The Fatty Changes. 197 



arated. infiltration as a relatively unimportant accumulation of fat 

 from deposition, the fatty degeneration as a serious and eventually 

 fatal process of disintegration with the appearance of fat, for one 

 reason or another, in the degenerative protoplasm.] 



Ribbert declares that the pathological essence of fatty metamor- 

 phosis is to be sought in the fact that the cells have undergone a 

 retrograde change which renders them incapable of further dealing 

 with the fat obtained from the blood, or that the cells actually 

 synthesize the carbohydrates, and possibl)' the albumen api^ropriated 

 from the blood, into fat, but cannot further deal with it, so that it 

 is not oxidized and remains unchanged. According to this view the 

 process is essentially one of disturbance of metabolism. The rela- 

 tion between pathological fatty degeneration and metabolic faults 

 is apparent, moreover, in the fact that it is especially likely to occur 

 whenever the processes of oxidation are impaired in the body ; as 

 in all disturbances accompanied by diminution in the red cells or 

 in the haemoglobin of the blood, the means of oxygen distribution ; 

 in general olig?emia caused liy blood loss or affections of the alimen- 

 tary tract ; in parasitic anremias and in local aucemias ; in the fatty 

 changes commonly resulting from imperfect vascularization and 

 its accompanying local anaemia, particularly in rapidly growing 

 tumors (carcinoma and sarcoma). Destruction of the erythrocytes 

 and consequent diminution of the oxygen content of the blood, or, 

 too, reduction in oxygen appropriation by the cells of a tissue be- 

 cause of some alteration, may result from various toxic causes ; 

 in these there arise, as important or associated lesions, fatty de- 

 generation of the liver, kidneys, myocardium and other structures. 

 If sets in with especial intensity and rapidity in phosphorus poison- 

 ing, in which the liver is usually dift"usely degenerated (phosphorus 

 liver), in poisoning with arsenic, antimony, iodoform, phenol and 

 in severe biliary intoxication of the blood (icterus). Bacterial 

 toxines in the circulating blood in infectious diseases likewise occa- 

 sion this metamorphosis. 



In regard to excess of fat in the tissue there does not obtain 

 any sharp limit between the physiological and pathological grades. 

 "Marked general increase of adipose cells gives rise to a condition 

 of corpulence or obesity (ob-edere, to eat up), adipositas (adeps. 

 fat) or lipomatosis { x/ttos, fat). Peculiarities of metabolism here, 

 too, are essential basic factors, occurring in individuals both as 

 congenital and acquired faults and arising after atrophy of the 

 sexual glands or after castration. 



