PRODUCTS, ADVENTITIOUS. 



characterized by the deposition of fat-globules 

 in the cortical substance. Of this alteration 

 he recognises three degrees or stages. In the 

 first, deposition of free fat-globules occurs in 

 the cortical substance, unattended with obvious 

 change in the tubuli or bloodvessels. In the 

 second stage, deposition of yellowish altered 

 fat-globules occurs within the tubuli of the 

 cortical substance; the bloodvessels continue 

 unaffected. In the third stage, deposition of 

 peculiar altered fat-corpuscles takes place in 

 rows in the site of the cortical tubuli ; these 

 tubuli being themselves destroyed in the same 

 manner as the biliary ducts in the most ad- 

 vanced stage of cirrhosis of the liver. More 

 recently Dr. Johnson* has given a character 

 of precision to our knowledge of the relation- 

 ship of fat-deposit to the morbid changes in 

 Bright's disease. He finds : 1. that the epi- 

 thelial cells of the healthy kidney contain oil 

 to a variable amount ; 2. that an excessive 

 increase of this fat constitutes, primarily and 

 essentially, Bright's disease ; 3. that the pres- 

 sure of this fat causes, by a simple mechanical 

 process, the presence of blood and albumen 

 in the urine, and atrophy of the kidney. We 

 are here simply engaged in considering the fact 

 of fat deposition in the kidney, and cannot 

 digress into a discussion on the anatomy of 

 Bright's disease. But we must venture to add 

 that careful observation has shown and conti- 

 nues to show us, that the compound state, 

 known as Bright's disease, (renal alteration, al- 

 buminuria, and dropsy, with the well-known 

 train of secondary morbid conditions,) may 

 exist without any undue deposit of fat in the 

 kidney in any known form or condition. 



(e.) Testicle. The testis is liable to 

 fatty destruction, the fat accumulating in 

 the oil-globule form without and within the 

 tubules. 



(/.) Lungs. Of fatty accumulation in the 

 lungs little is known. We have never seen 

 any condition cognizable by the naked eye, 

 referrible to such alteration of structure ; and 

 have not, even with the microscope, discovered 

 accumulated fat in tubercular lungs, except 

 amid the tuberculous matter itself. Under 

 these circumstances we have regarded the fat as 

 appertaining rather to the tubercle per se, than 

 to the diseased lung ; nevertheless it has ap- 

 peared to us that fat is associated in larger 

 proportion with tubercle of the lung than with 

 that of other organs. 



M. N. Guillot has recently informed the 

 French Institute f that, while the sum of fatty 

 matters contained in the fetal lungs varies 

 from 10 to 18 per cent., it falls to 6 per 

 cent, on the establishment of respiration. He 

 further conceives he has ascertained that in all 

 affections attended with temporary or perma- 

 nent suppression of respiration in a greater or 

 less extent of lung, the ratio of fat increases 

 in the impermeable tissue. The natural ratio 

 of fat to tissue being seldom more than as 

 10 : 100, it may change to even 50 : 100. 



* Med. Chir. Transactions, vol. xxix. p. 1. 1846. 

 f Comptes Kendus, Juillet, 1847. 



Had the author made these deductions from 

 the examination of phthisical lungs only, the 

 fatty elements of tubercle might have been 

 supposed to account for the excess of fat in 

 the impermeable tissue ; but he affirms that in 

 pneumonia the same phenomenon occurs. 



(g.) Arteries and cardiac valves. Of these 

 we have already spoken (p. 87). 



(/i.) Muscles. (1.) Voluntary. In cases 

 of continued inaction the muscles become in- 

 filtrated with fat ; a fact readily ascertainable 

 in those of paralyzed and of rachitic limbs. In 

 old people the muscles of the calf of the leg 

 and the sacro-lumbalis and longissimus dorsi 

 frequently undergo this transformation. It is 

 almost constantly observed in the muscles sur- 

 rounding joints which are the seats of unre- 

 duced dislocation ; and may be seen to ac- 

 company the atrophy produced by anchylosis 

 or other causes, and in the case of old ulcers 

 which have for a length of time interfered with 

 motion. In scurvy the muscles sometimes 

 undergo a similar change. 



In a portion of muscle, appearing to the 

 naked eye totally converted into fat, and 

 weighing 13 drachms, IA drachms were com- 

 posed of muscle, 4 grains of gelatin, all the rest 

 of fat.* The fact, thus chemically shown, that 

 even in the most apparently perfect cases of 

 disappearance of muscular substance, some of 

 this remains, is fully demonstrable with the 

 microscope also. Between and upon the 

 muscular fibres and within the sarcolemma ap- 

 pear fat cells and free oil globules. Gluge has 

 pointed out the existence of saline crystals in 

 rachitic fatty muscles. 



(2.) Involuntary. Fatty destruction of the 

 hearCs substance may coexist or not with de- 

 position of fat underneath the pericardium ; 

 and, as Bizotf has shown, has no connection 

 with superabundance of subcutaneous fat : in- 

 deed this is true of the entire class of fatty 

 changes, of which we are now speaking. The 

 deposition of fat is most common on the right 

 side of the organ, in the ventricle much more 

 than the auricle. 



In these cases there is but a superfluity of 

 natural fat, which encroaches on, and renders 

 soft and atrophous, the proper muscular tex- 

 ture. But there are certain forms of fatty 

 change in which the muscular element itself 

 is the seat of the primary disease, where 

 a mottled dull yellowish aspect of certain 

 portions of the organ is found to depend on 

 accumulation of oil-globules within the sar- 

 colemma. 



(i.) Tendon. Deposition of fat occurs 

 within the sheath, and amid the primitive fibres 

 of the tendons of paralyzed limbs. 



(.) Nerves. The same statement applies 

 to the nerves of such limbs. In cases of atro- 

 phy of the optic nerve, fat accumulates within 

 the neurilemma. 



(/.) Bones. The bones become infiltrated 



* Cruveilhier, Essai sur 1'Anat. Pathol. t. i. p. 186. 

 1816. 



t Mem. de la Soc. Med. d'Observation, t. i. 

 p. 353. 



