780 ORIGINAL COMMUNICATIONS-PETERS. Art. II.-Albuminoid Degeneration or Infiltration. By John ' C. Peters, M. D., President of the Medical Society of the County of New York, and of the New York Neurological Society, etc. New York City. These are names which are now frequently applied to the so- called waxy or lardaceous disease, and to amyloid degeneration. Any part or structure may be affected, and usually several organs are involved. The liver, spleen, kjdneys and absorbent glands are most liable to it, but it may attack the stomach, bow- els, supiarenal capsules, muscles, brain and cord and their mem- branes, the tonsils, serous membranes and bladder. It may also affect morbid deposits in connection with inflammation, tubercle, cancer, &c. The minute arteries and capillaries of these parts are almost always first affected, and the infiltration begins in their muscu- lar coat. Their walls become thickened, their channels nar- rowed, and on section the vessels remain open, and at the same time assume a compact, translucent appearance, looking like silver cords or threads. Next some of this peculiar substance makes its way directly through the walls of the capillaries into the tissues around, extending into the cells and intercellular tis- sues, enlarging the former and making them more spherical, de- stroying their nuclei and displacing their normal contents. These then coalesce, and the whole structure finally presents a peculiar glistening appearance. In short, the disease consists in the infiltration of a material without cells or nuclei, which, of course, appears quite structureless and homogeneous, and at first nearly transparent. The organ affected becomes enlarged, some- times to a great degree, but without any irregularity in form- ALBUMINOID DEGENERATION. 781 the surface being quite smooth and the margins apt to be rounded; its weight is increased, the specific gravity high, and the whole feels heavy and solid. It may be cut into regular, quite smooth pieces, or even, very thin slices, with sharp, firm margins. The cut surface is dryish, paler than normal, and pre- sents a glistening, quite translucent aspect, being quite smooth, uniform and compact, except when the infiltration is slight or limited to the capillaries, or to certain spots, as is well seen in the so-called sago-spleen, where it is confined to the Malpighian corpuscles. It may also be broken or torn into pieces-its consistence being peculiar, resembling in toughness, resistance and elasticity somewhat that of wax, or of wax and lard com- bined ; hence the names waxy and lardaceous. It is detected by peculiar chemical reactions; for when a wa- tery solution of iodine is applied, a deep, reddish brown color is produced, and the subsequent addition of a drop of strong sul- phuric acid gives rise to a violet or dark blue color. These re. actions are rather those of some form of starch or cellulose, and the disease has been called amyloid by some; but the view now most commonly adopted is that it is an albuminoid substance, its ultimate analysis showing that it is either a nitrogenous com- pound, or else a substance deposited in a nitrogenous tissue from which it cannot be separated. Dr. Dickenson supposes it to bo a de-alkalized fibrin, or a fibrin which is deprived of its alkali and then deposited in a crude form ; and most pathologists agree that it is a direct deposit from the blood, in consequence of some alteration of this fluid. But as this peculiar albuminoid substance has never been detected chemically in the blood, others suppose that it is modified after it escapes from the vessels, or that it is derived from some local degeneration or metamorphosis of albumen, after it has left the capillaries. This latter view is not held in high esteem. It is almost invariably, but not always, preceded by some disease, which, in the great majority of instances, is at- tended with long-continued and excessive suppuration, in which it is supposed that the fibrin of the blood becomes imperfect and is poured, out as such. It is common in caries and necrosis of the bones, and in lumbar abscess ; in chronic pulmonary phthisis, with much purulent expectoration; in chronic empyema; in py- 782 ORIGINAL COMMUNICATIONS-PETERS. elitis or other kidney affections ; in extensive ulceration of the bowels, and in prolonged ague and tedious malarial influence. It is also seen after syphilis, especially when attended with much suppuration and disease of the bones; and when it follows these, it often begins in the neighboring lymphatic glands,, which fact is considered by some as an argument in favor of its local origin in degeneration. Nutrition is impaired, and the patient is often extremely ema- ciated, becoming also pale and anaemic, with a peculiar trans- parency of tissues, or presenting a sallow, waxy look. There may be great debility, with a tendency to syncope, and oedema of the legs may occur from weakness and anaemia. The treatment is to check suppuration with the mineral acids, tannin, &c. The syrup of the iodide of iron is said to be al- most certainly, or at least often attended with considerable ben- efit if persevered in for some time. The above is the simplest view, of this disease, taken mainly from Roberts' Theory and Practice of Medicine. Others com- pare the infiltration to cerebrin, lecithin and other normal sub- stances of the brain and spinal cord, which are remarkable for their property of swelling up in hot -water into a substance re- sembling starch. Lecithin resembles -wax, may be easily melted, and gelatinizes in warm water like cerebrin. But Frey says there appear to be various kinds of lecithin, thus: 1st. Proto- gon is simply a mixture of cerebrin and lecithin ; 2d. Myelin is a substance of peculiar microscopic appearance, occurring in different parts of the body, especially in those undergoing de- composition ; it is tinged slightly brown by iodine, while in con- centrated sulphuric acid it becomes of a red, or, at times, violet- color. Myelin resembles cerebrin and lecithin in its swelling up into a gelatinous mass in hot water ; but it may also be obtained from a mixture of oleic acid and ammonia. Amyloid matter is another allied substance, which Frey thinks is a mixed product of the degeneration of many, especially of the glandular por- tions of the body, causing the so-called waxy or lardy degenera- tion, and which is colored of a peculiarly reddish brown, or brownish violet hue, by a solution of iodine, and whidi usually turns to violet on the subsequent addition of concentrated sul- phuric acid, or more rarely to blue. Finally, thirdly, the cor- ALBUMINOID DEGENERATION. 783 pora amylacea of the brain, which vary in their reactions, be- coming violet under the action of iodine and sulphuric acid, but frequently blue or blueish with iodine alone ; thus resembling starch in one respect and cellulose in another, although not ab- solutely composed of either. The corpora amylacea are found in the nervous centres of putrefying corpses, in quantity in- creasing with the advance of putrefaction. They are also met with of considerable size in the prostate gland and the susten- tacular connective tissue of the brain and spinal cord may con- tain them in abundance. Hence some pathologists think that amyloid degeneration arises from the incomplete conversion of starch into sugar and lactic acid. Other pathologists think that we must look for the origin of albuminoid or amyloid degeneration in some imperfect formation of fibrin, which is a derivative of albumen, and into which it can be resolved by solutions of various alkaline salts, especially the nitrates and carbonates of potash. According to A. Schmidt, no fluid fibrin exists at all in the animal fluids as long as they are in motion. It is first generated in the blood and other liquids by the chemical combination of two nearly related com- pounds, named fibrinogen and fibrino-plastin. The first, also called metaglobulin, is dissolved in the plasma of the blood; the second, or paraglobulin, which, combining with fibrinogen, con- verts it into fibrin, exists, on the contrary, in the bodies of the red blood cells, or passes from these into the plasma. Now lymph, chyle, pus, and many tissues containing cells, and also fluids into which these cell-contents have passed, viz.: the serum of the blood, synovia, saliva, &c., are all fibrino-plastic; while fibrinogen is also widely distributed through the system, so that it is found in almost all the serous fluids, as well as in those sat- urating the connective tissue and muscles. Both of them may be precipitated from dilute solutions by conducting a stream of carbonic acid through them ; but both are kept from uniting so as to form fibrin by the rapid mutation of matter which takes place in the moving juices of the body; but on the chemical combination of these two mother-substances, in order to form coagulated fibrin, the alkalies, which previously held them in solution, are set free. This brings us closely to Dr. Dickinson's theory of de-alka- 53 784 ORIGINAL COMMUNICATIONS-WALKER. lized fibrin as the basis of amyloid degeneration. He found, in tissues affected with it, that the proportion of alkaline salts, as determined in the ash left by incineration, was remarkably di- minished, even to the extent of 25 per cent.; while the propor- tion of lime was somewhat increased. He also found that the affected parts had lost the natural faint alkaline reaction of healthy tissues, and were either neutral or even acid, so as no longer to discharge the color of indigo-solution, but to become stained by it, and thus be as clearly recognized by it as by the iodine reaction. Finally, by treating fibrin with acids, he pro- duced a substance somewhat resembling amyloid material in its reaction, with iodine. But a committee of the London Patho- logical Society found that livers affected with this degeneration were deficient only in potassium and phosphoric acid, while they furnished an excess of sodium and chlorine. They also found a large proportion of cholesterin, and a generally increased pro- portion of fat. Jones and Sieveking finally say we do not know in how far the deficiency of alkaline salts is peculiar to the state of waxy degeneration, or whether it does not also occur in other anaemic conditions of the tissues. Still phosphoric acid and potash may be used in addition to tonics and iron, and the iodide of iron, in the treatment of the disease.