Case of fatal purpura associated with waxy degeneration of the striated muscles, and also of the vessels in the affected parts / by Wilson Fox, M.D.

  • Fox, Wilson, 1831-1887.
Date:
[1865], [©1865]
Catalogue details

Licence: Public Domain Mark

Credit: Case of fatal purpura associated with waxy degeneration of the striated muscles, and also of the vessels in the affected parts / by Wilson Fox, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    think it very possible that the same condition may have obtained for the vascular system, though the indications of minor degrees of the alteration were much less noticeable here, where, however, it must be remembered that the difficulties of observation were much greater. It appears to me that the affection of the muscular fibres of the heart was also one that had supervened acutely—an opinion borne out by the development of apex and basic murmurs while the patient was under observation, and which I should be disposed to attribute to corresponding imperfection in the contraction of the papillary muscles, as no organic alteration of the valves was discoverable post- mortem.1 2 These features of the cases all bear out the hypothesis that the alteration in the vessels had been an acute one, though whether this is sufficient to account for the haemorrhage, must, I think, remain an open question, until supported by further facts of a similar kind. I have classed the affection both of the muscles and vessels with the waxy, lardaceous, or amyloid degenerations, both from the naked eye appearances and from the reactions with iodine; and though I con- sider the latter the least valuable of the criteria by which we judge of this change, it is the only one often applicable for the discrimination of the affection. Its value was, however, very marked in judging of the affected spots in the skin. Simple pallor of the muscles I should not regard as indication of this change; though Zenker is inclined to believe that a peculiar pale appearance observed by Dr. Bennett'1 in the muscles in the neighbourhood of some tumours, indicates a change identical with those which he has described. I have lately observed appearances corresponding with those described by Dr. Bennett in a gluteus maximus tensely stretched over a fibroplastic tumour, which had grown very rapidly in a child from the saero iliac-synchondrosis. The fibres of the muscles here were extremely pale and indistinct. The normal colour and consistence of the muscle was completely wanting ; it did not react with iodine, and instead of being crisp and firm and brittle, it was simply much softened ; and though under the microscope the striation, both transverse and longitudinal, and also the nuclei, had almost completely disappeared, there was none .of the peculiar waxy refraction which Zenker has described, and which occurred also in the case now under consideration. As far as my ob- servation has extended, I believe the firm but very brittle character of the fibres to be an essential accompaniment of the true lardaceous change in muscle. That the change was of this description is also borne out by a similar affection of the intestines having been observed, the appearance of which corresponded closely, though not existing in as highly marked a degree as in some instances that have come under my observation, with those universally admitted as distinguishing this affection in these structures. Other questions of considerable interest arise with regard to the 1 A similar impairment of the functions of the voluntary muscles was also noticed in the weakness and tremulous movements of the extremities during life. 2 Cancerous and Cancroid Growths, p. 104.