DYSCRASIC NATURE OF THE AMYLOID DEGENERATION". 421 



goes a chemical alteration in its fluid constituents, than that 

 it contains the pathological substances in a material form. 



At all events it is unquestionable, that the amyloid 

 change even now holds a very high place among patho- 

 logical processes. The inevitable result of the affection 

 is, that the parts which are the seat of it, become totally 

 incapable of discharging their special functions ; that, 

 for example, gland cells which are changed in this man- 

 ner, are no longer in a condition to perform their special 

 glandular functions, and that vessels can no longer 

 subserve the nutrition of the tissues, or the secretion 

 of the fluids, the duties they had been in the habit of 

 performing. 



These considerations afford a ready explanation of the 

 circumstance that clinical disturbances so regularly con- 

 cur with these anatomical ones. We find, on the one 

 hand, well-marked conditions of cachexia, and on the 

 other, with extreme frequency, dropsy with the whole 

 complex group of changes, which are usually included in 

 the idea we form of Bright's disease. In nearly every 

 instance, in which the amyloid affection reaches an ad- 

 vanced stage, the patients are in a state of great maras- 

 mus. There are cases where the whole extent of the 

 digestive tract from the buccal cavity to the anus does 

 not contain a single minute artery, which is not affected 

 with this disease, and wherein every part of the oeso- 

 phagus, stomach, small and large intestines, the small 

 arteries of its mucous membrane are found changed in 

 this way. 



Now this state of things is very apt to escape obser- 

 vation, because this kind of metamorphosis, which 

 exercises such a decided influence upon the functions 

 of the intestines (causing deficiency of absorption, an<^ 

 tendency to diarrhoea), produces scarcely any effect per- 

 ceptible to the naked eye. The intestines are pale and 



