Upon paroxysmal angina pectoris and other forms of cardiac pain : with some remarks on the diagnosis of fatty heart / by George W. Balfour.

  • Balfour, George William, 1823-1903.
Date:
[1881]
Catalogue details

Licence: Public Domain Mark

Credit: Upon paroxysmal angina pectoris and other forms of cardiac pain : with some remarks on the diagnosis of fatty heart / by George W. Balfour. Source: Wellcome Collection.

    14/20 (page 780)
    I well remember one case of extreme cardiac pain and dyspnoea in a patient almost moribund from cardiac disease, and who did die only a few days subsequently, yet in her the immediate effect of chloro¬ form inhalation was to restore the pulse to her wrist, to enable her to breathe more freely, and in few seconds, instead of being black in the ' face, pulseless, and gasping partly from pain, and partly from extreme dyspnoea, she became quiet, natural in appearance, and in a short time was able to lie down and rest. But, you may say, in angina the heart is almost universally flabby and fatty; is chloroform not dangerous when we have a fatty heart ? The next case which I shall relate will be the best reply to this question. First, let me say that I doubt the possibility of diagnosing a fatty heart. We may suspect its existence, because the physical signs seem to warrant the sup¬ position, while the conditions present are apparently favourable to its development. Thus there may have been a long-persistent spantemic condition of the blood, or there may be a state of general (pernicious) anaemia, or there may be reasons for suspecting a purely cardiac anaemia from local causes, such as an atherosed and obstructed state of the coronary arteries, or an overgrown hyper¬ trophy of the cardiac muscle which has got beyond the feeding- powers of these vessels. For fatty degeneration of the cardiac muscle is the result of mal-nutrition, and seems never to be found apart from one or other of these conditions. But little acquaintance with pathology is, however, requisite to teach us that these con¬ ditions are not all of them easily and certainly recognisable, and that even when present fatty degeneration is not an invariable concomitant of any of them. Though, therefore, our suspicions may occasionally be right, they may more often be wrong. The signs of cardiac debility upon which we base our suspicions are much more commonly due to dilatation than to fatty degeneration, in spite of the possible co-existence of an arcus senilis. Besides, there are many cases of actual fatty degeneration in which there have been no faintings, cardiac asthma, feebleness of the pulse or of the cardiac impulse, no yellowness or pastiness of the com¬ plexion, and no arcus senilis—in fact, all the symptoms and signs connected with the heart have either been those of perfect health, or at all events they have not been such as are generally supposed to indicate fatty heart, yet the heart has been markedly fatty.1 I may refer to the case of Bridget Henry, who died from chloroform in the Cincinnati Hospital, U.S., 13th October 1870,2 as a well- known example of the conjunction of a normal impulse with a fatty heart; but indeed of this we could scarcely have a more 1 While this is passing through the press this statement has received a most forcible illustration in the death, from rupture of a fatty heart, of one of our best known and most esteemed medical practitioners, whose healthy appearance and great vigour both of body and mind were entirely opposed to all the more generally received ideas in regard to this form of degeneration. 2 Chloroform Deaths, by W. W. Dawson, M.D., Surgeon to the Cincinnati Hospital, 1871. Printed by Robert Clarke & Co., Cin.