THE LIVER. 



707 



case. In the interstitial tissue, exhibiting marked inflammatory changes, 

 there were observed in some places numerous bile-ducts, while in other 

 places these were entirely absent. 



The results of these researches may be summed up in the following 

 statements : 



1. Yellow atropliy consists in tlie breaking down of all constituent elements of 

 the liver into irregular lumps of medullary elements, accompanied l)y a considera- 

 ble loss of living matter. 



2. The disease has one feature in commonwith inflammation i. e., the reduc- 

 tion of the constituent tissues into inflammatory corpuscles ; but the essential 

 feature of inflammation, namely, the new formation of living matter, is absent. 



3. Fatty degeneration is no characteristic sign of yellow atrophy, as in both 

 cases fat ivas present only in a small amount. 



4. There are combinations of acute catarrhal or interstitial hepatitis with yel- 

 low atrophy, but in what causal relation to each other I have not determined. 



5. Red atrophy, combined with the yellow, is very probably due merely to a 

 partial engorgement of the capillaries and extravasation of blood. 



G. Most of the vessels belonging to the portal system of the liver being collapsed, 

 the conclusion is admissible that the disease is due to an impeded circulation in 

 the larger portal vessels. The partial engorgement of the capillaries and the 

 extravasation of blood could be explained by an impeded circulation in the hepatic 

 artery. 



One of the most recent writers, J. Dreschfeld,* gives" the following sum- 

 mary of the present condition of this subject, briefly stating the main points 

 about which authors at present disagree : 



"(1) As regards the icterus, many believed it to be of the hepatogenic, 

 others believe it to be of the hematogenic kind. 



"(2) While all are agreed that the chief lesion in the liver whether 

 acute liver atrophy be considered a general disease (as most observers 

 believe) or primarily a local disease consists in a fatty degeneration of 

 the liver-cells, some writers (e. g., Winiwarter, Wiener Mediz. Jahrb., 1872) 

 think that the first change consists in an inflammatory process in the inter - 

 lobular areolar tissue, which only secondarily causes fatty degeneration of the 

 liver-cells. Again, according to Levitski and Brodowski (Virchow's Archiv, 

 vol. Ixx., p. 421), there is, prior to the cell-degeneration, a cell-proliferation 

 in some parts of the liver-lobules, these observers having seen numerous liver- 

 cells three to four times smaller than the normal liver-cells in those parts of 

 the liver-parenchyma which had not yet undergone degeneration. 



" (3) As to the relation of the red to the yellow atrophy, most patholo- 

 gists now believe that the red atrophy is only a more advanced state of the 

 yellow atrophy, and is found in cases which run a slow course (Zenker, Perls, 

 etc.) ; while Klebs, on the other hand, believes the two to be essentially dif- 

 ferent processes. 



" (4) The red atrophy is characterized by a more complete disintegration 

 of the liver-cells, by the presence of an interlobular, embryonic tissue, and of 

 rows of cells resembling glandular tubes, supposed by some to be proliferat- 

 ing biliary ducts (Cornil and Eanvier), by others to be the surviving columns 

 of hepatic cells (Thierfelder, in Ziemssen's ' Cyclopedia,' vol. ix., p. 254). 



"On the Morbid Histology of the Liver in Acute Yellow Atropliy." Jour. Anat. and 

 Physiol., Lond., 1880-1, xv., 422-430. 



