On a case of syphilitic affection of the liver / by T. Grainger Stewart, M.D.

  • Stewart, Thomas Grainger, 1837-1900.
Date:
1864
Catalogue details

Licence: Public Domain Mark

Credit: On a case of syphilitic affection of the liver / by T. Grainger Stewart, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    segments; the aorta was very atheromatous. The lungs were ex- tremely oedematous ; the brouchi were congested, and full of mucus. The liver was about the natural size; on its surface were a number of nodules and cicatrices; at the bottom of some of the latter nodules ■were visible. On section, numerous nodular masses were found scat- tered throughout the organ; they were pale in colour, dense in struc- ture, and in their general appearance closely resembled bees'-wax. Their structure was very much denser than that of the surrounding tissue. In some nodules there were streaks of fibrous tissue through- out the substance and round the margin ; and the greater the propor- tion of these tissues, the deeper were the cicatrices. In the nodules ■whicli were elevated above the surface there were no such streaks, or very few; in those situated at the bottom of deep cicatrices the fibrous element was abundant, or even iu excess of the glandular. The fibrous bands passed into the tissues around the cicatrices and nodules. On applying iodine to these masses, the whole of the waxy-looking material assumed the brownish-red colour characteristic of the amyloid degene- ration ; but the fibrous streaks simply assumed a yellow tinge. On microscopic examination, the masses were found to be composed of amyloid or waxy hepatic cells; enlarged, transparent, and finely granu- lar. In some parts the cell-elements were broken down, and a finely granular material, containing some oil-globules, was present. The fibrous tissue in the masses presented exactly the characters of ordi- nary connective-tissue; and where it was most abundant the cells were most atrophied. Throughout the rest of the organ the cells wei-e little affected with the waxy degeneration; but some of the small vessels showed it distinctly. The sj^leen contained one cicatrized mass, which presented no reaction with iodine. The cortical substance of the kid- neys was somewhat contracted; the small arteries and Malpighian bodies afforded an excellent example of the amyloid degeneration. There was some degree of amyloid degeneration iu the villi of the small intestine ; the bowels were otherwise natural. The prepuce presented traces of an old chancre, and it had been previously ascertained that there were numerous sypliilitic ulcerations of the throat. It is evident that the waxy degeneration of the liver, in this case, was very different from the form of that degeneration usually met with in two respects—viz., first, that in the bulk of the organ, in- stead of affecting the cells it affected the vessels; and secondly, that groups of nodules in individual parts had become completely degene- rated, every cell presenting an exquisite s]jecinien of the degeneration, and the masses scattered like cancer nodules throughout the whole substance, and presenting an appearalice exactly like bees'-wax. It is well known that the amyloid degeneration is closely related to constitutional syphilis, and iu this case there can be little doubt that it was induced by that affection; but the peculiar form which occurred in the liver bears a certain relation to the hitherto recognised effects of the venereal poison on that organ, and seems to me to throw light upon the mode of origin of these lesions. Let us therefore first inquire what arc the venereal affections of the liver. Professor Dittrich, of Prague, first drew attention to these affections