29 Contrib. to Pract. Med., 1862.
The TREATMENT should be directed to the removal of the cause when possible, as the anæmia, febrile condition, etc. In all cases rest, quiet, and avoidance of excitement are to be rigidly enforced. Sudden exertions may prove instantly fatal. In the cases where there is hypertrophy with or without valvular disease, and the failing compensation is due to this cause, digitalis acts well, and should be combined with stimulants. In the senile and atheromatous cases great care must be exercised: the bowels should be kept loose, and the patient cautioned not to strain at stool or make any sudden exertion. He should lead a very quiet, regular life, and exercise great moderation in food, drink, and venery. Warm and Turkish baths are most dangerous. Iron, arsenic, and nux vomica are remedies from which benefit may be expected. Digitalis is, as a rule, contraindicated. We must remember that, as Sir William Jenner has remarked, fatty degeneration is sometimes a preservative lesion, and induces a due proportion between the cardiac strength and the arterial resistance, reducing the former when there is great atheroma and brittleness of the vessels. The application of blisters is often of use in allaying the pain, and nitrite of amyl should be given in the anginoid attacks.
4. Brown atrophy is a very common degenerative change in the heart-muscle, particularly in the hypertrophied organ of valve affections. In old people and in persons dead of wasting diseases it seems invariably present. When advanced, the color of the muscle is quite distinctive—a dark red-brown and the consistence may be greater than normal. Microscopically, the fibres present a central accumulation of brown pigment, generally arranged about the nuclei and extending up and down the cells. The cement-substance between the cells is often unusually distinct in these cases, and seems more fragile than in healthy muscle. The composition of the pigment has not, so far as I know, been determined, but it is doubtless, like that of the brown induration of the lung and red atrophy of the liver, derived from the hæmoglobin, and possibly, as in these latter conditions, is connected with feeble venous circulation.
5. Amyloid degeneration of the heart is occasionally met with, but rarely in so advanced a grade as to be recognizable macroscopically. It occurs in the intermuscular connective tissue and in the blood-vessels, not in the fibres, and occasionally may be extensive, as in a case mentioned by Ziegler.30
30 Pathologische anatomie, 3te Aufl., Lief. i., §59.
6. The hyaline degeneration of Zenker is sometimes seen in the heart-muscle in cases of prolonged fever. The affected fibres are swollen, homogeneous, translucent, and the striæ very faint or entirely absent.
7. Calcareous degeneration may occur in the myocardium, involving the fibres and forming a definite calcareous infiltration of the protoplasm, as well figured and described by Coats.31 It is a rare condition, whereas extensive calcified plates in endo- and pericardium are by no means uncommon.
31 Pathology, 1883.
Spontaneous Rupture of the Heart.