more, will not be the first example of an amyloid lesion arising in the absence of the ordinary causes. Wilks has reported two analogous cases,* and Frerichs, in the etiology of this alteration, has reserved a distinct paragraph for the indeterminate causes. For ameliorating the state of our patient, I have vainly had recourse to the recognized means, either against amyloid transformation, or against the chronic interstitial hepatitis. The iodide of potassium and the iodide of iron, which have sometimes given good results, have been ineffectually employed; the mercurials, under the form of calomel and blue pill, have not been any more useful; the muriate of ammonia, advised by Budd, in the dose of 60 centigrammes to 1 gramme daily, has equally failed, and after this fruitless. essay, not having it in our power to send the patient to the waters of Ems, Weilbach, Aix la Chapelle, or Carlsbad, which have succeeded in certain cases, and having but little confidence in the baths of dilute nitro-muriatic acid, I was restricted to a palliative treatment; I am sustaining the strength by wine, quinia, and iron; I treat the constipation when it is prolonged, and the diarrhoea when it persists beyond measure, and things will go thus for a more or less long time up to the death of the patient; this is the only possible termination of this disease. Three months and a half later, this patient died comatose, the epistaxis and hæmoptysis persisted to the end, and during the last weeks ascites supervened. There was no modification of the state of the liver and spleen. On autopsy, these two organs alone were altered. The spleen was enlarged, softened, and engorged with blood; all the portal system was markedly congested; it was pure serosity, which was contained in the peritoneum; the quantity was not measured. The liver, heavy and voluminous, presented the abnormal dimensions which percussion had *Wilks, Cases of Lardaceous Tumors and some allied Affections (Guy's Hospital Reports, 1836). recognized during life; immediate palpation gave the same results as mediate exploration, which had been so generally practiced across the abdominal wall; there was the same uniform induration, the same wooden-like resistance, as if the liver were placed flat upon a table; it was impossible to indent the convex face with the hand; the organ resembled a block of fibro-cartilage in its perfect compactness and homogeneousness. The surface, smooth and even, presented neither granulations nor depressions, but numerous white spots occupied the sub-hepatic peritoneum. The tissue creaked and resisted on cutting, and the section was clean and smooth; it was remarkably exsanguined, and of a grayish white appearance. Upon the background, there had appeared, isolated the one from the other, certain yellowish points representing the normal elements of the liver, bound down and atrophied by the immense development of the interstitial mass; the wide separation of these yellow points, clearly showed that a great part of the lobules had disappeared. The gray substance interposed was exactly like hardened lard, and the organ thus modified offered a perfect type of what has been called the lardaceous or waxy liver. Then, in the presence of these alterations so clear I could not, for an instant, doubt the simultaneous existence of the two lesions which I had diagnosticated. This phrase of Frerichs: "By the combination of the amyloid and sclerosis induration, it forms a great fatty liver, which, by its consistence and its color, presents a certain analogy to hardened lard;" this phrase, I say, comes to my mind, and confirms me in my opinion. The chemical examination decided otherwise; despite many trials, I could obtain but the first part of the reaction; the whitish gray substance, on contact with iodine, readily took on a reddish yellow color, but by the addition of sulphuric acid I could get neither the blue nor violet. There was then no amyloid matter; an hypertrophy of the connective tissue was then the only cause; not only had it produced great fibrous filaments, which partitioned off the organ, but the confluence and development of these neoplastic elements had been such, that they constituted by themselves, without any foreign deposit, this fibroid stroma, in which were plunged the surviving hepatic lobules. This was a perfect type of connective sclerosis, or interstitial hepatitis. By the union of these physical characters, this liver merited in a supreme degree, the appellation of lardaceous, or, better still, waxy, but it was not amyloid, and this fact well demonstrated the necessity of the distinction which I have elsewhere formulated.* We ought not to establish a parallel between the expressions waxy and fatty on the one side, and amyloid on the other; the words waxy and lardaceous appertain to physical characteristics, the word amyloid to chemical; the presence of the first does not necessarily imply that of the second; it is, then, not necessary by a synonymous terminology, to preserve a connection which is not real. Every amyloid liver is waxy, or lardaceous, but every waxy or lardaceous liver is not amyloid; observe the fact, our observation abundantly proves it. The liver was waxy, because it presented an excessive hyperplasia of connective tissue; it was not at all amyloid. You will find in the memoir of Mackelt on the lardaceous disease, many analogous cases, in which the waxy appearance existed and the iodo-sulphuric reaction failed. Under the influence of the always increasing development of connective tissue, the branches of the portal vein have been more and more compressed, and it is this which explains the appearance of dropsy during the last weeks of the life of our patient; on the other hand, the secretory elements of the liver have been more and more stifled by the parasitelike invasion of the neoplastic tissue, and the production of bile fell to a minimum which was incompatible with life. I do not hesitate to ascribe to the insufficiency of the biliary secretion, to the acholia, the comatose accidents of increas Jaccoud, Degenerescence amyloide. Nouveau Diet. di Med. et de Chirurg. Pratiques, II. Paris, 1865. † Meckel, Die Speck- oder Cholestrin-Krankheit (Ann. des Chariti Krankhauses, IV., 1853. ing gravity, which in six or seven days brought death to this woman. In cases of this kind, observe the fact, that it is not because the bile fabricated by the liver re-enters the blood that poisoning takes place, it is because the liver does not make more bile, and that the materials which serve in this operation accumulate in the nutritive fluid; it is thus acholia which kills, and not cholæmia. PROCEEDINGS OF SOCIETIES. LOUISVILLE OBSTETRICAL SOCIETY. The Society held its regular annual meeting on the 17th of November, 1870, and the following gentlemen were elected officers: President, Dr. J. A. Octerlony; Vice-President, Dr. W. Bailey; Recording Secretary, Dr. W. D. Morton; Treasurer, Dr. S. Brandeis; Librarian and Curator, Dr. W. H. Newman; Corresponding Secretary, Dr. S. H. Homor. The retiring President then delivered his farewell address to the Louisville Obstetrical Society, as follows: Gentlemen: As the term of office for which I have had the honor of presiding over this Society expires to-night, it becomes my duty to make to you a statement of the Society's condition and progress. The unbroken harmony of sentiment, and the uniform kindness of feeling that have prevailed among us as a body, make that a real pleasure which might otherwise prove a most embarrassing labor. While other organizations of a similar character in this city, and some of them of older date than our own, have been subjected to such painful dissensions and disorders as to result in the injury of all, and the entire disruption of some of them, we have without interruption continued our twicemonthly meetings throughout the entire year. Not eveu through the oppressive heat of the summer months did we permit an adjournment, as was the custom previously existing, and only once or twice have we failed to have a quorum at our meetings. And at these meetings we have spent no time in the discussion of idle and mischievous questions that would, probably, have resulted in rancor and bitterness; but, as I have before stated, and take pleasure in repeating, these meetings have been characterized by that cordial good feeling that should prevail among friends, and that respectfulness of language and deportment which the dignity of our calling demands from and for each other. During the last year, as will appear by the Secretary's Report, we have had five active members added to the Society, while we have to regret the loss of two by resignation; and, in common with the whole scientific world, do we mourn the loss by death of Sir James Y. Simpson, an honorary member, who was not only a master-spirit in our department, but was one of those whole-hearted Christian men in whom all humanity might find a friend and brother. To our list of honorary and corresponding members we have added most of the illustrious names of this country and of Europe; and you all must have noted, in listening to their letters of acceptance, how heartily they have extended to us their encouragement and good will. We have during the year received a few valuable contributions to our library with promises of others. These books and pamphlets, together with the periodicals heretofore subscribed for by the Society, constitute our present library. This collection of books, although valuable, is much smaller than it ought to be at this time of our Society's existence. I would therefore suggest for your consideration whether the ninety-two dollars, which the treasurer reports as on hand, or due the Society above its indebtedness, might not safely and very profitably be invested in books. It is certainly desirable that the Society should possess the writings of the best authors upon obstetricy, and by an annual expenditure of ninety-two dollars, we should in |