Hypertrophy

“ Hypertrophy does not in all cases involve an increase in bulk; for, just as in atrophy there may be no diminution in the size of the affected organ, so in hypertrophy there may be no increase. This is apt to be the case where certain only of the elements of an organ undergo increase, while the others remain unaffected or are actually atrophied by the pressure of the hypertrophied tissue, as is seen in the disease known as cirrhosis of the liver. ”

“ It sometimes happens, on the other hand, that the atrophy is obscured by an accumulation between the muscle and skin of adipose tissue, and an appearance of hypertrophy rather than atrophy may be produced in consequence, analogous to the same state of affairs in pseudo-hypertrophic paralysis, the relations of which disease to progressive muscular atrophy will be considered under the head of Diagnosis. ”

“ Hypertrophy—Enlargement of the Heart Definition.—An abnormal growth of the muscular tissue of the heart by thickening of the walls.
Varieties.—There are three. Simple Hypertrophy is the thickening of the walls without any change in the capacity of the cavities. Eccentric Hypertrophy is the thickening of the walls with dilatation of the cavities. Concentric Hypertrophy is the thickening of the walls with diminution of the cavities. The lesion is usually associated with other diseases, and especially with affections of the lungs. ”

“ COURSE OF THE DISEASE.—As already stated, a period of paresis may precede all signs of hypertrophy for several weeks, months, or even years. From the time that the enlargement of the calves has once begun about a year and a half is required before the maximum of hypertrophy is attained. Then the disease usually remains stationary for two or three years before the third period is ushered in by aggravation of paralysis in the lower and by extension of paralysis, together with hypertrophy or atrophy, to the upper limbs. ”

“ This kind of hypertrophy develops slowly because the resistance in the circulation is gradual or intermittent. In athletes and in soldiers who are required to march long distances, hypertrophy generally occurs. This hypertrophy, if slowly developed by gradual, careful training, is normal and compensatory. In effort too long sustained, especially in those untrained in that kind of effort, and even in the trained if the effort is too long continued, the left ventricle will become dilated and the usual symptoms of that condition occur. Such dilatation is always more or less serious. ”

“ The plain fact is there is an epidemic of Hypertrophy—Contagious Hypertrophy—which you have about as much claim to control as you have to control the solar system. The thing is as old as the hills. There was Hypertrophy in the family of Anak. Quite outside your range, at Cheasing Eyebright, at the present time there is a baby———"
"Shaky up and down writing. Old gentleman apparently," said Redwood. "But it's odd a baby———"
He read a few lines further and had an inspiration.
"By Jove!" said he. "That's my missing Mrs. Skinner!" ”

“ There may be hypertrophy, in which the entire organ or part becomes larger as a whole, the active cells and stroma sharing alike in the process, or there may be an hyperplasia, in which the active cells of the part proliferate abnormally. When the interstitial tissue alone develops excessively it is known as an infiltration. Under such circumstances the parenchymatous cells often undergo what is termed pressure atrophy; they are diminished by squeezing. ”

“ At the time of report, after recovery from the injury, the patient exhibited remarkable tolerance of great doses of digitalis. When not taking digitalis, his pulse was 100 to 120, regular, and never intermittent.
Hypertrophy of the Heart.—The heart of a man of ordinary size weighs nine ounces, and that of a woman eight; in cases of hypertrophy, these weights may be doubled, although weights above 25 ounces are rare. According to Osler, Beverly Robinson describes a heart weighing 53 ounces, and Dulles has reported one weighing 48 ounces. ”

“ Hypertrophy of the digits is the result of many different processes, and true hypertrophy or gigantism must be differentiated from acromegaly, elephantiasis, leontiasis, and arthritis deformans, for which distinction the reader is referred to an article by Park. ”

“ The actual structural change is the visible effect of the law that over-use of a muscle produces over-growth or hypertrophy. This is not a law of disease, but of purposeful utility, designed to meet emergencies of life. Still there is a further law in nature, that long-continued excessive use of any muscle leads to a form of hypertrophy28 which cannot maintain its vitality, but degenerates. Arteries must be treated as muscles, for their muscular coats contract and dilate, as circumstances demand, under the control of the nervous system. ”

“ The pseudo-muscular hypertrophy of children so strikingly resembles in many particulars the progressive muscular atrophy of adults that the theory of their essential identity could not fail to suggest itself. ”

“ In a case of Eve’s the facial hypertrophy extended to the brain.
In the ordinary forms of congenital hypertrophy [138] the size of the part is augmented by an unequally distributed hyperplasia of the skeleton and soft parts. Almost all the cases narrated in detail are of this kind. In nearly all, the arterial supply is proportionate only to the normal size of the part, and the functional capacity (power, sensibility, &c.) , although not seriously altered, is to some extent deteriorated. ”

“ DEFINITION.—Pseudo-hypertrophic paralysis is a rare and predominantly infantile disease, characterized by a considerable increase in the volume of some or all the muscles of the lower extremities, associated with progressive diminution in their functional energy, and accompanied or followed by paresis and atrophy of the muscles of the trunk and upper limbs. Many of the hypertrophied muscles subsequently atrophy; many of the muscles in which atrophy is the most conspicuous lesion pass through a preliminary period of hypertrophy. ”

“ For our present purpose hypertrophy may be considered as it affects the axile or the foliar organs, and also according to the way in which the increased size is manifested, as by increased thickness or swelling—intumescence, or by augmented length-elongation, by expansion or flattening, or, lastly, by the formation of excrescences or outgrowths, which may be classed under the head of luxuriance or enation. ”

“ It is true of all forms of functional hyperkinesis, that the indefinitely prolonged repetition of the same act leads finally not merely to muscular hypertrophy, but to a ceaseless over-activity of contraction in all the muscles affected. That this hypertrophy and hyperexcitability depend on some organic central lesion is not the necessary sequel. A purely functional exasperation may entail visible augmentation of movement, the cause of which is not central, but lies in the external manifestation of muscular over-activity. ”

“ Examples of physiological hypertrophy are found in the ovaries, uterus and mammary glands, where there is an increased functional activity required at the period of gestation. Local hypertrophy may also be due to stimulation resulting from friction or intermittent pressure, as one may see in the thickenings on the skin of the artisan's hands. ”

“ The term hypertrophy may serve as a general one to comprise all the instances of excessive growth and increased size of organs, whether the increase be general or in one direction merely. General hypertrophy is more a variation than a deformity, unless indeed it be caused by insect puncture or the presence of a fungus, in which case the excessive size results from a diseased condition. ”

“ In the majority of cases the functional power of the enlarged part is not augmented, but true unilateral hypertrophy, i.e., increased tissue hypertrophy with proportionally increased functional activity, is sometimes found. ”

“ In a well-marked case the hands and feet are greatly enlarged, but not otherwise deformed, and the normal functions are not disturbed. The hypertrophy involves all the tissues, giving a curious spade-like appearance to the hands. The feet are similarly enlarged, although the big toe may be relatively much larger. The nails also become broad and large. The face increases in volume and becomes elongated, in consequence of the hypertrophy of the superior and inferior maxillary bones. The latter often projects beyond the upper teeth. The teeth become separated, and the soft parts increase in size. ”

“ There are three aspects in over load training” normal load” “crest load” “over load”
Over load simply means development of Hypertrophy which results from an increase in the intensity of work done in an unit of time and greater the intensity greater the hypertrophy. This says that an activity must always be upgraded to a consistantly higher level through maximal or near maximal stimulation. That is, all work should be performed with a progressively increased load or resistance or with increasing speed or near maximum rate. ”

“ A considerable 23obstacle to the circulation offered by some important structure in a diseased or disordered state, throwing more strain upon the heart, causes hypertrophy of its muscular walls; and this change which is, so far as concerns the primary evil, a remedial one, often entails mischiefs in other organs. ”

“ It has been long known, that the muscle as the result of frequent functional excitation by means of adequate nerve impulses, that is, prolonged activity, is considerably increased in size, whereas in the absence of such it loses more and more in volume. A hypertrophy of activity, produced by functional stimuli, and the atrophy of inactivity, the result of the discontinuance of the functional excitation, is universal and can be observed in the various tissues of our body. ”

“ The majority of cases of hypertrophy of the heart are due to mechanical causes leading to increased resistance and increased work on the part of the organ. Under these circumstances, as in other hollow viscera, the muscle develops, gets thicker and firmer, and capable of accomplishing the extra labor thrown upon it. ”

“ It is a fact of some importance to know, that cerebral hypertrophy may present symptoms indicative of effusion, and may even terminate fatally, yet without any other morbid appearance than extraordinary development of the brainular mass, and with only very little fluid in the ventricles. Instead of effusion, the convolutions of the brain appear flattened from previous pressure, exhibiting increased density of structure. ”

“ In these cases a single measure or practise of any kind, no matter how good or true, when persistently inculcated or exercised without timely and appropriate variation or addition, soon comes to the end of its chief usefulness; for the nature of the human mental and nervous organization predetermines that atrophy and decay in the realm of feeling and willing just as surely follow closely upon the over-exercise which produces an initial hypertrophy, as it does similarly in the physical realm. ”

“ In Ollier’s case [36] the face, thorax, abdomen, and both extremities of one side, were uniformly larger than the corresponding parts of the opposite half of the body, the vascularity of the hypertrophied side was increased, the temperature elevated, and the limbs were more powerful. There were no nævoid growths, and it is noteworthy that in association with an absence of evident abnormality of thoracic, pelvic, and abdominal viscera, the mammary glands preserved their symmetry. The cases of Devouges, Adams, and Finlayson, also presented certain points of resemblance to true hypertrophy. ”

“ No better example of this can be seen than in the case of certain forms of heart disease, where from defect at some of the natural orifices of that organ the onward flow of the blood is interfered with, and would soon give rise to serious embarrassment to the circulation, were it not that behind the seat of obstruction the heart gradually becomes hypertrophied, and thus acquires greater propelling power to overcome the resistance in front. ”

“ But, if we further take into consideration that the influences of the medium are themselves of a manifold nature, each kind affecting the protoplasm with a specific energy of its own, it can be readily conceived that a most complicated molecular disturbance must ensue. This must be all the more the case in a substance in which the forces of the medium have not each their definite, circumscribed, and attuned channel of functional stimulation; but are attacking more or less every part of its circumference. ”

“ The energy of each, whatever be its particular mode, has its source in the breaking up of the protoplasm. Chemical changes, including the assumption of oxygen and the production, complete or partial, of carbonic acid, and therefore also entailing a certain amount of secretion and excretion, must take place in each and every tissue. And so with all the other fundamental properties of protoplasm; even contractility, which, for obvious mechanical reasons, is soonest reduced where not wanted, is present in many other tissues besides muscle. ”

“ The steam from the kettle is like the steam from the boiler, it has molecular energy, and by this will co-operate in the production of mechanical work, if the mechanism be adjusted to it. The molecular energy of the protoplasm in muscular fibre may be indispensable to the movements of the muscles, but these, and not the protoplasmic movements alone, are muscular contractions. An hypothesis, therefore, which is obliged to declare that muscle-fibre and nerve-fibre are not living, even when active in the organism, seems to me defective at its base. ”