albuminoid, or lardaceous degeneration is a common lesion in the child, and the liver is often found to be enlarged from this cause. The liver, however, may not suffer alone. The spleen commonly, and the kidney frequently, are also affected ; and often there is a similar condition of the lymphatic glands.
Causation.—The degeneration is always secondary to a general cachectic condition. It occurs sometimes in syphilitic children, and may be a conse quence of scrofula and tubercle. The commonest cause is, however, the existence of chronic suppurations and purulent discharges. In fibroid in duration of the lung, where there is a copious secretion in the dilated bron chi, amyloid disease is a familiar symptom ; and in cases of empyema, in early life, if a chronic fistulous opening become established, lardaceous de generation of organs very generally follows.
Morbid Anatomy.—The amyloid liver is uniformly enlarged, heavy, and excessively dense. Its edge is thin and resisting ; its peritoneal coat very smooth and tense. The section is dry and homogeneous looking, of a gray colour and a glistening bacony appearance. No blood oozes from the cut surface. If, as sometimes happens, there is concurrent fatty degeneration, the knife after the section may look greasy. The seat of the disease in the liver has been disputed. According to Illeckel and Virchow it affects the liver-cells, while Wagner and others are of opinion that the amyloid change is confined to the capillaries, and that the cells are merely atrophied. Ac cording to Rindfleisch, the morbid process begins in the arterial zone of the hepatic lobules, half way between the centre of the lobule and the circum ference, and implicates the arteries, the capillaries, and the hepatic cells. It then spreads to the centre and afterwards to the circumference of the lobules. Kyber, too, declares that he has recognised the change in unmistakable liver cells which he had isolated by pencilling. According to this pathologist, the trunk and larger branches of the hepatic artery are never affected, the morbid process being confined to the smaller' hepatic arteries ; but the change may be detected in the hepatic and portal veins, and even in the vena, cava. The affected arteries and capillaries are diseased in various degrees.
When the amyloid process is advanced in a vessel, its coats become thickened and pellucid ; and the affected hepatic cells lose their normal shape, their granules, bile-pigment, and nuclei, and become irregular and glassy looking. The addition of iodine solution stains the affected parts of a reddish brown colour, and sulphuric acid turns them first violet and afterwards blue.
Symptoms.—Although the enlargement is perfectly painless, the organ may produce inconvenience by its weight. It causes distention of the belly ; but as there is no compression of the bile-ducts or of the branches of the portal vein, there is no necessary jaundice, ascites, or prominence of the superficial abdominal veins. All these symptoms may, however, be found.
The mesenteric glands, like other internal organs, frequently participate in the amyloid degeneration ; and if the glands occupying the hepatic notch are enlarged, they may compress both the bile-ducts and the blood-vessels at this spot. In such a case, the skin, conjunctiva, and urine are jaundiced ; there is some effusion into the peritoneum, and the veins of the abdominal parietes are dilated. Even in the absence of jaundice, the stools may be light-coloured if the disease is advanced, owing to impaired function of the hepatic cells.
On palpation of the belly, the liver is found to project several fingers' breadths below the margin of the ribs. Often its lower edge is on a level with the navel ; sometimes it reaches to the crest of the ilium. Its sub stance feels firm and resisting, and its edge remains thin and sharp. There is no tenderness on pressure. In at least half the cases, the spleen, too, is enlarged, and can be felt several fingers! breadths below the ribs on the left side.