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.

  • Ormerod, Edward Latham, 1819-1873.
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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    tion of the characters of the form more im- mediately under consideration has supplied the means of comparing the two. The third form of disease was first, as far as I am aware, described by Rokitansky, who speaks of it as affecting the heart by preference; then, next in order of fre- quency, the voluntary muscles, and some- times, though very rarely, the involuntary muscles,—as, for instance, the coats of the gall-bladder.* The subject has been also investigated by Mr. Pagetf with his usual ability. To his description of the morbid appearances I have nothing to add, and have only to offer my humble confirmation of the correctness of his remark that the fatty matter is partly within, and not wholly external to, the sarcolemma, as described by Rokitansky. But I cannot omit to acknow- ledge the extreme pleasure and advantage I have derived from the assistance of Mr. Paget, as well on the occasion of working out this part of the subject, as always on other occasions, whenever the direction of his pathological researches has happily coin- cided with mine. To the unassisted eye, the muscular sub- stance of a healthy heart presents characters distinguishing it from ordinary muscular tissue; for it is more compact and homo- geneous, and not loosely divided into bun- dles of fibres, as is ordinary muscle. Under the microscope it also presents some striking differences, the transverse striae being less distinctly marked, and the fibres having a singular granular appearance. It is very important to notice this normal differenc3 at the outset ; for the first step towards fatty degeneration consists in the loss of continuity of the transverse striee, and in the increase of this granular marking of the fibres, which would seem to be in some degree their normal appearance. This is the first step, and, as wholly un- discoverable by the naked eye, may often pass unnoticed, unless something in the symptoms, or some change in the general condition of the heart, call particular atten- tion to that organ. Such conditions may be, a small, pale, flabby state of the heart, not inaptly compared to the colour of withered leaves, and to the feel of a moist glove. But such are not commonly the signs which call attention to the existence of this structural change : they are ordinarily much more obvious. On opening a heart thus affected, the interior of the ventricles appears to be mottled over with buff-coloured spots of a * Rokitansky. Anat. Path. Bd. II. ss. 360, 459, III. s. 368; Budd, Dis. of the Liver, p. 191. t Lectures on Nutrition, &c, London Mkd. Gaz. May 1847, Lect. VI. singular zigzag form. The same may be noticed beneath the pericardium also j and in extreme cases the same appearance is found, on section, to pervade the whole thickness of the walls of the ventricles and of the carnese columnse. Of these latter the musculi papillares seem most liable to be affected. Not to say that this form of disease never occurs in the walls of the auricles,—at least, I have never seen it there. Microscopic examination reveals the na- ture of these spots : they are not deposits, but distinctly degenerated muscular fibres; the outline, not merely of the masses, but of each single fibril, is accurately preserved. Instead, however, of transverse strise and nuclei—the evidences of active vitality— there is little to be seen but a congeries of oil-globules. The whole history of the de- generation may be traced in one of these little spots. First, from the immediate neighbourhood of the spot we may obtain healthy muscular fibre ; then the transverse Fig. 1. Fir. 1.^Healthy muscular fibres of the heart. stria? become less distinct; tbey are rows of dots rather than continuous lines ; then the intervals between the dots become wider, and the dots themselves run into longitudinal rather than transverse lines; and then all regularity is lost, and the dots appear to stud the surface all over, like the points on a bit of fish-skin. Probably long before this time the fibre has lost all its properties