Pathology. — The process may be either general or localized. Thus, when circumscribed it may be limited to the uppermost or subpericardial layers, as when induced by pericarditis. The same minute foci and yellowish grim may be observed in the superficial subendocar dial layers, especially in the trabeculw of the papillary muscles ("tabby-cat" stri ation). Blocking of one of the branches of the coronary artery (as a rule, the anterior) by a thrombus or embolus leads to the production of an anemic necrosis or white infarct, which is often composed of fatty debris.
In general fat-degeneration the mus cular substance throughout presents a pale- or a light- yellowish appearance, and is quite friable, the finger being readily thrust into it. Rarely, the color tint is brownish in circumscribed areas from associated brown atrophy.
The various chambers of the heart are often enormously dilated with marked overstretching of the intracardial ori fices. Coronary-artery diseases and atheroma of the arch of the aorta are among the most constant associated le sions.
In fatty degeneration the sarcous sub stance of the fasciculi is directly con verted into globular fat, as contrasted with the condition of fatty infiltration, where the fat is deposited between the fasciculi.
There is only one condition—namely, phosphorus poisoning—in which fatty degeneration of the heart can be said to occur with sufficient regularity or in sufficient amount as to be of signifi cance. Krehl (Dent. Archly f. klin. Med., B. 51, S. 417).
The occurrence of fatty degeneration of the myocardium in certain diseases in human beings is even at this time ques tioned by some authors. Notwithstand ing the recent study and criticism of Krehl, it must be admitted that there are disease processes in human beings in which it is often present, and that in one class of affections—namely, chronic heart disease with hypertrophy and dila tation of the organ—there can be no doubt of the common occurrence of fatty degeneration. The endeavor to make a fatty metamorphosis of the pro teid constituents and cells dependent on the diminution of the oxygen supplied to them has not met with success. In the anmmias which occur in human be ings, and can be produced experimentally upon animals, fatty changes are often absent or occur in only inconsiderable degree; and the effect of fever alone is all but established to have a relatively slight importance in bringing about such changes as act injuriously upon the heart's function. Therefore it seems un
avoidable to connect with the occurrence of fatty degeneration in its severer forms in the infectious diseases of man and animals a disturbance of cell-metab olism more nearly like that which phos phorus intoxication induces. The re searches of Voit, Bauer, and others have shown that the fatty change is pro duced out of the proteid constituents and the cells. Flexuer (Johns Hopkins IIosp. Bull., Mar., '94).
Microscopically, the cell-fibres are ob served to be displaced by minute gran ules and oil-globules, the latter first making their appearance at the poles of the muscle-nuclei; the striae and nuclei become indistinct, and finally are wholly lost. The characteristic brown granules of brown atrophy may sometimes be visible, either at the extremities of the nuclei or uniformly distributed. The microscopical appearance of fattily degenerated muscular tissue is sometimes confounded with albuminoid degenera tion, but the form may be distinguished by the characteristic brown coloration when stained with osmic acid, and also the fact that on treating a section with acetic acid the fat-globules are not thus affected, while the albuminoid granules are dissolved.
It is questionable whether an ordi nary microscopical examination of por tions of the heart-muscle suffices for an absolute recognition of fatty degenera tion. Chemical examination strongly recommended. Iirelil (Dent. Archiv f. klin. Med., 13. 51, S. 417).
Prognosis.—This is unfavorable. The increasing liability to sudden death must be steadily borne in mind (Tyson).
Case of rupture of the heart observed occurring during the act of passing a soft-rubber stomach-tube for purposes of lavage in the treatment of a gastritis from which the patient was suffering. The patient was a woman, 60 years of age, and not particularly stout. The tube had just been passed into the stom ach, without any excessive retching or straining on the part of the patient, when suddenly a pallor spread over the patient's face and her eyes rolled up. The tube was immediately removed, the patient was placed on her back, and every possible means used to resuscitate her, but she was dead. At autopsy the heart was found ruptured. Extensive fatty changes of the heart and liver were found. Greig (Canadian Practi tioner, p. 81, Feb., '98).