718 DISEASES OF THE LIVER. 



sourse, and the rapid and extensive destruction of the liver-cells, would 

 indicate an inflammatory process. Moreover, Frerichs claims to have 

 found a free exudation surrounding the lobuli of the liver, in some 

 parts of the organ, where the process was not yet far advanced. Leav- 

 ing out of the question this interstitial exudation, which is probably 

 not constant, acute yellow atrophy of the liver would appear to belong 

 to the parenchymatous inflammations, i. e., to those forms of inflam- 

 mation where there is no free exudation between the elements of the 

 tissue, but where the elements of the parenchyma themselves swell by 

 taking up an albuminous substance, and subsequently undergo a com- 

 bined molecular and fatty degeneration. Against this view, which was 

 advanced by Liebermeister, or, at least, first precisely stated by him, 

 the most we can say is, that the course of inflammations in other organs, 

 particularly in the kidneys, is entirely different, and that there is no 

 parenchymatous inflammation in which, in a very short time, while the 

 affected organ rapidly becomes smaller and softer, the tissue' elements 

 are destroyed, as they are in acute yellow atrophy of the liver. 



Whether the destruction of the parenchyma-cells of the liver, in 

 acute yellow atrophy, be of inflammatory origin or not, this disease is 

 apparently not primary and idiopathic, but the result of a severe con- 

 stitutional affection. The supposition that this constitutional disease 

 is due to the action of a poisonous, miasmatic substance taken into the 

 blood, to an infection, cannot at present be proved, although the occa- 

 sional epidemic occurrence of the disease is favorable to such a view. 

 The popular comparison of acute yellow atrophy of the liver with the 

 fatty liver seen after poisoning by phosphorus, is unsound, and has 

 caused many mistakes. In phosphorus-poisoning we have a fatty in- 

 filtration in acute yellow atrophy there is a fatty degeneration of 

 the liver-cells : these are decidedly different forms of disease. I con- 

 sider the attempt to refer acute yellow atrophy of the liver to poison- 

 ing by the bile-acids as a failure. Even the slight grade of the icterus 

 existing in most cases refutes the correctness of this hypothesis. It 

 must be acknowledged that the greater or less intensity of the jaundice 

 gives the best means of judging whether much or little bile has been 

 reabsorbed ; for, although we can only determine from this the amount 

 of \n\o-coloring matter that has been reabsorbed, still this gives the 

 means for deciding the amount of bile-acids absorbed. It is true, 

 Leyden has attempted to explain the frequent absence of symptoms of 

 poisoning by the bile-acids in excessive and protracted icterus, by say- 

 ing that, in most cases, their collection in the blood is avoided by theii 

 elimination through the kidneys. But this explanation is very doubtful, 

 Daily experience teaches that, in closure of the excretory bile-ducts, in 

 spite of large quantities of bile-pigment being steadily thrown out bv 



