704 THE LIVEE. 



was of an acute character, the person having died eight days after the first 

 appearance of jaundice ; while in the second case, two weeks before death, 

 severe symptoms characteristic of yellow atrophy set in, though the clinical 

 symptoms for some time previous had been those of interstitial hepatitis, 

 with cirrhosis. 



In specimens obtained from these two cases, a difference was noticed in 

 accordance with the clinical history. In the first case all the evidences 

 pointed toward a very acute destructive process in the liver, without any 

 other complications; in the second case, the features pointed toward an 

 acute catarrhal or interstitial hepatitis, combined with those of yellow 

 atrophy. In fact, some observers have claimed that both these processes are 

 so far identical that yellow atrophy must be considered merely as a very 

 acute interstitial hepatitis. This view, however, I cannot corroborate. 



Sections obtained from the first case, when brought under the microscope, 

 exhibited as the most striking feature the want of calibers throughout the 

 portal system, the intra-lobular capillaries, and hepatic veins. The second 

 striking feature was the more or less marked reduction of the size of the 

 lobules of the liver. The third point was a partial engorgement of the 

 capillary blood-vessels of some lobules, combined with extravasation of 

 blood. The fourth point was the disappearance of the lobules and the trans- 

 formation of all the constituent tissues of the liver into a granular mass 

 the so-called detritus. In addition to these points a fifth was present in the 

 second case, comprising the phenomena of acute interstitial hepatitis. 



Whereas, in normal liver-tissues the portions between the lobules abound 

 in large veins belonging to the portal system, in yellow atrophy such vessels 

 are either invisible, or, if present, considerably changed in their aspect. 

 Portal veins, which were still recognizable as such, presented an irregular, 

 seemingly jagged, bordering line surrounding an angular, as if compressed 

 or collapsed caliber. This, instead of containing blood, held only a brown 

 granular mass, composed of shriveled, partly disintegrated blood-corpuscles. 

 The branches springing from such portal veins were stretched to a narrow 

 slit, which was bounded by medullary corpuscles, and, outside of these, by 

 the so-called structureless layer present beneath the endothelia in the normal 

 condition. The stretching of the vessels of the portal system to such a 

 degree that their calibers were entirely lost, was observed in all places in 

 which the disease had reached a high degree, though still in its initial stage. 

 The former caliber was marked by the presence of endothelia, partly broken 

 down into medullary corpuscles which were closely attached to each other, 

 and on either side was seen a somewhat denser tract of connective tissue 

 corresponding to the walls of the vein. The capillaries exhibited the same 

 features ; most of them were compressed to such a degree that the endothelia 

 of the wall touched each other. Such thoroughly compressed capillaries were 

 in communication with less compressed ones, filled apparently with detached 

 endothelia and medullary corpuscles, evidently sprung from endothelia, and 

 with scanty red blood-corpuscles. 



The interstitial tissue was everywhere augmented, and composed of a 

 large number of globular or irregular elements, such as we observe in the 

 inflammatory process. But, while in simple acute inflammation the globular, 

 homogeneous elements composed of solid bioplasson are largely prevailing, in 

 yellow atrophy they were much less numerous, the finely granular bodies 

 being largely in excess. The latter are divided into lumps of small size, 



