Case of fatty infiltration of the heart in a woman of 40, weighing 220 pounds, who had been asthmatic and suffered from delirium cordis, and, from time to time, anginoid attacks. Similar case in a woman of 50, who weighed 310 pounds, in whom there was, besides, extreme dyspncea, cyanosis, and exhaustion on exertion. In the latter appropriate treatment reduced the weight 125 pounds, and the patient recovered. Fatty infiltration of the pericardium probably existed in this and other cases reported in which reduction of weight caused very marked improvement. An ders (Amer. „lour. Sci., Apr., 1901).
The nutrition of the body and the maintenance of it at a given weight are regulated by a nervous mechanism, in the same way that the heat of the body is controlled. It is essentially a condi tion of altered metamorphosis closely allied to gout, diabetes, ehlorosis, myx cedema, and arrests of development. Habitually more food is taken than is needed to maintain the nutrition of the tissues and in the ordinary oxidation for the production of energy. The re maining food is oxidized and gotten rid of under the regulating influences of the nervous system. Debove (La Semaine .Mar. 13, 1901).
Fatty degeneration of the heart di vided into three stages: The first stage is that one in which the prognosis is most favorable; that is, if the patient does not yield to the primary disease he will probably recover with a sound heart if properly treated. In the second stage prognosis is not good for total arrest of the fatty process, but much improvement may be brought about. The third stage is marked by profound implication of the internal viscera. the prognosis is unfavorable, and the end may be expected within a few months. Fatty degeneration of the heart is a common affection; it is not to be classed as a disease Rui geneav, but as a process attending non-valvular as well as valvular affections. It is caused by fevers. toxxmias, dyscrasias, disorders of nutrition, and mechanical injuries, but it may he a physiological process, as in senility or after parturition. T. E. Sattertlrwaite Medical News, Feb. 2, 1901).
Under the head of fatty heart there are at least two different conditions: There is the small heart, free from ac cumulation of fatty tissue upon its ex terior, which is degenerate through out,—to such an extent, indeed, that the apex of the ventricle may consist of nothing but fat. There is, again, the large, heavy, thick heart, which is over laden with fat deposited beneath the pericardium, which fills up both the transverse and longitudinal sulci, and which penetrates between the muscle fibres of the organ, finally involving the fibres themselves. B. Hirsch (Wiener
med. Wochen., :March 22, 1002).
Prognosis.—Cases in which fatty de generation has not as yet been set un afford a favorable prognosis, especially if the cause be removable. On the other hand, in long-standing cases of excessive obesity, more or less fatty change of the muscle-fibre may be safely inferred to exist, and the outlook is dubious, though much will depend upon the special cause and its degree of removability, as well as the presence or absence of serious complications. Among the latter, the more important are arteriosclerosis, al buminuria, glycosuria, anginal attacks, pulmonary congestion, oedema, and the like. Permanent results are not always attainable in cases dependent upon the patients' habits, since the latter are liable to relapse into them after a variable de gree of improvement.
Treatment. — PROPHYLAXIS. — Al though such cases generally first come under observation too late to receive the benefits of prophylactic measures, there are, nevertheless, many favorable oppor tunities presented to the wise family physician to attend to this important matter, even in the earlier years of those showing an hereditary predisposition to obesity. The fat-forming foods, particu larly the carbohydrates, must be greatly restricted in the dietary. The amount of drink must also be diminished, as a rule. Fats and proteids are allowable, and their proportions must be regulated ac cording to the amount of muscular ac tivity. Systematic exercise, in the fresh, open air, along with cool baths, are meas ures to be adopted. Persons in middle life who manifest a predisposition to cor pulency should be cautioned against all imprudences in eating and drinking; they should pursue a prescribed dietary, in which not only the character, but the quantities of the various substances al lowed should be noted. If there be the slightest tendency toward anemia, an open-air existence, short of injurious ex posure, is imperative. Gymnastics and out-door sports, if wisely regulated, should play a part in the prophylactic management of these cases. If anemia be associated with fatty overgrowth, then greater care and caution must be exer b cised in recommending physical exercise, the amount of liquid may be much di minished, and the fat-forming dishes should be rigidly excluded. I have long been prescribing arsenic, strychnine. and iron, in small doses, in such cases.