Fibroid Degeneration.—This condition has been ascribed to a number of causes, among which long-continued excess in alcohol is unquestionably an important one. Bramwell holds the opinion that in a certain proportion of cases of this description, in which fibroid degeneration of the heart is connected with similar changes in the kidneys (sclerosis), the lesions of both organs are due to alcoholism. Alcoholic fibrosis differs in no respect from that due to other causes. The condition may escape recognition by the unaided eye if it be disseminated throughout the muscle and the change consist in thickening of the perimysia around undivided fibres. The heart is larger than normal, perhaps a little paler, and its consistency a little more firm. When, as is more commonly the case, the fibroid change is localized, and masses of new tissue are developed in and around the muscular fibres, the heart assumes a flecked or streaked appearance, due to the contrast between the yellowish-white fibroid tissue and the brownish-red muscular structure. The microscope shows excessive development of fibrous tissue, with atrophy of muscular fibres. The effect is to weaken the force of the heart's action, and to weaken the walls of the cavities at the affected parts in such a manner as to cause local bulgings or cardiac aneurisms.
The symptoms and physical signs of fibroid degeneration of the heart are very obscure and indefinite, and the diagnosis is always attended with difficulty, and in many cases is impossible. Jubel-Renoy, however, regards the diagnosis as having already attained some clinical exactitude, and regards as important the association of the following diagnostic data: first, feebleness of the systole and the pulse, with augmentation of the frequency without irregularity; second, moderate enlargement, varying within considerable limits; and third, absence of murmurs in the greater number of the cases. Death is apt to occur suddenly. Welch, upon investigation of the clinical histories of cases in which fibroid degeneration of the heart was found after death, concluded that they might be clinically grouped as follows: first, cases in which there is no symptom of heart disease; second, cases of sudden death without previous heart symptoms; third, sudden death preceded by one or more attacks of angina pectoris; fourth, after cardiac insufficiency of a few days' standing; and fifth, in cases of old heart disease.
Fatty Heart.—Under the term fatty heart two distinct pathological conditions are comprised. Of these the first is fatty infiltration, which consists in an excessive development of the normal subpericardial fat, with a deposition of fat-cells in considerable number between the muscular fibres of the myocardium. This condition occurs chiefly in individuals suffering from general obesity, and is particularly apt to occur in alcoholic obesity. Large masses of fat fill the grooves and furrows of the organ, the surface of which is covered with a thick layer of yellowish fat. The right heart is first and most affected, but in advanced cases the whole heart may be encased in a thick fatty layer. When the fat-cells infiltrate the intermuscular spaces, they exert pressure which may produce atrophy and degeneration of the muscular elements. This condition may exist to a certain extent without symptoms, but it is, however, apt to be manifested by a certain amount of cardiac dyspnœa and inability to endure excessive strain or acute illness. In cases in which the fatty infiltration attains a high grade, inducing by mechanical pressure degenerative changes in the muscular substance of the heart, there are signs of embarrassment of the circulation. The precise diagnosis is usually difficult, often impossible.
The second form of fatty heart is known as fatty degeneration, and consists in changes in the muscular fibres by which the albuminoid constituents are broken up and replaced by microscopic particles of fat. After a time the transverse striæ disappear, and the functional activity of those muscular fibres which are affected is completely lost. All conditions which interfere with the supply of oxygen to the muscular tissue or which seriously derange its nutrition are capable of producing fatty degeneration. Among these are alcoholic excesses. The color of the heart is paler than normal, usually fawn or pale buff. It has been described as the faded-leaf color. The consistence is softer than normal, the wall of the heart in many instances being readily broken down by the pressure of the finger. The left ventricle is the part most likely to be affected, the papillary muscles being often profoundly altered. Next in order the right ventricle is involved, then the left auricle, and finally the right auricle. When this form of degeneration is due to disease of the coronary arteries, the lesion is usually localized, sometimes limited to the distribution of the branch of the artery which is affected.
Upon microscopical examination the affected muscular fibres are found to contain minute molecules of fat, often of a uniform size, sometimes arranged in rows, but commonly distributed irregularly throughout the substance of the fibre. The transverse striæ are indistinct, and sometimes wholly absent. The functional activity of the affected fibres is seriously interfered with or wholly lost, and as a result the force of the circulation is greatly weakened. These two forms of fatty change are occasionally associated. Among the more common symptoms are shortness of breath upon exertion, with dry hacking cough. In advanced cases the dyspnœa may become constant. The fatal issue is sometimes preceded by the Cheyne-Stokes respiration. Other symptoms are due to cerebral anæmia. The memory is impaired, the patient becomes wayward and irritable, and is apt to become faint upon suddenly changing from the recumbent to the erect posture, and in most instances is incapable of concentrated mental effort or active bodily exertion.
The Blood-vessels.—Capillary dilatation is one of the earliest and most persistent effects of alcohol. The visceral congestions which constitute so important a factor in the pathology of alcoholism are in part the result of the paralyzing action of alcohol on the vaso-motor system, and in part of the degenerative changes in the unstriped muscular fibres of the arterial walls.
Atheroma.—Alcoholic excesses play an important part in the etiology of atheromatous degeneration of the arterial walls, not so much by the direct action of the alcohol itself, as by its indirect action in increasing the tension in the main trunks, and in leading to an irregular life in which excitement, sudden and severe exertion, exposure to cold, and depressing influences of all kinds play a part.
Valvular lesions of the heart do not occur as a direct result of the action of alcohol.
e. Disorders of the Genito-urinary Apparatus.—The Kidneys.—Alcohol, as has been shown above, is a diuretic. In large doses it produces renal congestion. Ollivier36 observed acute transient albuminuria resulting from the influence of excessive doses of alcohol.