THE LIVER. 



589 



lesions as well as upon the degree of degenerative change. In general, 

 if the lesion is well marked, the liver is small, flabby sometimes almost 

 fluctuating and the capsule wrinkled. On section the cut surface may 

 show but little trace of lobular structure, but presents an irregular mot- 

 tling with gray, ochre-yellow, or red ; sometimes one, sometimes another 

 color preponderating. 



Microscopical examination shows varying degrees of degeneration and 

 destruction of the liver cells. Most evidently in those parts which have 

 a grayish appearance, the 

 outlines of the cells are 

 preserved and the proto- 

 plasm is filled with larger 

 and smaller granules. In 

 the yellow portions the out- 

 lines of the liver cells may 

 be preserved, and they may 

 contain varying quantities 

 of larger and smaller fat 

 droplets and granules of 

 yellow pigment. Or the 

 cells may be necrotic or 

 disintegrated, and in their 

 place are irregular collec- 

 tions of fat droplets, pig- 

 ment granules, red and yel- FlG . 355.-ACUTE YELLOW ATROPHY OF THE LITER. 

 low Crystals, and detritus; The liver cells in the periphery of the lobule are little changed : 

 Only the Connective tissue those toward the centre are largely destroyed. 



and blood-vessels of the 



original liver tissue remaining (Fig. 355). The red areas may show 

 nearly complete absence of liver cells and cell detritus, and some- 

 times irregular rows of cells which are variously interpreted as being 

 new-formed gall ducts or proliferated liver cells. 1 In these areas it ap- 

 pears to be, in part at least, the blood contained in the vessels which im- 

 parts the red color. Sometimes the interstitial tissue is infiltrated with 

 small spheroidal cells resembling leucocytes. Crystals of leuciu and ty- 

 rosin are sometimes found intermingled with the cell detritus. In some 

 cases the liver is not diminished in size. 



These lesions of the liver are frequently associated with enlargement 

 of the spleen and parenchymatous degeneration of the kidney and of the 

 heart muscle. Multiple haemorrhages may occur in the gastro- intestinal 

 canal, kidneys, bladder, and lungs. There is usually marked jaundice. 

 This disease is more common in women than in men and in many cases 

 has occurred in the puerperal state. Various forms of bacteria found in 

 the liver are of doubtful significance. The excitant of the disease is un- 

 known, and it is an open question whether it is a disease primarily of the 

 liver or an acute infection or intoxication with marked local lesions. It 



1 For a study of regenerative changes in the liver after acute yellow atrophy see 

 MacCallum, Johns Hopkins Hosp. Reports, vol. x., 1902, p. 375. 



