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Amyloid Degeneration of the Liver.

Problems:

Synonyms:—Lardaceous liver; waxy liver; amyloid disease; albuminoid infiltration.

Definition:—A condition in which there is a deposit in the connective tissues of the liver, of a substance which is thought to be a form of coagulated albumin.

Etiology:—The condition follows suppuration of other of the body structures, particularly of the bones. It also occurs as the result of syphilis, tuberculosis, or any septic infection, or it may follow chronic malaria, rachitis, and malignant disease wherever located. Experiments upon animals in which micro-organisms have been introduced, have shown as the result of this artificial infection that amyloid change has taken place not only in the liver, but in the spleen. Chronic ulceration, either of the stomach of of the intestinal canal, or of the trachea or larynx, is apt to be followed by this condition. It occurs in adult life, and usually after the age of thirty years. It is more common in men than in women.

Symptomatology:—The most conspicuous phenomenon is that of failing health, with a cachectic or waxy appearance of the countenance, which is pallid, and anemic. There is but little jaundice or pain, but dropsical effusions are apt to appear early. There is a tendency to constipation and jaundice is usually absent, and the feces are clay colored, from deficient secretion of bile. The liver is enlarged, sometimes to twice its usual size. The surface of the gland is smooth and there is generally no great degree of tenderness; the spleen is also enlarged. There are gastrointestinal symptoms, quite marked, and the urine contains albumin and waxy casts, is scanty and high colored with high specific gravity, and deposits urates upon standing.

Diagnosis:—The dependence must be placed upon the symptoms named and upon the history of the case, with the possible presence of infectious disease as a complication.

Prognosis:—The prognosis is unfavorable in all cases. The complications are so serious that recovery is usually impossible. The disease extends over a period of from eight months to two years.

Treatment:—If there are pus sacs to be found anywhere these must be located, evacuated, and if possible irrigated. The treatment must then be directed to the improvement of the blood, and to the rapid elimination of all septic material. The anemia which forms a conspicuous part of this disease must be treated with iron, and other direct restoratives in order to facilitate the carrying of oxygen into the blood. The use of one or more of our excellent vegetable alteratives will produce favorable results. Echinacea stands at the head and with this there is phytolacca, polymnia, stillingia, baptisia, corydalis, yellow dock, burdock, and dandelion, with the specific liver remedies. These may be persisted in for weeks at a time with only good results. For their general tonic effect the glycerophosphates, hydrastis and strychnin will be selected.

Tea, coffee and alcohol in every forrp must be avoided, as must also the fat-forming foods. Oatmeal, stale bread, toast, zwieback, lean meats, fruits and vegetables in season, may be taken freely. These patients should be treated with massage, and the galvanic current, and should have an abundance of exercise in the open air. If their power to resist the cold is not greatly impaired they should sleep in the open air in mild weather.


The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.



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