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

  • Thomas Grainger Stewart
Date:
1864
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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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    in his excellent paper in the * Prager Vierteljahrschrift' for 1849. The conclusions at which he arrived were the following: 1. The participation of the liver in constitutional syphilis consists in an inflammatory exudative process, of which the most common termination is healing, either perfect or imperfect, leaving a cicatrix composed of fibrous tissue, with or without some granular matter enclosed within it. The exudative process never affects the liver sub- stance as a whole, but only individual scattered parts. 2. The healed exudative process in the liver sometimes leads to no apparent consequences, sometimes to important lesions of the organ itself, or of the whole organism. 3. The participation of the liver in the syphilitic infection is usually in the period of the so-called secondary affections. 4. The rest of the organ may be subject to syphilitic or non-syphi- litic affections. 5. The syphilitic blood-disease is either simple or combined with other dyscrasise, particulai'ly the tuberculous, and the exudations in the liver are correspondingly modified. That an exudative process is at the foundation of the syphilitic affection of the liver Dr. Dittrich thinks beyond doubt, although from the non-fatal character of the affection the earlier stages of con- gestion, swelling, and exudation are not seen. He conceives that the products vary according to the character of the exudation—one part plastic and capable of organization with fibres, another soft and glue- like, and more or less readily absorbed and removed. In a third part another form appears, which neither goes on to form fibres nor is absorbed, but gradually dries up, becomes firmer and harder, and forms a greyish white or whitish yellow mass of a tough and leather-like consistence. Microscopic examination shows that these are composed of fatty and other granules, structures resembling nuclei, and shrivelled atrophied cells and ill-formed connective-tissue. Such are the views of Dittrich as to the charactei-s and mode of production of the syphilitic affections of the liver. I shall quote from him one special description of a case closely resembling mine :— On the surface of the liver were numerous cicatrized depressions; in the deeper part of both lobes there were yellow rounded masses of the size of a hazel-nut, which showed towards the surface a lardaceous, fibroid, callous tissue, with a yellow, cheesy, tuberculous mass enclosed in the centre. The proportions of these two materials varied in different nodules. The observations of Yirchow' and Wilks have extended, confirmed, and in so far corrected the opinions of Dittrich; and the general view of pathologists is that, in connexion with constitutional syphilis, cicatrices and occasional nodules are met with in the liver, and that they are results of a simple or gummy inflammation of portions of the oryan. This case, I think, proves that the cicatrices may result from amy- loid or waxy degeneration. There can be no doubt that the lesions ' ViiT.how'jt Arcliiv, Band xv. * Wilks on the Syphilitic Affections of Intci nul Organs.
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