Further observations on the waxy or amyloid form of Bright's disease / by T. Grainger Stewart, M.D.

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

Licence: Public Domain Mark

Credit: Further observations on the waxy or amyloid form of Bright's disease / 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.

    6/18 (page 6)
    1-Iis tongue is clean; his appetite goorl; his bowels are moved twice a-day. Tiie liver is much enlarged, me.isures eight inches vertically, and extends con- siderably across the epigastrium to the left side. The spleen is also enlarged. The blood contains an excess of white corpuscles. Expiration is harsh and prolonged at the apices of both lungs. The heart-sounds are altered in tone, but not of a blowing character. 13th August 1862.—The patient again presented himself. He is more emaci- ated. States that from increasing debility he has been unable to work for a month past. He still makes large quantities of urine, which is albuminous, but not so intensely as before. It deposits a sediment containing hyaline tube- casts, with oil-granules here and there arranged in groups, as if resulting from disintegration of cells. There has been no dropsy of late. The liver, though still enlarged, is decidedly diminished since last report. He complains much of his breathing. 22d September 1863.—He complams much of difficulty of breathing, and ot cough and headache when he attempts to stoop; he has also dropsy; and from all these symptoms feels himself unable to follow his usual work. The amount of urine is still large. He is obliged to rise three or four times every night in order to micturate. The urine is albuminous, and contains casts. , ijp pntaKaa-tl.in-Inilrma.ry, and under the care of 1^ Sauders improvedi-BO m» , tn lie ithin tn gft mtt-,-n-n^-fr a -time pnrsue his Ttsnat 'avoratioTre7~bH*-i« t . November^« again-preswited hwmelf, complaining of a further aggravation /^of his syfi^oms—4+e died soon after admisaiou,,in .November 186<i, and-4ri6 ^k4^| b(>dyj?resented the following post-mortem appearances:— The body was somewhat emaciated.^Thc heart was enlarged; its left side tt^ ^ i'was much hypertrophied. The aortic valves were competent; but at the base/''• / of one of tlie segments there was a calcareous mass. The aorta was very atheromatous. The lungs were vciy ccderaatous; the bronchi 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 of a pale colour were visible. On section, numerous nodules were fouud scattered throughout the organ; they were pale, dense, and had an appearance exactly resembling bees-wax ; their structure was much denser than that of the surrounding tissue. In some nodules there were streaks of fibrous tissue throughout the substance and round the margin, and the greater the proportion of that tissue the deeper were the cicatrices. In the nodules 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 in excess of the glandular. On applying iodine to these masses, the whole of the waxy-looking material assumed tlie brownish red colour oliaraotopietic of the-ftm-34oiLd-d-eg«ue]atam), but the fibrous streaks simply assumed a yellow tinggy Microscopically, the masses were found to present exactly the char- rmeters\jf ordmarj' aiimlBi4hepatic cells. They were composed entirely of these ' cells, erflarged, transparent, and finely granular. In some parts the cellular elements Were broken down, and a finely granular material containing some oil-globules was present. The fibrous tissue m the masses presented the J ' ordinary characters of oonncctl^-tissue; and where it was most abundant the cells were most atrophied. Throughout the rest of the organ the cells were little affected with the waxy degeneration, but some of the small vessels showed Ov^ ■ it distinctly. The fibrous bands were seen passing into the tissues round the %^ cicatrices and nodules.^^ The capsule of Glisson was thickened in some parts, \iind on applying the iodine externally to the cicatrices no reaction was observed. T*lie spleen contained one cicatrized mass, which presented no reaction with iodine. The kidneys were somewhat contracted in the cortical substance, and presented a very well-marked instance of the 'ny'''^ degeneration of the t^A^VV vessels and Malpighiaii bodies. Tliere was some degree of imiytoid degenera- /j tion of the villi of the small intestine; the bowels were otherwUc natural. ,-. 'Irke-prcpuce presented traces of the old syphilis, and it .had been previously •' ascertained that there were numerous^sjji)luliiiiwjl«ei«it4<me-hi-+h«-thTTm^ * /