HYPERTKOPHY OF THE LIVER. 143 

 I. THE WAXY, LARDACEOUS, OR AMYLOID LIVER. 



HISTORICALLY. The ancient physicians had but an 

 obscure idea of this form of disease. Stahl and 

 Bcerhaave, described this and other forms of enlarge- 

 ment as infarctions, obstructions, and engorgements. 

 Portal sub-divided these engorgements into an albu- 

 minious, gelatinous, and a mucous variety. Andral, 

 as hypertrophy ; Budd, as scrofulous enlargement : it 

 was, however, left to that brilliant pathologist, Carl 

 Eokitanski, of Vienna, to give us a clear description of 

 the essential characters of this waxy or lardaceous 

 degeneration, and its pathogenetic relations to certain 

 cachectic conditions of the body. 



ANATOMICALLY. -Waxy degeneration of the liver 

 commences in the glandular cells; the organ is enlarged, 

 the increase of size taking place chiefly in a lateral 

 direction; it edges are flattened and swollen, the 

 peritoneal covering is smooth, shining, transparent, and 

 tense; the structure is soft, and pits on pressure; its 

 colour, internally and externally, is uniformly yellowish 

 red, or light yellow, resembling that of "autumnal 

 foliage ;" the structure is pale and exsanguine, and 

 contains a large amount of fat, as evidenced by the 

 greasy deposit when cut with a dry warm knife, or as 

 proved by submitting the liver to a high temperature. 



This disease then consists in a deposit of fat in the 

 substance of the liver, and to such an extent as notonly 

 to replace the true glandular structure, but to penetrate 

 and permeate the entire organ, to the exclusion of the 

 vascular tissue. In the early stages of this affection the 

 various signs just alluded to are less marked. 



