642 



ADNOUMAL CONDITIONS OF THE HEART. 



lesion which has been sometimes designated 

 " aneurisma herniosum," and sometimes 

 " internal mixed aneurism." This form of 

 arterial aneurism has been described by Ilaller, 

 Dubois, Dupuytren, and Breschet. 



In a large number of these cases of aneu- 

 rism of the heart, the pericardium has been at 

 some period or other of the disease more or 

 less extensively inflamed, and adhesions are 

 consequently found : the endocardium like- 

 wise frequently exhibits marks of inflammatory 

 action, opacities, white spots, &c. and this 

 sometimes extends to the valves. In some the 

 muscular substance in the neighbourhood of 

 the sac is degenerated, and assumes the cellulo- 

 fibrous form.* 



Atrophv of the heart. The heart, or a por- 

 tion of it,' may be said to be in the state of 

 atrophy, when its muscular fibres are pale, 

 soft, easily torn, inelastic, attenuated, so that 

 the thickness of the parietes is greatly di- 

 minished, and the pericardium covering the 

 heart or the atrophied part of it, is shrivelled 

 and wrinkled. When atrophy affects the whole 

 heart, that organ becomes much diminished in 

 size, the capacity of its several cavities being 

 proportionally diminished ; and in some in- 

 stances the diminution of the general size ap- 

 pears to be more at the expense of the dimen- 

 sions of the cavities than of the thickness of 

 the walls. 



Morbid deposit of Jut on the heart (fully 

 degeneration of some authors). There is an 

 alteration met with not uncommonly in the 

 muscles of animal life, which is very often de- 

 scribed as the fatty degeneration of muscle, 

 but which is in truth an atrophy of the mus- 

 cular tissue, and not at all a transformation into 

 fat. This condition, which resembles fat only 

 in its yellow colour, and may be easily 

 distinguished from it by its fibrous form, has 

 never, I believe, been met with in the heart ; 

 a perfect cessation from active contraction must 

 be essential to its production ; and as such a 

 state of quiescence cannot occur in the heart 

 during life, this form of degenerate muscular 

 tissue is not found in that organ. \V'e do, how- 

 ever, meet with cases frequently, in which fat 

 seems to take the place of the muscular fibres 

 of the heart: in proportion as they appear to 

 waste away the fat is deposited under the 

 serous membrane, until the muscular parietes 

 of the heart are reduced to a vety thin lamina, 

 of a pale colour and easily torn, between which 

 and the pericardium a thick stratum of fat is 

 deposited, so that a superficial examination 

 might lead one to suppose that the walls of the 

 heart were wholly converted into this tissue. 

 The ventricles are generally, if not uniformly, 

 the seat of this deposit, which must be re- 

 garded as an increase in the deposit which is 



* On the subject of aneurisms of the heart, the 

 reader may consult with benefit Corvisart's clas- 

 sical work, Adams in Dublin Hosp. Rop. vol. iv., 

 lircschrt sur 1'Aneurysme Faux consecutif du 

 {'itur. Rep. Gen. d'Anat. t. iii., Dr. Hope's work, 

 lilliotson's Lectures on Diseases of the Heart, but 

 especially the admirable paper of Mr. Thurnum. 



found naturally along the course of the coro- 

 nary arteries. It occurs chiefly in old persons, 

 and it is difficult to say whether the muscular 

 atrophy which is always present is a con- 

 sequence of the fatty deposit, or precedes it. 

 So enfeebled has the muscular tissue become 

 that persons labouring under this disease very 

 commonly die of a rupture, or rather a giving 

 way, of the wall of one of the ventricles. It 

 occurs in persons of debilitated habits, who 

 either are incapable of active exertion or from 

 circumstances never attempt it, and, what is 

 remarkable, the subjects of this disease are 

 frequently very emaciated : thus M. Bizot* 

 found this condition in fourteen out of twenty- 

 nine emaciated females. The disease is like- 

 wise more common in women than in men ; 

 and sometimes free oil is present in the blood 

 in inordinate quantity. 



Such I believe to be the correct history of 

 this state of the heart, of which most erroneous 

 notions have been formed, owing in a great 

 measure to the name under which the disease 

 has been so often described. Tlie description 

 which I venture to offer has been drawn up 

 from several cases of the disease in various 

 grades of the deposit, which have come under 

 my observation, and on comparing this 

 description with some of the best detailed 

 cases on record, it seems perfectly to con- 

 sist with the appearances described in them. 

 In Mr. Adams' case,f for instance, " the 

 right ventricle seemed composed of fat, of a 

 deep yellow colour through most of its sub- 

 stance". The reticulated lining of the ventricle, 

 which here and there allowed the fat to appear 

 between its fibres, alone presented any ap- 

 pearance of muscular structure. The left ven- 

 tricle was very thin, and its whole surface was 

 covered with a layer of fat. Beneath this the 

 muscular structure was not a line in thickness, 

 and was soft, easily torn, and like liver." Two 

 cases, recorded by Mr. R. Smith,} presented 

 the remarkable concomitant of an oily con- 

 dition of the blood; in one " numerous glo- 

 bules of oil were found floating on the surface 

 of the blood which escaped from the divided 

 vessels ;" and in the other " the surface of the 

 blood was thickly covered with globules of 

 limpid oil." In this last case the condition 

 of the heart's substance is described as follows : 

 " the heart was remarkably soft, pale, and 

 flaccid, its substance most easily broken, and 

 its surface covered with a layer of fat a quarter 

 of an inch in depth ; the parietes of the ven- 

 tricles were thin." The anatomical condition 

 of the former case is not so precisely described 

 as to admit of comparison. The subjects of 

 both these cases were old women, one aged 

 ninety, the other seventv ; and the former died 

 of rupture of the left ventricle. 



I am quite unable to account for the follow- 

 ing description of a case by Dr. Elliotson. 

 He says, " I once saw the muscular substance 

 of the heart completely changed, except ut the 



* Mem. de la Soc. Med. d'Observatinn. 

 f Dublin Hosp. Rep. vol. iv. p. 396. 

 $ Dublin Journal, vol. ix. p. 412. 



