On fibroid degeneration and allied lesions of the heart, and their association with disease of the coronary arteries / by John Lindsay Steven.

Date:
[1887?]
Catalogue details

Licence: Public Domain Mark

Credit: On fibroid degeneration and allied lesions of the heart, and their association with disease of the coronary arteries / by John Lindsay Steven. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    8/60 (page 6)
    an etiological factor, nor are there any references to fibrous change as a morbid state of the heart-wall sui generis, and apart from aneurysm. Although in several of the cases the coronary arteries are mentioned as ossified, no opinion is expressed as to the probable relationship of this to the aneurysmal state. Interesting statistics are also given by Thurnam as to the situation of the aneurysm. Out of 74 cases, 53 were situated in some part of the left ventricle; and the 67 aneurysms which occurred in the 58 cases, omitting one case in which this is not mentioned, may as regards situation be thus distributed: at or near the apex of the ventricle, 27; in different parts of the base, 21; in intermediate portions of the lateral walls, 15; in the interventricular septum, 3. To conclude these observations on the situation of the aneu- rysms of the left ventricle, the only general conclusion that ■we can come to appears to be that the thinnest parts of its walls, or the apex and highest part of the base, are those which are much more frequently than any others the seat of the disease. This in general agrees with the observa- tions of more recent writers and also with my own. It wiU thus be seen that in the record of Thurnam's cases we have a most important contribution to the literature of this subject from a pathological as well as from a historical point of view. In 9cases the muscular tissue was the seat of more or less extensive flbro-cellular degeneration, caused by in- flammation it was supposed, if the disease waspresent to such an extent as to cause aneurysm in so many of the cases, we have strong reason for supposing that in its slighter mani- festations, which are easily overlooked, it may occur much more frequently. The flbro-cellular degeneration, however does not seem to have been regarded by Thurnam himself or by others as an independent morbid state; and one of the objects which I have at present in view is an attempt to establish that in fibrous transformation of the heart wall we have a diseased condition which has as much right, from a clinical as well as from a pathological point of view, to be considered an independent affection of the heart as fatty degeneration, or even as certain valvular lesions. Another reference in regard to this subject, important from an historical point of view, may be found in the work