration. This morning she was quite easy, and unusually cheerful, while she was having her bed straightened. About a quarter of an hour after having been changed, she cried out suddenly, Oh my breath ! and seemed much distressed, but was revived by a little ammonia. In a little while she seemed again to be sinking ; complained of pain in the right arm, and kept swaying it in the air. She grew livid, and the Bweat streamed down her ; and still she kept cry- ing out at intervals Oh my breath 1 till she died, in about twenty minutes from the time that she first called the sister's attention to the queer feeling in her throat. On examination of the body sixty hours after death, the limbs were still rather rigid ; the blood was nearly all fluid. The brain and spinal cord were healthy, except the dorsal region of the latter, where it was closely pressed upon in front by a sharp ridge, over which it bent. This ridge was produced by the projection backwards of the intervertebral ligaments between the sixth, seventh, and eighth dorsal vertebrae. The body of the seventh was wholly, and that of the eighth partially, destroyed. There was about one ounce of pus in the right mass of dorsal muscles, in a cell, with smooth polished walls, about half an inch from the surface. This abscess was not evidently connected with diseased bone, but it passed between the spinous processes of the seventh and eighth dorsal vertebrae. The heart was healthy ; there were about two ounces of fluid in the pericardium. The pleurae were free, with four or five ounces of fluid in each cavity. A single, small, chalky tubercle existed in the apex of the left lung ; otherwise the lungs appeared quite healthy. A large cylindrical coagulum, which had fallen out on the table, first called attention to the pulmonary arteries, which were all found more or less closely plugged by similar concretions. In the large trunks these coagula were hard, wrinkled, and of a dirty reddish-grey colour, but in the ramifications of the third order they were smooth, soft, and black. They were all free from adhesions to the coats of the vessels. It would be out of place to digress any further on the various points of interest which this case presents, apart from that in illustration of which it has been adduced. C
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