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
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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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    stay in St. Bartholomew's the. nausea and vomiting, of which he for a while complained, were removed by a blister-plaster applied to the epigastrium. There was absolutely nothing else to notice in the progress of this very obscure case. The body was examined 12 /tours after death.—Passing over the lengthened details of the dissection relating to the state of re- cent disease of the lungs, and encephaloid disease of the pericardium, with doubtful scirrhus of the pylorus, the heart was found natural in size ; there was an ordinary white spot at the apex ; there were no traces of any malignant deposit in the tissue of the heart, but beneath the lining mem- brane, and also on section of the walls, ap- peared numerousbuff-colouredzig-zag spots. The valves were all evidently quite efficient. The other organs were healthy. The first explanation of the fatty degene- ration which suggests itself in this case is, that the heart had been stronger, to fit it for the requirements of the daily labour of a na- vigator. But when this daily labour was changed for a bed of sickness, the fibres immediately became atrophied and fatty. Another explanation would refer this fatty degeneration to the effects of old inflamma- tion of the muscular structure of the heart; looking for its cause in the encephaloid masses of the pericardium, and for its symp- toms in the wandering epigastric pains. Abstractedly there is no objection to eithe planation: both, indeed, may be correct. But while it is certain that the premises of the first conclusion existed, it is not certain that those of the second did. It is possible that the connection between granular disease of the kidney and fatty de- generation of the heart does not appear from the details of dissections to be as close as it really is. For with granular disease of the kidney there is very often connected some great obstruction to the capillary circulation, the signs of which appear, before death, in dropsy and in an increased action of the heart. And after death, an hypertrophied left ventricle, with an aorta which it has twisted from side to side of the spine by its violent contractions, are traces of a state of things which could as little have allowed of atrophy as could the ventricle of a heart affected with valvular disease. T.is cir- cumstance may prevent the change from manifesting itself: whether there be any strong tendency to such a change, there will be occasion to consider hereafter. Ca-k XVIII.—Anasarca—disease of the kidneys—Fatty degeneration of the heart. Catharine Knowles, aged 27 ; Mary back ward, April 1847; a needlewornun, tem- perate, and healthy till three years ugo, when the catamenia ceased after exposure to cold. At that time her legs swelled, but the oedema seems to have disappeared, till eight months ago, when her legs began to swell again ; and now she is generally oedematous, and has ascites also. She has pain in the right, hypochondriurn, cough, and dyspnoea. Active purging by bitartrate of potash re- lieved the swelling, but she gradually sank about a fortnight after admission. It does not appear certain that her urine was ever examined. On examination of the body after death, the lungs were found generally emphysema- tous, and oedematous in points. The heart was small, the valves healthy ; there w- re a great many little zig-zag bufF- coloured lines beneath the lining of the right ventricle ; none beneath that of the left. The kidneys were large, rather uneven on the surface, the capsule not unnaturally ad- herent. The cortex was of a pale yellow, contrasting in this respect with the pink colour of the pyramids, and containing dis- tinct small fatty deposits: [it is not men- tioned in the original note in what structure these deposits had their seat]. The next case also presents the fatty de- generation limited to the right side of the heart. In this respect only, and in the fact of the kidneys being diseased, does it resem- ble the case last detailed. Two more dissi- milar conditions of life can scarcely be con- ceived than those of a suburban actor, and an overworked London sempstress. The renal affection is one of the many diseases caused alike by dissipation and distress : the cause of the degeneration of the heart is not equally obvious. Case XIX.—Anasarca —Albuminuria — Fatty degeneration of the heart. Robert Adams, aged 46; John front ward, April 1848 : an actor, intemperate, but healthy till lately. He had rheumatic fever some time ago, and since then has had palpitation on exertion. He had a severe cold six months ago, but the present symptoms do not date more than two months back. He is a large, heavy man, face sallow, expression anxious ; tongue furred on the dorsum, red at tip and edges; pulse 108, small, soft; bowels* regular. He suffers from anasarca, with slight ascites. The heart's impulse is forcible to the right of the sternum and in the epigastrium, un- accompanied by any abnormal sound; urine, sp. gr. 1010, albuminous. lie was under observation for a week. The chief point of interest was the difficulty of administering opium to calm the delirium from which he Buffered; and which appeared to have arisen from the want of his usual
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