ACUTE YELLOW ATROPHY OF THE LIVER. 



the kidneys, the icterus increases regularly as long as the bile-ducts 

 remain closed. What right have we to suppose that absorption of the 

 bile acids into the blood is compensated for by their excretion through 

 the kidneys, when it is so evident that this does not occur in the case 

 of the coloring matter ? 



The disease is very rare ; it never occurs in childhood. It is met 

 with more frequently in women than in men, and most frequently 

 during pregnancy. It is interesting to note that pregnancy, which 

 greatly favors the occurrence of parenchymatous inflammation of the 

 kidneys, is undoubtedly accompanied by a predisposition to analogous 

 disease of the liver. 



ANATOMICAL APPEARANCES. In high grades of acute yellow 

 atrophy of the liver, the organ is much diminished in bulk, occasionally 

 being less than half its normal size. Its thickness is particularly di- 

 minished, so that it appears flattened. Its serous covering is loose, 

 often even in folds. The parenchyma is relaxed and flabby, and the 

 liver is sunk in against the posterior wall of the abdomen. The organ 

 is dull yellow, its consistence diminished, and its acini irrecognizable. 

 On microscopical examination, instead of the normal liver-cells, we 

 only find detritus masses, fat globules, and pigment granules. In the 

 right lobe, where the changes were less advanced, Frerichs found 

 " between the lobules, surrounded by hyperasmic vessels, a dirty gray- 

 ish-yellow mass, which separated them. Farther off the hyperaemia 

 of the capillaries disappeared, the lobules became smaller and yellow- 

 er, and the intervening gray substance was in excess." The gall-ducts 

 and bladder usually contain a scanty mucous secretion. The faeces 

 are generally only slightly colored ; the contents of the intestines are 

 often bloody. The spleen is enlarged in most cases. Ecchymoses 

 are frequent, particularly in the peritonaeum and in the gastric and 

 intestinal mucous membrane, and not very rarely in the other serous 

 membranes and in the skin. In the kidneys, Frerichs not only found 

 deposits of pigment in the epithelium, but also fatty degeneration and 

 disintegration of the epithelial cells. The same observer found quan- 

 tities of leucin in the blood, and in the urine evacuated from the blad- 

 der; in the latter there were also tyrosin and a peculiar extractive 

 matter. 



SYMPTOMS AND COURSE. The first stage of the disease has no 

 very characteristic symptoms. The patients suffer from loss of appe- 

 tite, pressure and fulness in the epigastrium, and other symptoms that 

 remind us of gastro-intestinal catarrh. There is also in most, but not 

 .n all, cases a moderate jaundice, which may excite the suspicion thai 

 the catarrh of the duodenum has invaded the ductus choledochus. Not 

 a single symptom betrays the great danger overhanging the patient 



