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Updated: June 16, 2025


The pain is most marked on rising from the stooping or sitting posture, and may extend down the back of the hip, especially if, as is commonly the case, lumbago and gluteal fibrosis coexist. Once a patient has suffered from lumbago, it is liable to recur, and an attack may be determined by errors of diet, changes of weather, exposure to cold or unwonted exertion.

Chronic dilatation of the heart, However, perhaps not sufficient to cause edema, slowly and insidiously develops from persistent strenuosity, or from the insidious irritations caused by absorbed toxins due to intestinal indigestion. A fibrosis of the heart muscle and of the arterioles gradually develops, and the heart muscle sooner or later feels the strain.

The negative results of tuberculin tests may assist in the differentiation from tuberculous disease, but the more certain means of excising one of the suspected glands and submitting it to microscopical examination should be had recourse to. The sections show proliferation of endothelial cells, the formation of numerous giant cells quite unlike those of tuberculosis and a progressive fibrosis.

If the cause of the increased systemic tension is an arterial fibrosis, sooner or later the heart will become involved in this general condition, and a chronic myocarditis is likely to result.

On dissection, the swelling is found to be made up of dilated, tortuous, and thickened lymph vessels in which the parent worm is sometimes found, and of greatly enlarged lymph glands which have undergone fibrosis, with giant-cell formation and eosinophile aggregations. The fluid in the dilated vessels is either clear or turbid, in the latter case resembling chyle.

From their ranks are recruited a whole army of those secessions from and rebellions against the body at large the tumors, from the treacherous and deadly sarcoma, or "soft cancer," to the harmless fatty tumor, as well as the tubercle, the gumma of syphilis, the interstitial fibrosis of Bright's disease.

Such are fibroid changes in the lungs, emphysema, prolonged chronic bronchitis, the last stages of pulmonary tuberculosis, old neglected pleurisies with cirrhosis or fibrosis of the lung, and repeated attacks of asthma anything, whether valvular defect or pulmonary circulatory disturbance, which increases the pressure ahead and the work of this ventricle.

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