418 LECTURE XVII. 



stage, however, it is essentially the hepatic cells which 

 are affected by the change ; and indeed, what is again 

 very characteristic, just those hepatic cells, between 

 which lie the capillary ramifications of the hepatic ar- 

 tery. If namely we picture to ourselves a single acinus 

 of the liver, we can, in accordance with the pathologi- 

 cal changes which may often be recognized even with 

 the naked eye, distinguish three different zones within 

 each acinus (Fig. 110). The most external part, which 

 lies next to the branches of the portal vein, is the chief 

 seat of fatty infiltration ; the intermediate part, which re- 

 ceives the capillary terminations of the hepatic artery, 

 belongs to the amyloid degeneration, and the central 

 part of the acinus around the vena hepatica is the most 

 common seat of pigmentary infiltration. Even with 

 the naked eye the pale colourless, translucent and re- 

 sistant zone of the waxy or amyloid change is sometimes 

 recognized between the most external j^ellowish white, 

 and the most internal yellowish, or greyish brown, layer. 

 If a single hepatic cell be watched, its previous granu- 

 lar contents, which give every hepatic cell a slightly 

 cloudy appearance, are seen gradually to become homo- 

 geneous ; the nucleus and cell-wall gradually disappear, 

 and at last a stage sets in in which nothing more can 

 be perceived than an absolutely homogeneous, slightly 

 shining body, if you will, a simple flake (Scholle). In 

 this manner the whole of the hepatic cells in the zone 

 I have described are sometimes converted into amyloid 

 flakes, and if the process attains a very high pitch, the 

 change at last even oversteps this zone, and it may hap- 

 pen, that nearly the whole substance of the acinus is 

 transformed into an amyloid mass. Thus out of the 

 hepatic cells there is at last produced in these cases a 

 kind of corpora amylacea, only they are not laminated 

 like those we have already spoken of, but form uniform, 



