LARDACEOUS LIVER. 691 



mogeneous, with a gray color and very lardaceous lustre. When there 

 is a coincident fatty degeneration, the knife-blade is covered with fat. 

 There is almost always a similar degeneration of the spleen, and not 

 unfrequently of the kidneys also. 



On microscopic examination, the polygonal liver-cells appear round 

 and enlarged ; the fine granular contents, and usually also their nuclei, 

 are atrophied, and the cells filled with a translucent, homogeneous 

 substance. If there be at the same time fatty degeneration, we find 

 small discrete fat globules in the degenerated cells, particularly at the 

 periphery of the lobules of the liver. On the addition of a solution of 

 iodine, there is not a yellowish-brown but a peculiar reddish-brown 

 color ; after the addition of sulphuric acid, there is a violet and subse- 

 quently a blue color of the preparation. 



SYMPTOMS AITD COURSE. The very gradual enlargement of the 

 liver causes no pain ; and the patient's attention is first called to his 

 disease, when the enlarged organ fills the right hypochondrium, and 

 causes a feeling of pressure and tension. Budd considers ascites as a 

 constant symptom of lardaceous liver, and refers it to the compression 

 of the portal vessels. He also believes that, in children debilitated 

 by scrofulous diseases of the glands and joints, the recognition of a 

 painless enlargement of the liver, accompanied by ascites, is sufficient 

 for the diagnosis of the disease in question. In opposition to the view 

 that ascites accompanying lardaceous liver is due to obstruction of the 

 portal vein, Bamberger very correctly says that in such a case there 

 should also be symptoms of congestion in the other abdominal organs, 

 but these never occur. It is far more probable that the dropsy is due 

 to the general cachexia and hydrsemia, from which all patients with 

 lardaceous liver suffer. In the cases observed by J3amberger 9 the 

 ascites was always preceded by oedema of the feet, and in those re- 

 lated by Sudd it does not appear that the ascites preceded the oedema 

 of the feet. The enlarged liver-cells do not compress the bile-ducts 

 any more than they do the blood-vessels, and icterus is absent as a 

 rule. Icterus may, however, result from complications, such as lar- 

 daceous enlargement of the lymphatic glands at the porta hepatis, so 

 that Frerichs warns us against considering the absence of icterus as 

 a diagnostic criterion of lardaceous liver. The faeces have little color, 

 on account of the impaired function of the diseased liver-cells. It is 

 difficult to decide how far the bad nutrition of the patient, the pale- 

 ness of his skin and mucous membranes, the hydrsemia and dropsy, de- 

 pend on the degeneration of the liver, as this disease only occurs in 

 those who are cachectic at any rate, and as the spleen is almost al- 

 ways diseased at the same time, and the kidneys are very frequently 

 ao. The etiology, the hard liver-tumor readily felt on palpation* 



