Treatment. When met with in meat producing animals the best resort is to turn these over to the butcher. When in an animal which is mainly valuable for breeding purposes, or in horses or carnivora, something may be done to check the progress of the malady, and maintain at least the present condition. The value of this will of course depend on how far the disease has already progressed. Cows that have spent a winter in a hot swill stable are of little use afterward for breeding or dairy uses and advanced cases of fatty degeneration in the horse or dog hold out little hope of a satisfactory issue. For cases in the earlier stages, nothing can be better than a run at grass, where there is opportunity for shelter from the noonday sun. If the pasture is short and the animal has to exercise to secure a living, so much the better. If kept indoors the patient should have a clean, roomy airy box stall, with a moderate allowance of easily digested food, and laxatives and cholagogues daily such as Glauber salts, aloes, calomel, podophyllin or cream of tartar. Mineral acids, especially nitro-muriatic acid, and bitters may also be given. The preparations of iron are sometimes useful in maintaining the tone of the digestive organs and counteracting anæmia but they must be conjoined with diuretic doses of bicarbonate of soda.
There is great advantage in stimulating the skin, and active brushing, currying, hand-rubbing, and even cold douches may be resorted to.
AMYLOID DEGENERATION OF THE LIVER.
Degeneration of basement substance of connective tissue, swollen, transparent, homogeneous, colored mahogany brown by iodide. In wasting diseases, tubercle, cancer, malaria, dysentery, leukæmia, suppuration, ulceration, pleurisy, pericarditis, peritonitis, chronic catarrh, broncho-pneumonia, orchitis, biliary calculi, nephritis. Chronic. Lesions: Affected part swollen, sinks in water, bloodless, clear, smooth, homogeneous, yellowish or reddish gray, under compound solution of iodine becomes mahogany brown, under sulphuric acid dark violet. Extends from vessel walls to adjacent connective tissue. Symptoms: Of wasting diseases, but not diagnostic. Treatment: Unsatisfactory, directed to causative disease.
This is a condition in which the basement substance of the connective tissue, and especially of the walls of the vessels, becomes swollen and composed of a transparent, homogeneous substance, albuminous in character, and which stains of a deep mahogany brown on the application of a solution of iodine. The degeneration is usually associated with severe wasting diseases, in the human being with tuberculosis, syphilis, malignant tumors, malarial infection, dysentery, leukæmia, and chronic suppuration or ulceration, especially of the bones.
In the lower animals (horse, dog, ox, sheep, rabbit, poultry) it has been seen to attend or follow on similar cachectic conditions. In the horse it has been seen in connection with the effusions of pleurisy, pericarditis and peritonitis (Rabe), in chronic bronchial catarrh (Fischkin), in chronic broncho-pneumonia, and dilated right heart (Trasbot), in orchitis, phlebitis and cachectic states (Caparini), and in calculous obstruction of the biliary duct (Burgoin). In cattle it has accompanied chronic nephritis (Brückmüller), tuberculosis, leukæmia, etc. In lambs kept in confined stables, though well feed on oats (Werner). In long standing suppurations and in animals fed on distillery swill it has been observed.
It may last for months or years, and predispose to other disorders, functional and structural. It does not, however, interrupt secretion as bile continues to be formed.
Lesions. The affected part of the liver is enlarged, the entire organ in the horse may amount to 32 lbs. It is smooth and even, though thick and rounded at its inferior border, yet occasionally on the posterior aspect there may be hyperplasia and a rough irregular surface. The diseased liver is heavy and sinks in water, unlike the fatty liver. In the horse it is soft and friable or even pasty whereas in man it is firm and resistant. The cut surface is bloodless, smooth, clear, homogeneous and grayish, yellowish or reddish gray. When treated with a solution of iodine and potassium iodide it changes to a deep mahogany brown; if dilute sulphuric acid is then used it changes to a deep violet, almost black color. If the iodine solution is brushed over the smooth cut surface the mahogany color of the amyloid stands out in marked contrast with the bright yellow of the healthy hepatic tissue. The amyloid commences in the walls of the smallest arteries, in the media and intermediary layers of the intima, and thickens the walls so as to obstruct their lumen more or less completely and render the part comparatively exsanguine. It may extend to the connective tissue of the organ, but it is not certain that the hepatic cells are involved in the process. The cells are, however, pressed upon by the diseased vessels and stroma and undergo consequent fatty degeneration. The amyloid may be confined to but a small part of the liver or to its smaller blood-vessels or it may extend to the whole. In fowls it is always in multiple centres (Leisering). It may be found in other important organs, kidneys, spleen, lymphatic glands, intestinal mucosa, etc.
Symptoms are not diagnostic. If with an old standing, exhausting disease, paresis, weakness, emaciation and unfitness for work, there is loss of appetite, dryness of the mouth, congestion of the rectal mucosa, yellowish, whitish, or dark tarry fæces, and a slightly brownish or yellowish tinge of the visible mucous membranes (Rexante) it may be suspected. In fowls Leisering noticed, weakness, lameness, ruffling of the feathers and attacks of vertigo. Icterus, ascites and tenderness over the region of the liver may all be absent. In the absence of ascites, tympany, or an excess of fat in the smaller animals, manipulation may detect the considerable enlargement of the liver, and the characteristic smoothness, of its surface. In other cases some indication may, at times, be had from the increased area of dullness on percussion.
Treatment is essentially unsatisfactory even if a correct diagnosis can be made. The most hopeful course would be to correct the debilitating disease in which the amyloid seems to have originated. Diseased bones, ulcers, chronic suppurations, and catarrhs may be done away with, and at least any further advance of the degeneration arrested. Open air exercise and a green or otherwise laxative diet would be indicated. The amyloid in lambs fed on oats was corrected by a change of diet (Werner). As medication the alteratives, potassium iodide and potassium arseniate have been mainly resorted to. Bitters and iron may also be of use to build up the strength. The latter should be given with potassium bicarbonate.