Fatty Degeneration Of The Body - The Interdependace Of Diseases. Continued

In Angina Pectoris, again, Dr. Wilks, in common with other observers, has found that "the heart is usually fatty, and the coronary arteries ossified." - (Ibid.)

"It is impossible," says Dr. Ormerod (Op. cit.), "to read any collection of cases of angina pectoris without feeling how much further fatty degeneration goes to explain the symptoms than does any other morbid change usually found on dissection."

Sir James Paget classes the heart and arteries first among the frequent seats of fatty degeneration. - (Op. cit., Vol. I., p. 116.)

Among the vessels of which the coats have been found degenerated are those of the lungs and placenta; and pulmonary or uterine haemorrhages may result from this state of the vessels.

Against the extreme vital depression which accompanies such diseases as peritonitis, influenza, and diarrhoea, the subjects of fatty degeneration have no resisting power; they are among the first to succumb; and thus fatty degeneration becomes a cause of death in these and other depressing diseases when they attack adults.

Out of 164 deaths from Childbirth in the Dublin Hospital during the seven years ending November, 1826, as recorded by Dr. R. Collins, I find thirty-two attributed to rupture of the uterus, and eleven to tedious or difficult labour. Recent investigations into the causes of rupture of the uterus, show that fatty degeneration of its walls is a most frequent if not a constant coincidence.

Fatty degeneration of the uterus, then, is a cause of death in childbirth by producing or disposing to rupture of the organ; but it has yet another influence on these deaths, for we may be quite sure that a degree of degeneration must often exist, not sufficient to lead to rupture, but quite sufficient to render the organ incompetent to vigorous muscular contraction, even under the influence of unusual stimuli. And thus it may become the cause of those hopelessly tedious labours which, as we have seen, assist to swell the death-rate in parturition.

Thus do we see that among the rational causes of dread that haunt the brain of the accoucheur during a tedious labour, fatty degeneration of the uterus has a right to stand foremost.

In Pneumonia, Dr. Wilks says that, in "far the majority of fatal cases, some pre-existing and more chronic disease is found in some organ of the body." - (Op. cit.)

Speaking of the probabilities of death in pneumonia, Dr. Walshe has made the following very well-considered observation: -

"There are certain other circumstances (besides treatment) beyond the control of the physician, which exercise a most indubitable influence on the issue (of pneumonia). Among these the pre-existence of organic disease and the state of health generally of the individual hold an important place. But of all the collateral conditions, age is the most important. While at the two extremities of life, in the new-born infant and in the octogenarian, pneumonia is almost inevitably fatal, the mortality between the ages of six and twelve years scarcely exceeds two-and-a-half per cent." - (Manual of Diseases of the Chest, 2nd edition, p. 438.)

To this I would add, that the octogenarian may be represented at any period of life by the subject of fatty degeneration.

I need hardly remind you that, in protracted Chronic Bronchitis there is no one feature more fearfully prognostic of a fatal issue, sooner or later, than the co-existence of fatty degeneration.

In speaking of Senile Gangrene, Sir James Paget says it occurs, "as its name implies, in the old, and often in those who are old in structure, rather than in years; it affects tissues already degenerate. I think that, in some cases, its beginning may be when the progressive degeneration of the part has arrived at death. But, if this do not happen, some injury or disease, even a trivial one, kills that which was already nearly dead, as a severe injury might kill any part, however actively alive." - (Op. cit., Vol. I., p. 461.)

Under the heads of Liver-disease, Jaundice, and Kidney-disease, I may mention some interesting cases examined by Rokitansky. (On Fatal Steatosis - Fatty Degeneration - of the Liver and Kidneys.)

The cases referred to consisted in steatosis of the liver, accompanied by a high degree of steatosis of the kidneys. Their importance rests upon the possibility of proving them to be parallel to the cases of acute atrophy of the liver, and the analogous renal affection which co-exists with it.

It is evident that in our cases we have not to deal with that steatosis of the liver which occurs so commonly in the course of consuming suppurative processes, but with fatty livers, as they not rarely develop themselves to a high degree, at the side of an abundant formation of fat in the areolar tissue, without the disease being always attributable to gross feeding.

There exists thus a steatosis of the liver, occurring in individuals inclined to the formation of fat, to which sooner or later a steatosis of the kidney is added, both which diseases attain slowly and imperceptibly so high a degree that, finally, a cessation of the biliary and urinary secretion supervenes, and, after a slight degree of icterus, death rapidly sets in from anaemia and a hemorrhagic decomposition of the blood. - (Banking's Abstract, Vol. XXXI., p. 40.)

I might prolong this subject much further - so widely spread is the influence of this seemingly spontaneous atrophy, this Vestige of disease. I might give you quotations from reliable authorities to show in how many more diseases than I have yet referred to, the fatality is determined by fatty degeneration; but I should exhaust your patience and overstep our time. I will, therefore, conclude the list by simply enumerating the causes to which death was attributed in sixty-eight cases analysed by Dr. Quain, in all of which there was fatty degeneration. - (Med.-Chir. Transactions, 1850.)

List of causes to which death was attributed in sixty-eight cases of fatty degeneration.

Rupture of the heart. Cancrum oris.

Exhaustion. Gradual decay.

Coma. Lethargie.

Pleuropneumonia. Haemorrhage into the pericardium.

Syncope anginosa. Cerebral haemorrhage.

Cardiac apoplexy. Diarrhoea.

Syncope. Gangrene of the intestines.

I must briefly remind you, in the words of Sir James Paget, that "Fatty degeneration of the heart often introduces unexpected dangers into the ordinary practice of surgery. It is, I believe, not rarely the cause of sudden death after operations. It is one of the conditions in which chloroform should be administered with more than ordinary caution. They who labour under it may be fit for all the ordinary events of a calm and quiet life, but they are unable to resist the storm of sickness, an accident, or an operation." - (Op. cit., Vol. I., p. 129.)

To sum up; we have seen that this vestige of disease, fatty degeneration, may claim as its victims a certain number of deaths out of each of the following headings of the Registrar's report: -