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Original Department.

FATTY DEGENERATION OF THE HEART WITH ILLUSTRATIVE CASES.

BY J. W. DOWLING, M. D.,

Professor of Physical Diagnosis, Diseases of the Heart and Lungs and Clinical Medicine, New York Homœopathic Medical College.

Any tissue of the body deprived of its normal blood supply will undergo pathological changes.

Any tissue of the body taxed beyond its normal powers of endurance, without sufficient intervals of rest, will undergo pathological changes.

As an illustration of the first of these axioms, might be mentioned the condition which entitles this article; again, oedema of the great nerve center the brain, as a result of imperfect blood supply; and necrosis or softening of local patches of brain tissue, resulting from total loss of blood supply from embolism, or the pressure of a clot left from a cerebral hæmorrhage. Then the familiar condition known as hæmorrhagic infarction of the lung, spleen or kidney, may be mentioned as an example of necrosis from damming of arterial twigs, the result of a thrombus loosened from the valves of the heart or elsewhere. As an illustration of this, I may be pardoned for mentioning a case from my own practice, already reported, of sudden and total blindness of the right eye, from embolism of the central artery of the retina, the clot producing the obstruction having been washed from the aortic valve. The case was one of constriction of VOL. XXII.-1.

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the aortic orifice, the accident occurring during a period of unuusally weakened action of the heart, following a profuse and obstinate epistaxis.

As an illustration of the second axiom, may be mentioned chronic cerebral hyperemia resulting from over mental strain; dilatation and hypertrophy of the heart from long continued over-action and strain of that organ, with subsequent fibroid changes in its walls and valves; permanent dilatation of the pulmonary air vesicles with loss of elasticity of lung fibre and hypertrophy of the inspiratory muscles and ossification of the costal cartilages, as a result of long continued expiratory pressure in the use of the blow pipe, etc. I endeavor to emphasize these two truths, because fatty degeneration of the heart is in nearly every instance the direct result of one of these causes : overstrain, or lack of sufficient blood supply.

Before proceeding to the consideration of our subject it will be well to impress upon the mind of the reader the differentiation between the condition known as fatty deposit or infiltration, and fatty degeneration or metamorphosis. The former is comparatively a harmless condition and results from an abnormal deposit of fat in the connective tissue cells of organs, the fat being derived from the various fat-forming foods, and it is generally a complication of obesity. The latter, when involving vital organs is an alarming and often fatal pathological condition, in which there is actual destruction-deathof the tissues, their place being taken by fat globules, the fat being derived, not from the food consumed, but from cell metamorphosis, and this condition is often found in thin subjects. In the former, the original elements of the tissue are intact, but surrounded by fat, and perhaps hampered in their physiological action by its presence. In the latter, the cellular elements of the tissues are destroyed.

Fatty liver, the result of infiltration with fat, and fatty degeneration of the liver, the result of disease process, are two distinct conditions. In the former, the liver is enlarged by the infiltration, and its function, perhaps, interfered with. In the latter, there is actual degeneration of the liver cells, with total destruction of function in the part involved. So in cases of fatty deposit on, and fatty infiltration of, the walls of the heart, so common in obesity, the muscular elements remain intact, but are hampered by being obliged with every systole to lift the weight of fat deposited upon them; while in fatty degeneration of the heart the muscular fibers of the portion involved are destroyed, their place being taken by fat globules, the result of cell metamorphosis.

In a magazine article it will be impossible to dwell at length on the etiology, pathology, prognosis, treatment and the causes of death, of a disease like fatty degeneration of the heart, which is generally preceeded by grave pathological changes in other organs, and which is in itself the direct cause of pathological changes in every organ of the body. I shall therefore cite a few cases which have occurred in my own practice, afterwards commenting upon them and endeavoring to explain the causes of accompanying symptoms and pathological conditions in other organs. But first I will relate a case, now under observation, of fatty deposit on, and infiltration of the heart, interesting because it had been diagnosed fatty degeneration of the heart, which diagnosis was the cause of the patient's visit to my office.

Mr. J. H., age 45, height 5 feet 4 inches, weight 190 pounds, a professional man of sedentary habits, always blessed with good digestion and a hearty appetite, which he had never attempted to curb, and which had been stimulated with a too liberal use of the milder forms of alcoholic beverages. Of late he has become short of breath on exertion, and for this, his only symptom of ill-health, he consulted a physician, who pronounced his condition, as aboved stated, to be fatty degeneration of the heart. There was no degeneration of the upper border of the cornea, and physical examination demonstrated positive absence of organic disease of any of the viscera aside from slight cardiac hypertrophy-the apex of the heart being a little below and to the left of the normal position. The heart sounds, although obscured by the immense accumulation of fat on the thoracic walls, were pure and distinct. The pulse at the wrist strong and the arteries well filled, the walls showing evidences of hypertension. The arterial sounds in the neck perfectly normal and the urine normal in quantity, of proper specific gravity and free from albumen. The case is one of obesity, with abnormal deposit on the heart and probably along the borders of the lungs, and it is the lifting of this accumulation of fat with every systole, together with the extra effort necessary to overcome the resistance of the tense arterial walls, which has produced the compensating hypertrophy of the heart. He has been under advice one month, the treatment consisting of entire change of diet, the exclusion of alcoholic stimulants of every kind, exercise, at first moderate, but now increased to that suited for a man of ordinary weight. He has lost several pounds of flesh and is now able to ascend stairs with. much less shortness of breath, and on his anti-fat diet, with a continuance of the exercise, I hope soon to effect a perfect cure of his one alarming symptom, which arises not alone from the hampered