A system of practical medicine. By American authors. Vol. 5

by Unknown

²⁸ Brit. and For. Med.-Chir. Review, Jan., 1868.

In all of 11 autopsies reported by Pye-Smith²⁹ there were cardiac lesions found. In every case old or recent deposits were observed upon the valves. In two instances the heart was hypertrophied, and in one there was pericarditis. Changes in the nervous system were less often found by this writer. In 1 case there was hyperæmia of the cord, and in 3 cerebral hyperæmia.

²⁹ Guy's Hospital Reports, 1874.

Dickinson found in 22 fatal cases of chorea 17 in which the heart was diseased. “In every instance making up the large tale of cardiac disease there were recent vegetations on the mitral valve, and often also elsewhere.”

In the fatal case of Hutchinson referred to above the heart was found diseased, the aortic valves were incompetent, the leaflets being swollen and softened, and the aorta was atheromatous above the sinus of Valsalva.

Of late years a number of careful autopsies have been made in cases of chorea. The brain and spinal cord have been closely examined, and in almost every instance some lesion has been found in both of these organs.

Steiner reported in 1868 the results of post-mortem examinations in 3 fatal cases of chorea. In 1 case he found cerebro-spinal anæmia, serous effusion into the spinal canal, and proliferation of the connective tissue in the upper part of the cord; and in another hyperæmia of the brain and cord.

Elischer,³⁰ who reports a fatal case in a parturient woman who had an attack of chorea in her eighth year, two in her sixteenth year, and another in a previous pregnancy, found at the autopsy hyperæmia and œdema of the brain and gray substance of the cord. Microscopically, the brain showed fatty, amyloid, and pigmentary changes in the nerve-elements and vessels of the large central ganglia, small secondary extravasations of blood in the connective tissue, and numerous emboli in the smallest vessels, especially in the cortex. In the spinal cord there was seen abundant proliferation of nuclei in the adventitia of the vessels. In the central canal serum was found, and the surrounding connective tissue was harder than usual.

³⁰ Cyclopædia of the Practice of Medicine, Von Ziemssen, vol. xiv. p. 450.

Dickinson has contributed an excellent paper on the pathology of chorea.³¹ He relates the particulars of the autopsies in 7 fatal cases in which he personally made microscopical examination of the brain and spinal cord. He also adds the results of post-mortem examinations in 17 other cases at St. George's Hospital and at the Hospital for Sick Children. In all of the 7 cases in which microscopic examinations of the brain and cord were made there were found hyperæmia of both of these structures, in many instances hemorrhages into the substance of the nervous tissues, dilatation of the smaller vessels, and in chronic cases sclerotic changes in the course of the vessels. “The first visible change,” he remarks, “would seem to be the injection or distension of the arteries, succeeded by extrusion of their contents, to the irritation and injury of the surrounding tissue.” The changes seemed to affect both brain and cord in all cases. The parts of the brain most constantly affected lay between the base and the floor of the lateral ventricles in the track of the middle cerebral arteries, the substantia perforata, the corpora striata, and the beginning of the Sylvian fissures. “Of the cord no region was exempt, but perhaps the cervical and dorsal regions were usually more affected than the lumbar. With regard to the vertical or physiological divisions of the cord, these all, whether white or gray, shared in the vascular destruction; this condition, however, was usually most marked in the vessels belonging to or in connection with the lateral part of the gray matter about the root of each posterior horn. And it is to be observed that this was also the chosen situation of the more definite and special changes, whether hemorrhagic (as in two instances), sclerose, or exudatory. Speaking generally, the chosen seats of the choreic changes are the parts of the brain which lie between the beginning of the middle cerebral arteries and the corpora striata—the parta perforata; and in the cord the central portion of each lateral mass of gray matter comprising the root of each posterior horn.”