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
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 / 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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    It is certainly a condition of disease, but probably not an important one, and needs no additional illustration here. 2d. In the nest form the fat collects chiefly about the apex of the heart (Laennec, Auscult. Mediate, Tome iii. p. 225). The deposit begins from without, and is not at- tended with so great an enlargement of the heart as in the form first described; for the fat is deposited at the expense of the muscular tissue—in its place, not merely laid upon it. Moreover, the degeneration is partial, and in patches, not general. This tendency to limit itself to particular spots is seen most characteristically in those cases where a single carnea columna is converted into adipose tissue, but still preserves the form of the muscular band whose place it has usurped. This form occurs in persons who have, as is popularly said, an unhealthy disposition to grow fat; in those where the fat has generally throughout the body, as in the heart, a tendency to accumulate in the place of, not in addition to, the proper structures. The disease is, in some sense, a degeneration in this form, but not perhaps so strictly as in the form remaining to be described, the proper subject of these re- marks. To this second form belong nearly all the cases, as far as I am able to judge, described as examples of fatty disease of the heart. This fact in itself bespeaks the much greater importance of the second than of the first form ; for there the change in the heart is commonly described as a morbid appearance among many others; here it is the change on which the interest of the case is made to turn. Dr. Cheyne, and other Dublin practition- ers, among whom the disease has excited a good deal of interest, have recorded cases of this description. But instead of repeating one of their well-known cases, the follow- ing, for which I am indebted to my friend Dr. Kirkes, will serve as an excellent illus- tration :— Sudden death—fatty degeneration of the heart. A German clock-maker, a powerful, well- built man, applied for admission at St. Bartholomew's Hospital, in August, 1847, and he looked so pale and ill that the only empty bed in the house was given him, though a fever patient had to be refused ad- mission. His friends said that he had always had remarkably good health, and that he was a man of great strength and powers of endu- rance. But within the last year he had been subject to occasional fits, during which he lost consciousness, fell, and struggled for a short while. He had one such fit ten days ago. His face was now pale; his expres- sion languid ; his gait tottering; pulse thrilling, occasionally irregular. He said he had no uneasiness in the chest, only he had wandering pains, with a sense of faint- ing and debility. He was put to bed, and lay quiet and unnoticed that evening and night. Early on the following morning the nurse found him quite dead in his bed. On examination of the body thirty-six hours after death, The limbs were still rather rigid. A large quantity of fluid blood escaped from the divided cerebral vessels; the brain itself was healthy. Nothing particular was ob- served in the lungs, or in the abdominal viscera. The heart was rather larger than natural: it was marked with two white patches externally ; it felt like a loose bag, its walls being quite flaccid, and it was already partly decomposed, its walls interiorly being stained by the dark grumous blood which it con- tained. The right side of the heart was of the natural size, though the auricle was just then distended with blood. The left cavi- ties were smaller than natural. On close examination, the heart appeared as if en- tirely overlaid with a layer of dirty yellowish fat, separated by a distinct boundary from the muscular substance of the organ; but the muscular tissue itself was pale, like dead leaves, contrasting forcibly with the bright red colour of his abdominal muscles. The rapid decomposition which a portion of the heart set apart for the purpose under- went, vitiates any conclusions from the microscopic examination. A piece of abdo- minal muscle, from the same subject, had, in the same time, undergone no change.* For the present, let this brief summary and this single example suffice for this very common yet very terrible form of the dis- ease. Regarding it as the standard and recognised form, as it were, of fatty dege- neration of the heart, it will be better to return to it hereafter, when the full exposi- * I am indebted to my brother for the particu- lars of the following case, which, however, want of microscopic examination prevents my num- bering among the undoubted examples of this affection:— A gentleman of about 40 years of age had al- ways been fat and indolent. He bore the ap- pearance of indolence to such a degree, that, as he walked along the streets, he used to be made the subject of practical jokes on that account, and to exertion of any kind he seemed to have an innate repugnance. For the last fear years of his life he had been resident in Australia. I am not not aware that he had been previously ill, he certainly had suf- fered no pains in the region of the heart, when one day he was taken as it were with the symp- toms of death, and so died in about a quarter of an hour ns he was moving about the room. Nothing was found on examination of the body to explain these symptoms but the exist- ence of a small fat heart. *