690 DISEASES OF THE LIVER. 



sions, with the most moderate manner of living, have not, by any 

 means, the same effect. Several very crude hypotheses have been ad- 

 vanced concerning the action of the alkaline-saline springs ; the body 

 of a Karlsbad patient has even been compared to a soap-factory, and 

 the characteristic passages have been regarded as soap, which was said 

 to be formed from the soda of the waters and the fat from the body. 

 We should not, however, wait to find a better explanation, but should 

 send fatty patients with fatty infiltrations of the liver to those water- 

 ing-places. This is occasionally very erroneously done with patients 

 whose fatty liver depends on decided emaciation, because the patients 

 or the physician do not recognize the significance of the disease. It 

 is unnecessary to state the contraindications to the use of the alkaline- 

 muriatic springs. If the blood be impoverished, we should carefully 

 try if the Eger Franzensbrunnen, or the Kissengen Ragoczy waters, 

 are borne, and, if they are not, we should be satisfied with regulating 

 the diet and mode of life. This rule refers also to those cases where 

 patients with fatty liver are inclined to diarrhoea. 



CHAPTER VII. 



LARDACEOUS (OR WAXY) LIVER AMYLOID DEGENERATION OF TUB 



LIVER ( Virchow). 



ETIOLOGY. Lardaceous degeneration of the liver depends on a 

 deposit in the liver-cells and in the walls of the hepatic vessels ( Wag' 

 ner) of a substance whose nature we do not yet know, but whose re- 

 action to iodine and sulphuric acid closely resembles that of amylum 

 and cellulose. From this similarity of chemical reaction, which may 

 perhaps, be accidental, the title of " amyloid degeneration " has of late 

 been given to that state which was formerly called " lardaceous degen- 

 eration," from its external resemblance, but particularly from its pecu- 

 liar lustre. 



Lardaceous liver never occurs in persons otherwise healthy ; it is 

 more apt to occur in advanced cachexia, particularly in cases resulting 

 from scrofulous, cachectic, or syphilitic affections, from mercurialism, 

 tedious suppurations, and caries of the bones ; it is also occasionally 

 found in patients with pulmonary consumption ; in some cases it is in- 

 duced by malaria. 



ANATOMICAL APPEARANCES. A lardaceous liver is usually de- 

 cidedly increased in size and weight, and resembles fatty liver in form, 

 as it appears elongated, flattened, and thickened at the edges. The 

 peritoneal covering is smooth and tense, and the liver is hard as a 

 board. The cut surface is very dry and bloodless, smooth, almost ho- 



