ACUTE YELLOW ATROPHY OF THE LIVER. 



Xirinu ; and if, besides these symptoms, we have severe disturbances of 

 the nervous system, I consider the diagnosis of haematogenous icterus 

 as quite certain. Ley den also reckons among its criteria the discolora* 

 tion of the urine, which is very slight in proportion to that of the skin, 

 and particularly the absence of bile-acids from the urine. If it were 

 proved that, even in moderate grades of hepatogenous icterus, the bile- 

 acids could be constantly and certainly found, their absence from the 

 urine would, indeed, be a certain criterion of haematogenous icterus. : 

 TREATMENT. Haematogenous icterus does not require any par- 

 ticular treatment ; it disappears as soon as we can remove the original 

 disease. But, unfortunately, we are rather powerless in this respect ; 

 still r in those cases occurring during very intense fever, we may expect 

 most from an antipyretic course of treatment. 



CHAPTER XIV. 



ACUTE YELLOW ATROPHY OF THE LIVER. 



ETIOLOGY. In acute yellow atrophy of the liver a very obscure 

 disease, for which we find no analogy in a short time the liver becomes 

 smaller, soft, and pulpy, and, on microscopical examination of the atro- 

 phied and softened organ, we find that the liver-cells are mostly de- 

 stroyed. 



From the fact that the liver, which has been swollen by continued 

 biliary obstruction, occasionally becomes smaller, and softens, and that, 

 in this form of atrophy, the liver-cells are also found disintegrated, 

 acute yellow atrophy has been referred to obstruction of the bile in 

 the finer bile-ducts. But this supposition is opposed, on the one hand, 

 by the circumstance that, in acute yellow atrophy of the liver, the gall- 

 ducts are found empty, or filled with mucus ; and, secondly, that iic 

 obstruction to the flow of bile can be found in them. 



Other observers take the view that the destruction of the liver-cells 

 is, it is true, the result of pressure on them, or on the vessels nourish- 

 ing them, and that this pressure is exercised by the distended bile- 

 ducts, but that the over-filling and distention of the bile-ducts do not 

 depend on stasis of their contents, but on excessive formation of bile, 

 on polycholia. But since, neither at the commencement of acute 

 yellow atrophy of the liver, nor during its first stages, are there signs 

 of increased flow of bile into the intestine, the supposition of excessive 

 formation of bile, as the cause of this disease, appears neither proved 

 nor probable. 



Most recent pathologists consider acute yellow atrophy of the livei 

 as the result of a peculiar form of hepatitis ; and, indeed, its acute 



