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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    The subject of the following remarks is, therefore, one form only of fatty degenera¬ tion, which, after some pains in the inquiry, I am content to believe is, if not exactly, as Rokitansky says, a form as yet unnoticed, at least a form which he was the first cor¬ rectly to describe. In the writings of Morgagni there are accounts of several fat hearts, but as the large size and abundant deposit of fat are the points particularly dwelt upon, these cases obviously will not do for the present purpose; for an excess of adipose tissue is far from being a common accompaniment of the particular form under consideration. The case detailed in Epist. xlv. §. 23, is the only one which I have met with, in looking through his great work, which seems with any high probability thus explica¬ ble. But the case is too long for insertion on the grounds only of probability. It is not under the head of fatty degene¬ ration of the heart that we are to expect to find illustrations of the present subject. Fat there is, but not of a nature to be detected by the unassisted eye. Much more might be expected from the examination of re¬ corded cases of softening or discolouration of the heart. These were conditions familiar to Laennec, and well described by him. But the microscope was not then in daily use, as at present, and, without the micro¬ scope, this form of disease could scarcely have been separated from that form which has below been described as the second, and for whose accurate description we are in¬ debted to Laennec. As a general expres¬ sion, nothing could be more correct than Laennec’s remarks (Auscultation Mediate, Tome iii. p. 223), where, after combating the notion that softening of the heart was neces¬ sarily an inflammatory condition, and to be treated by antiphlogistic means, he says— “ To me softening of the heart appears an affection sui generis, the result of a dis¬ turbance of nutrition, through which the solid constituents of a tissue are diminished in proportion as the fluid or haif-fluid con¬ stituents are increased.” But he failed to perceive the whole connection between softening and fatty degeneration of the heart; for he says further on (op. cit. p. 226)—“ There is in this case no evident perversion of nutrition, because there is no accidental [i. e. adventitious] product/’ which is contrary to the actual state of things under consideration. The great French pathologists are not exactly agreed with Laennec; but their differences of opinion are not material to the present subject. Dr. Hope (On Dis¬ eases of the Heart, p. 332, third edition) follows Laennec’s classification of white, yellow, and red softening, without connect¬ ing these conditions—or rather the second of them—with fatty degeneration. Dr. Joy (Lib. Pract. Med. Vol. iii. p. 365) ex¬ presses very plainly the possible connection between fatty degeneration and general softening of the heart, and speaks of them as probably explanatory of many a sudden death by syncope. Dr. Copland (Diet. Pract. Med. Vol. ii. p. 227) has given a very full bibliography of this subject; and a clear, concise statement of all which was at that period known of it will be found at page 216 of the same work. Little could be added to his description of what there will be occa¬ sion to speak of as the second form of fatty disease of the heart. But, upon a careful examination of several of the authorities re¬ ferred to, there do not appear to be any cases certainly referable to the third form, the immediate subject of this paper. One case only by Mr. Adams (Dublin Hospital Reports, Vol. vi. p. 396) appears to belong here ; for, besides the fat which had dis¬ placed the muscular tissue on the outside of the heart, “ in both ventricles, even in the lining fibres, yellow spots, where fat had occupied the place of muscular structure, were to be observed. The muscular struc¬ ture was soft and easily torn, and a section of it exhibited more the appearance of liver than of a heart” (Op. cit. pp. 398-9). But the clear, accurate manner in which this and other of the cases are detailed, almost forbids one to put any other interpretation upon them than what their authors have ex¬ pressed. In the absence, therefore, of any other cases which may with perfect certainty be quoted as the basis of an analysis, it ap¬ peared the best way to detail at length such as my own experience affords, rather than to adduce merely the inferences from them; though the security against error, or the means of correcting it, is purchased at the expense of great prolixity. I have only to observe on this subject, that my opinion as to the nature and importance of the disease rests on the facts placed before the reader, and that it is not to impress the im¬ portance of the change in every case, that every case has been adduced. Rather, seeing under what great variety of circum¬ stances it may be found, I should hope that the same observations would lead him to the same conclusions as myself on the points hereafter to be investigated. There are three forms in which fatty dis¬ ease of the heart may occur :— 1st. In the first form the fat is accumu¬ lated in those parts where it is naturally de¬ posited in the greatest abundance, as at the base of the heart. This is met with in those persons who have a general tendency to ac¬ cumulate fat; and to this form, probably, most of what are called fat hearts belong.