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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    PART I Of fatty degeneration in general—primary and secondary. Fatty disease of the heart—writers on the subject—of three kinds—illustration of the second kind. The third kind the subject of this paper —its anatomical characters. Fatty de¬ generation a specific form of disease—its clinical history. Fatty degeneration of the heart as a cause of sudden death—the compatibility of extensive disease with apparent health— manner of death—death by coagulation of the blood in the pulmonary artery ; difference of the symptoms of, illustrated. Old coagula in the heart, connected with capillary phlebitis, only coincident with fatty degeneration of the heart. Death from valvular or fatty disease of the heart; points of resemblance between. There are few subjects which have engaged the attention of pathologists of late years so much as fatty degeneration. It is a field in which the microscope has done good service in the hands of Mr. Gulliver, Mr. Bowman, Mr. Rainey, and Dr. Johnson, with many others. Mr. Paget has expressed so well the general principles of the process, in his Lectures on Atrophy (Med. Gaz., 1847, Lecture V. and VI.), as to render any lengthened exposition of them here quite superfluous. It will be sufficient merely to note the chief outlines, referring for further details, to those elegant and instructive lec¬ tures to which the author of this paper must express his great obligations. Fatty degeneration may occur under two conditions—viz. as a primary or a secondary affection. Primarily, it may occur in a part \ which is no longer wanted, as in the muscles of aged or crippled limbs, and in the struc- | ture of crippled organs. Such a change we !see best in the bodies of some old people. The parts which are no longer wanted are not simply atrophied, but converted gra- I dually into fat, and the blood apparently is so overloaded with this ingredient that it fails to remove the fat from those parts l which are in earlier years naturally padded or distended with this substance.* So the ] body retains, in many respects, the form a and plumpness of youth, but the texture is 3 flabby, and the colour pale, for the want of I _______ * See Mr. R. W. Smith’s two cases. Dublin J Quarterly Journal, Vol. ix. p. 413. blood and muscle to give it the hue and firmness of youthful life. The other condition frequently connected with this peculiar form of atrophy, which may then be called secondary, is the pre¬ vious occurrence of chronic inflammation in this part. Here, as in the former case, we must look to the general habit of the indi¬ vidual for some share of the explanation ; but the fact of the one being occasionally ingrafted on the effects, or accompanying the progress of the other, rests on the best evi¬ dence. This is most commonly seen, as might be expected, in internal organs. Pro¬ bably the same cause which has induced in¬ flammation has itself, in a very large ma¬ jority of cases, given the tendency to fatty degeneration of the particular organs. Of the nature of this fatty degeneration, under whatever circumstances, there can be no doubt : it is essentially an atrophy, whereby the most highly organized elements of the body are replaced by one of the simplest. It is not that the substances are changed into fat, that is plainly impossible, but that the nutritive processes of muscle, or gland, or bone, no longer restore particle for particle whatever is lost by the daily use of the parts, but replace it with oil. Nutrition goes on in-some sort, but the ad¬ ditions are of matters wholly unsuited to the office of those that they have replaced : they can neither move nor secrete, nor even mechanically support the weight of the body. It is not proposed in the following pages to discuss the entire subject of fatty disease of the heart in general ; for there is little to be added to what we already know of many parts of it. The records of medicine abound with instances of apparent conversion of more or less of the substance of the heart into adipose tissue ; instances more strik¬ ing in themselves, and better recorded, than any which the authorcould adduce. The clinical history, too, of this class of cases, appears to be perfect ; we know where to expect such degeneration, andin what way to dread its consequences ; and if we have ceased to look for more exactly patho¬ gnomonic signs of its existence, it is because we know that it is not in the nature of ;he disease that there should be such. B