On a rare type of necrosis of the liver 



by 



Dr. C. Magarinos Torres. 



(With plate 32). 



Following Dr. B. C CROWELL's 



advice and instructions, I made a study of 

 some anatomical lesions of the liver found 

 during an autopsy which are comparatively 

 rare. 



Necrosis of the liver may be central or focal. In fo- 

 cal necrosis, there are small necrotic areas in the hepatic 

 lobules, which are not in direct relation with the central 

 vein; this type is found in acute infectious diseases such 

 as pneumonia, yellow fever, eclampsia, scarlet fever and 

 diphtheria. These lesions are sometimes of infectious and 

 sometimes of toxic origin. 



In central necrosis, the lesions surround the central 

 vein of the lobule and are due to toxic conditions. This 

 kind of necrosis is often observed in certain infectious 

 diseases, and also in some other cases; it is found, for 

 instance, in acute yellow atrophy of the liver and also 

 in chloroform poisoning. Central necrosis with hemorrha- 

 ge is found in some cases of chronic passive congestion. 

 In a recent paper on chronic passive congestion, LAM- 

 BERT and ALLISON (1) indicate the following five ty- 

 pes of lesions : 



A) dilatation of the capillaries with atrophy of the 

 central cells of the lobules: 



B) central degeneration with or without dilatation of 



the capillaries : 



(l)-LAMBERT, R. A. and ALLISON, B. R.-Ty. 

 pes of Lesion in Chronic Passive Congestion of the Li- 

 ver (Illustrated). 



Bull, of the John Hopkins Hosp. 1916, XXVII. 350. 



C) marked fatty infiltration in the cells around the 

 hepatic vein, with congestion of the middle zone: 



D) central necrosis with hemorrhage: 



E) Cirrhosis of cardiac origin. 



I shall have to refer to some of these types of 

 lesions while describing the present case, though strictly ' 

 speaking, these types were not found in our case. 



It is not difficult to observe our type 

 of necrotic lesion in experimental conditions 

 and it is often found in other organs at 

 post-mortem examinations; it has no appa- 

 rent connection with the limits of the lobu- 

 les, and is associated with a relatively slight 

 inflammatory reaction. 



Microscopic preparations revealed throm- 

 bosis of some capillaries of the liver 

 caused by long, thick, rectilinear or slightly 

 curved, Gram-positive bacilli without spores 

 or capsules {Bacterium coli ?). These capilla- 

 ries were found more or less in the centre 

 of the necrotic areas, but some were found 

 in the liver tissue not necrosed. 



The liver is enlarged and macroscopi- 

 cally the appearance of the lesion is quite 

 peculiar. (Plate 32, Fig. 2). 



The lesions may be partly explained by 

 the bacterial thrombosis of the capillaries, 

 if one supposes also the existence of a toxin 



