136 VIRCHOW, ON THE COURSE 



determinate influence upon the production of the affection in 

 the spleen, liver, and kidneys. It is usually the case that 

 primary, long-continued disease of the bones, especially caries 

 and necrosis of the larger bones or portions of the skeleton, 

 in their subsequent course, induce cachexia and dropsy, and 

 particularly albuminuria and degeneration of the kidneys, but 

 how is the connexion between the primary and secondary 

 affections to be explained ? Two hypotheses, with respect to 

 this, might be entertained, either the disease in the osseous 

 system may so far interfere with the general nutrition that the 

 constituent elements of the spleen, kidneys, and liver may be 

 deprived of their normal supply of nutriment, and disposed to 

 undergo the amyloid change, or the disease in the bones may 

 actually produce the amyloid matter, which is deposited 

 secondarily in the other organs. In the former case there 

 would be a peculiar metamorphosis, an idiopathic, morbid 

 change in the elements of the spleen, liver, and kidneys ; and 

 in the second an instance of metastasis, in which the glandular 

 organs would be merely the seat of the deposition of the 

 morbid material. 



Hitherto Virchow has not found in the bone itself a sub- 

 stance corresponding to that which occurs in the abdominal 

 glands, whilst he has always detected its presence in the car- 

 tilages. In an aged individual, who presented in many of the 

 joints the changes peculiar to senile arthritis, the pubic sym- 

 physis in particular, towards the interior aspect, was much 

 enlarged, and unusually moveable. When cut across, there 

 was apparent in the middle of it an irregular, vertical fissure, 

 with uneven, somewhat tuberous walls, and without any fluid 

 contents. The layers of cartilage on each side were consider- 

 ably thickened, of a dirty, yellowish colour, and very unequal 

 density ; the parts immediately contiguous to the fissure were 

 more especially softened in places, greasy, and as it were, 

 broken up, so that portions, of considerable size, Avere almost 

 separated from the rest, or were held together only by slender 

 connexions. Microscopic examination disclosed a great variety 

 of constituents. The cartilage cells were generally enlarged, 

 their capsules very thick and wide; in many places consider- 

 able-sized groups of them might be observed in a proliferous 

 state, but in some might also be seen minute, roundish, or 

 flattened corpuscles. Towards the surface of the fissure many 

 cartilage cells were in a state of fatty degeneration, the matrix 

 being, at the same time, transformed into a soft, clouded, 

 streaked, and granular substance, in which the presence of 

 cholesterin was here and there perceptible. In these situa- 

 tions the condition might be described as " atheromatous dege- 



