Amyloid Liver.

Synonyms.—Waxy Liver; Lardaceous Liver.

Definition.—A deposit of starchy-like material in the substance of the liver.

Etiology.—This is a part of a general and peculiar degeneration, in which the spleen and kidneys are frequently involved. It may be congenital, although it is usually associated with prolonged suppurative processes, especially of a tubercular nature, and where the bones are involved. Next in frequency is syphilis, either hereditary or acquired. It is also found associated with chronic malaria, rickets, ulceration of the rectum, cancer, and other affections, characterized by depravity of the blood.

It occurs more frequently in men than women, and between the ages of twenty and forty, although it may occur at any age of life.

Pathology.—The organ is of exaggerated size, sometimes double that of health, is symmetrical, smooth, and edges rounded. The color is pale yellow or mottled. On section, the liver is found tough and resisting, and, when treated with an iodine solution, stains a mahogany-brown color. The capsule is tense, smooth, and glistening.

Symptoms.—There are no characteristic . symptoms of this form of degeneration. There is no jaundice, although the stools may be light or clay-colored. The patient is pale or waxy, there is anemia, and, in the advanced stage, dropsy.

Digestion is impaired; there is loss of appetite, furred tongue, eructation of gas, nausea, and sometimes vomiting. Constipation ' is the rule early in the disease, and diarrhea later. The urine is scanty, high colored, and contains albumin and waxy tube-casts, due to degeneration of the kidneys. There is .usually but little, if any, pain, and no fever.

The physical examination reveals enlargement of the liver to the extent of bulging in the right hypochondrium. The edges are sharply denned. There is generally enlargement of the spleen in most cases, due to the same degeneration.

Diagnosis.—The history of the patient previous to the enlargement of the liver is of great diagnostic value; this, with enlargement of the organ, absence of pain, and tenderness, general anemia with dropsy, and increase in size of the spleen, and albuminuria, renders the diagnosis comparatively easy.

Prognosis.—This is unfavorable, the disease extending over a period of months or years, but always progressive. Death results from anemia, kidney complications, pneumonia, dysentery, or exhaustion. Dropsy is usually marked at death.

Treatment.—In the treatment of amyloid liver, we are to remember that back of the disease is a depraved blood from syphilis, suppurative processes, malaria, etc., and that only in so far as we are able to correct these wrongs will we be able to stay the process of degeneration. Recognized late in the disease, we have no specific for the degenerated condition, and our efforts are directed to correcting the wrongs of the blood. In this way we prolong the patient's life, but a permanent cure is not to be encouraged.

Suppurative bone lesions are to be corrected, when existing,—anti-syphilitics, such as echinacea, Donovan's solution, stillingia, corydalis, etc., when due to syphilis, and quinia when due to malarial wrongs. Having accomplished these ends, such remedies as echinacea, nux vomica, hydrastin, polymnia, stillingia, rumex, iris, phytolacca, etc., will be used.

A nutritious diet of nitrogenous articles, with a minimum amount of fat and plenty of fruit, will give the most favorable results. Exercise in the open air should form an important part in the treatment. Alcoholic stimulants should be avoided. Farinaceous, starchy foods, and sugar, should also be restricted.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.