Similar changes are usually found in the spleen, kidneys, and mucous mem branes of the intestines.
Amyloid disease of the liver is local ized to the tiny blood-vessels at first, to tlie walls of the trabeciilar capillaries; later. of the intralobular capillaries. Amyloid matter forms a solid cylinder of the former arterial walls, with al most total obliteration of the lumen of the vessel. When the liver-cells show changes, these begin near the affected capillaries. Thus it is that specimens may show three layers in a lobide—a narrow periphery of fatty degeneration normal liver-cells in the centre. and be tween t hem t he intermediate layer show ing the changes of amyloid degeneration. The cell-TT:mutations are gradually re• placed by this material. Others claim that the hepatic cells never become amy loid, the changes found. in them being due to mechanical forces alone. The author Tives a dkailed deseription of the histological findings in two cases of ainyloid disease of thc liver. Ilis inves tigations show that amyloid degenera tion is 110t Seen ill tile liver-cells at all. the ehang.es there found being those of compression, deformity, and atrophy, al ways. :secondary and mechanical. B. Auche (Jour. de Ared. de Bordeaux, Sept. l5, 1901).
Prognosis. — The prognosis iS bad. Many, however, claim that a cure is pos sible in the initial stage if the cause is removed.
Treatment. — There is no effective remedy for the disease known; therefore the treatment should be prophylactic.
Tuberculous disease of bones should be treated surgically and cured as soon as possible, as should also chronic suppura tions of all kinds. Syphilis should be vigorously treated. The patient should be nourished and the strength main tained as well as possible.
Fatty Liver.
Fatty liver occurs under two forms: fatty infiltration and fatty degeneration. The former represents a normal condi tion, since liver-cells always contain some minute globules of fat. In this form the particles of fat penetrate the liver-cells, where they coalesce into growing drop lets and push aside the cell-protoplasm and often destroy it by interfering with its nutrition.
In fatty degeneration there is a conver sion of the protoplasm itself of the cell into fat probably by the action of some toxic agents, snch as phosphorus.
Fatty Infiltration.
Symptoms.—There are nO distinctive symptoms. The liver may, if large, be felt to be smooth, soft, not tender, and with rounded edges. There is no jaun dice. Addison long ago drew attention
to a semitransparent, pale, smooth, soft skin, feeling like softest satin, occurring in fatty liver. He considered it almost pathognomonic. And Hebra noticed a similar condition of skin in habitual spirit-drinkers, and in them fatty liver is common.
Diagnosis.—The fatty liver can usually be recognized by its soft, smooth ter and its occurring in the obese or the emaciated. The large amyloid liver is distinguished by being firm, larger, and by the history of the cause and the evi dence of renal disease.
Etiology. — The conditions under which fatty infiltration occurs may be divided into two main classes, strikingly in contrast with one and other. In one class the fatty liver results from dietetic errors, from eating an oversupply of rich food, and as a part of general obesity, chiefly in persons of sedentary habits. The blood is overcharged with fat, of which much is stored in the hepatic cells. The other class consists of cachectic cases, of which pulmonary phthisis fur nishes the greater number. In these, on account of the low powers of oxidation, even the small amount of food that is taken is not properly oxidized and much of it is converted into fat and deposited in the liver-cells.
The autopsy reports at the New York Foundling Hospital studied with special reference to the condition of the liver. These consisted of some 500 cases, and showed that cirrhosis of the liver is very rare in infancy, as is also the condition of waxy liver. A careful study of fatty livers gives, in contradistinction to the ordinary statements given in text-books, the following conclusions: (1) fatty livers occur very frequently in the in fants and children that come to autopsy at the Foundling Hospital,—in about 41 per cent. of all cases; (2) the condition of nutrition of the child apparently has no connection with the fatty condition of the liver, the condition of nourishment in the cases having fatty livers averaging about the same as in the whole number of cases; (3) fatty livers occur rarely in the chronic wasting diseases, such as marasmus, malnutrition, or rachitis and syphilis, unless such condition be com plicated by an acute disease; (4) with tuberculosis fatty livers occur not more often than w ith other conditions; (5) fatty livers occur most often AN ith acute meningitis, gastro-intestinal dis orders, measles, and diphtheria. R. G. Freernan (Boston Med. and Surg. Jour., Oct. 19, '99).