Volume 2

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 / [Edward Latham Ormerod].

  • Ormerod, Edward Latham, 1819-1873.
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 / [Edward Latham Ormerod]. Source: Wellcome Collection.

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    in the very persons, in fact, who are likely to be the subjects of fatty degeneration of this organ. As far, however, as their patho¬ logy is made out, the connection of capillary phlebitis and growths in the heart with fatty degeneration is only that of coinci¬ dence. Case VI.—Bronchitis— Sudden death, with fatty degeneration of the heart. Thomas Bennington, aged 55. Luke back ward, February 1847. A large, full- made man, a porter, intemperate; healthy, save a liability to winter cough, till three weeks before admission, when he began to suffer from cough and dyspnoea, with oedema of the feet towards evening. Now his face is- dusky, his expression anxious, and he cannot lie down in bed. Loud rhonchus and sibilus mask all the other sounds in his lungs. His urine is not albuminous. He got a little better under the use of diuretics and stimulants; when awake he did not seem to suffer much, but his appear¬ ance of lividity and dyspnoea during sleep were truly horrible. On the fourth day after admission he had occasion to go to the water-closet: he returned safely, rolled himself up in his blankets, and was dead in a few minutes. On examination of the body after death, the blood was all fluid. The brain was found healthy as far as it could be examined. The lungs were emphysematous and oedema- tous, and universally adherent; the bronchi dusky, and full of puriform mucus. The heart was of the natural size ; the valves all healthy ; the right ventricle marked internally with buff-coloured zigzag lines. To this extent the muscular fibres, examined under the microscope, resembled irregularly granular cords, but there was no marked abundance of distinct fat or oil cells. The kidneys were large, lobulated, and the cortex of the left ill defined. There was nothing abnormal to note in the condition of the other viscera. Looking back to these six cases, designed to present the disease in its most formidable point of view,—they were none of them in perfect health : the first was scarcely escaped from the threatenings of some coming dis¬ ease ; the second was liable to pain, such as to require medical attention ; the other four were actually suffering from the most serious disease, which it will be worth while to con¬ sider a little more in detail. Clearly, had no marked change been found on examining the body of Case III., there would have yet been no hesitation in attri¬ buting his death to the same cause—syncope, the result of his being incautiously placed in the upright posture. It is right, however, to remark, that though this is an accident we should always be led to apprehend and provide against, from the loose flabby tex¬ ture of the heart discoverable after death during delirium tremens, still, that fatty de¬ generation is not in these cases ordinarily found in conjunction with that soft flabby state.* Of five dissections after death, from simple uncomplicated delirium tre¬ mens, of which I have records, the heart is noticed to have been particularly soft and flabby in four, and in four to have presented numerous small ecchymoses beneath the in¬ vesting or lining membrane. In one, the heart, though flabby, was not dilated like the rest, but small, and loaded with fat. Examination by the microscope failed, how¬ ever, to detect the slightest evidence of fatty degeneration in its structure. Between the three last cases (IV., V., VI.) there is a very close resemblance. The his¬ tory is the same in all,—a more or less gra¬ dual breaking up of the health, with an in¬ effectual attempt to keep at work,—cough and dropsy,-—a short stay in the hospital,— and, at last, sudden death, following the exertion of walking to the water-closet, ap¬ parently by syncope. A little inquiry would show that the general history of cases of valvular disease of the heart is very similar, especially as regards the somewhat singular mode of termination of the cases. The actual state of things at last, indeed, is much the same in both, though brought about by different means. In the one class the ob¬ struction increases till the heart can no longer overcome it; in the other, the heart becomes less and less able to carry on the circulation against the natural resistance of the tissue, till, as in the former case, from whatever cause, it suddenly ceases to act. How much of this series of symptoms preceding the fatal termination was justly referable to the condition of the heart, I would not pretend to determine. Frankly I would claim only the pain behind the ster¬ num, and the sudden death, as the results of the heart disease. For all the rest, and per¬ haps for the pain, the co-existing disease supplied a most sufficient explanation. But without the change in the heart, the death by sudden syncope occurring in all three cases is not easily intelligible. * Dr. Watson says (Lectures, vol. i. p. 399, 1st Ed.) one morbid condition 1 have found constant in persons dead of delirium tremens—a remarkably soft, pale, and flabby state of the muscular tissue of the heart.
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