35 Barth, Archiv. générales, 1871.
36 This was a case which illustrated well the latency of many cases of fatty heart. The patient was an active merchant, aged sixty, who had never complained of cardiac trouble, and had only a short time before his death effected a reinsurance upon his life for a large amount.
In protracted cases the nausea and vomiting may for a short time lead to the supposition that the case is one of severe indigestion, but, as mentioned above, in the great majority of cases death occurs at once, and in the others there can rarely be any question of diagnosis, and still less of treatment.
Atrophy of the Heart.
DEFINITION.—A diminution in size and weight of the organ, due to degeneration and atrophy of the muscular fibres.
The old writers applied the term phthisis of the heart to this condition. The decrease is always in weight, and usually in size; it is doubtful if there is an atrophic and dilated heart in which, with the wasting, the size is maintained by the dilatation. In many of the degenerations, particularly fatty and fibroid, there is local atrophy of the muscle-fibres and yet the weight and size of the organ are not changed.
The varieties which have been recognized correspond to those of hypertrophy—viz. the simple, eccentric, and concentric forms, but the two latter are probably only conditions of contraction or dilatation in a wasted heart. The post-mortem contraction in the small left ventricle of persons dead of chronic disease may be excessive; and here, as in concentric hypertrophy, the examination must be made with care.
ETIOLOGY.—The atrophy is either congenital or acquired. The congenital atrophy which is most frequently seen in women is in association with defective development of the arterial system and the generative organs. This is occasionally very marked in chlorosis, and is described and figured by Virchow in his monograph on this subject.37 But apart from this general hypoplasia of the heart and vessels in women, we sometimes in the post-mortem room find in a man, dead perhaps of an acute disease and without any cardiac symptoms, a heart small out of all proportion to the size and general nourishment of the body. Many of the older writers mention this. Gowers refers to a case which Allan Burns narrates, in which the heart of an adult was not larger than that of a child of six or seven. Morgagni has a similar observation.
37 Ueber die Chlorose, Berlin, 1872.
The great majority of the cases are secondary or acquired, and are met with in the wasting diseases, as cancer, phthisis, prolonged suppuration, and diabetes. The cardiac wasting is part of the general marasmus which affects the whole body. In about half the cases of phthisis the heart is small.38 In cancer of the pylorus the most extreme wasting has been found. Disease of the coronary arteries is an occasional cause, but it most frequently produces local atrophy or degeneration. Compression by pericardial effusion, fatty infiltration, and pericardial adhesions are mentioned as rare causes.