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

  • Steven, John Lindsay, 1859-1909.
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 University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    ji^ive an idea oE their wide scope. For it is to be observed, says he, at page 89, that this affection uever attacks the ■whole heart at once, nor even the whole of a single chamber. It is always more or less localised, and sometimes in- vades only a very small tract. Such a statement seems to me to be a very strong argument in favour of the circula- tory theory of its origin. At page 90 he says, In the early stage, however, it sometimes seems that a retrograde change in the muscular fibres of the heart advances more rapidly than the growth of the fibrous tissue that should accompany it ; and he goes on to show how a softening, not unlike a pjtemic abscess in appearance, may be produced in some cases. It is very strange that he should have argued in this way, and yet not have suggested any connexion between obstruction of the coronary arteries and the lesion in question. We must, however, regard these statements of Dr. Hilton Fagge as forecasts of the still more modern views and observations of Weigert and Huber on this subject. He goes on to speak of the frequency with which aneurysm is due to this affection, and to point out how rupture of the heart, so frequent in local fatty degeneration of the muscular fibre, very rarely occurs in this condition. I think, however, that this statement must be received with some hesitancy, for, as I pointed out about two years ago in a paper on Kupture of the Heart, there is good reason for believing that many cases are not due to localised fatty change at all, but to infarction. With regard to the causes of fibroid disease of the heart, says he, we seemto be at present completely in the dark. He discusses in detail the ibfluence of pericarditis, syphilis, &c., and points out that fibroid change of the heart wall may be a cause of sudden death. As I have already indicated, the relationship existing between diseased coronary arteries and localised extreme fatty degeneration (leading to rupture in some cases) had been insisted on by Quain and others many years ago; but to show that the possibility of disturbed coronary circula- tion setting up other morbid states of the cardiac wall (more nearly allied if one may judge from the descriptions given to the conditions forming the subject matter of the present remarks) was an idea which occurred to one of the greatest living masters of our art in the earlier years of his work,