328 INANITION AND MALNUTRITION 



Figure 88 is a field graph showing the liver weight plotted against body 

 length in a large number of atrophic cases up to 20 years of age, from various 

 sources. Most of the cases clearly lie below the curve for normal average liver 

 weight. 



The data for atrophic infants will now be considered. 



Parrot ('68, '74, '77), the pioneer in the study of infantile athrepsia, suspected 

 that disorder of the liver plays an important role in this condition, although he 

 could find no marked changes in this organ. He found the hepatic parenchyma 

 congested and dark reddish or violet. Although he considered visceral steatosis 

 characteristic in athrepsia, he was unable to demonstrate any large' amount of 

 fat in the liver cells, especially in extreme marasmus. The gall-cyst appeared 

 distended with bile. 



Ohlmuller ('82) noted a weight of 104.2 g. in the liver of an atrophic 

 infant 56 days old; body weight 2,381 g. (previous weight not given). In a 

 "normal" control of the same age, the liver weighed 144.6 g., body weight 



4,i5° g- 



Cantalamassa ('92) found the gall-bladder distended with thick bile in 

 infantile starvation. Thiercelin ('04) stated that the liver in athreptic 

 infants is usually hypertrophied. Inflammatory lesions have been described 

 (Gaston) . The hepatic cells contain a large nucleus and some pigment granules, 

 but no fat. 



Bovaird and Nicoll ('06) presented data from 571 autopsies on children, 

 and concluded that the weight of the liver is largely dependent upon the state 

 of general nutrition, and is very low in the emaciated. 



Lucien ('08) mentioned the liver in athreptic infants as dark violet in color 

 and of firm consistence. Histologically no marked or characteristic lesions are 

 found. A more detailed description was given by Lucien ('o8d). In weight, 

 the liver is nearly normal, averaging 141 g. (8c-2io g.) in infants of 2-10 

 months. Intense congestion is found, but otherwise no constant or character- 

 istic structural change. Lucien therefore concluded that gastroenteritis and 

 intestinal infections are not of primary importance in athrepsia. 



Helmholz ('09) likewise found inconstant changes in the liver of atrophic 

 infants. Of 22 cases, however, only 2 failed to show pigmentation (with iron- 

 reaction;) 8 others showed only the normal amount; 12 showed much pigmenta- 

 tion and 6 excessive amounts. In the latter, "Die Leberzellen sind leicht 

 geschwollen, was bei den Alkoholpraparaten durch die zuriickbleibende 

 Membran zu erkennen ist, trotz der Schrumpfung der Zellen; das Proto- 

 plasma ist leicht gekornt, keine fettige Degeneration. In den Leberzellen 

 ist groberes und feines, dunkelbraunes und goldgelbes Pigment, das sich 

 meistens um die Kerne gruppiert. Besonders fallt aber in diesen Praparaten 

 auf die starke Pigmentation der Endothelzellen der Leber, die mit olivengriinem 

 Pigment z. T. in grossen Schollen gefiillt sind." 



Triboulet, Ribadeau-Dumas and Harvier ('10) noted that the liver in 

 athreptic infants appears small, firm, and violet colored, with congestion and 

 periportal fibrosis (insular cirrhosis). The gross atrophy of the liver is due to 

 atrophy of the cords of liver-cells, which appear narrow, between the dilated 



