ACUTE YELLOW ATROPHY OF THE LIVER. 721 



occurring during the disease are apparently the result of disturbed 

 nutrition of the capillary walls, of an acute haemorrhagic diathesis, 

 which is also seen to occur in many other severe diseases that affect the 

 composition of the blood. Frerichs refers the intestinal haemorrhage, 

 and the enlargement of the spleen, partly to compression of the capil- 

 laries of the li ver. 



Physical examination gives very important results, as it shows very 

 rapid decrease of the liver-dulness, the sole pathognomonic symptom 

 of acute yellow atrophy of the liver. At first the percussion-sound 

 becomes very full in the epigastrium, because the diminution in size be- 

 gins in the left lobe of the liver ; but often, even after a few days, we 

 can find no trace of liver-dulness. The total disappearance of liver- 

 dulness is partly due to the relaxed organ shrinking together and be- 

 ing pressed against the spine by the inflated intestines. Besides the 

 decrease of liver-dulness, the increase of spleen-dulness is important ; 

 but the enlargement of the spleen is not always so marked that it can 

 be made out by physical examination, and sometimes it does not 

 occur. 



TREATMENT. It is evident that we can say nothing that is re- 

 liable and founded on experience, concerning the treatment of a dis- 

 ease of which it is doubtful whether it ever ends in recovery. If we 

 could distinguish the first stage of this disease from that of catarrhal 

 jaundice, we should apply leeches about the anus, cold compresses 

 over the right hypochondrium, and give saline laxatives. In the 

 second stage, according to all observations made, abstraction of blood 

 has an injurious effect on the course of the disease. On the other 

 hand, powerful drastics, aloes, extract of colocynth, croton-oil, etc., are 

 recommended, particularly by English physicians. While there are 

 symptoms of irritation in the nervous system, great excitement, delir- 

 ium and subsultus, ice is usually applied to the head ; when paralysis 

 occurs, cold douches are given ; this treatment, having been found of 

 occasional benefit in inflammatory brain affections, has been applied to 

 the cases from poisoning: Although almost all comatose patients re- 

 vive momentarily during the douche, we cannot count on a permanent 

 benefit from it in acute yellow atrophy of the liver. The same is true 

 of the internal and external use of irritants, which are recommended 

 for the paralytic symptoms ; of the mineral acids given when petechia? 

 occur, and of the ice-pills that are prescribed for the severe vomiting, 

 and for the gastric and intestinal haemorrhage. 

 47 



