PRODUCTS, ADVENTITIOUS. 



95 



sition chiefly takes place in the interlobular 

 cellular membrane which has first undergone 

 hypertrophy : he confounded cases of cirrhosis 

 with true "fatty" change. 



Vauquelin found that by exposing slices of 

 fatty liver to a gentle heat, incapable of 

 causing decomposition of animal matter, their 

 composition, as the mean of several experi- 

 ments, appeared the following : yellowish con- 

 crescible oil, 0.45; parenchyma, 0.19 : mois- 

 ture, 0.36. This fat unites with alkalies, and 

 forms a soft soap with the usual properties. 

 From a specimen immersed in boiling water 

 by Dr. Bostock*, a quantity of oil exuded, 

 rose to the surface, and, when the water 

 cooled, was converted into a hard white sub- 

 stance, physically resembling tallow. It be- 

 gan to melt at 80, and was completely fused 

 at about 1 10 ; in its chemical properties it 

 generally resembled tallow. 



Of the causes of this condition of the liver 

 little is known. The fact of its frequent exist- 

 ence in France in phthisical subjects, already 

 stated by Bayle and Laennec, was numerically 

 proved by Louis.-{- This observer found fatty 

 impregnation of the liver in 40 of 120 phthi- 

 sical subjects, in 9 only of 230 persons dying 

 of other affections; he also discovered that 

 (uninfluenced by age) its proportional fre- 

 quency in males and females is as 1 : 4. An- 

 dral|, speculating upon these facts, suggests 

 that, inasmuch as, in consequence of the mor- 

 bid state of the lung, a sufficient quantity of 

 hydrogen is not expelled in the form of pul- 

 monary aqueous vapour, this element is sepa- 

 rated in excess from the blood in the paren- 

 chyma of the liver, and there helps to form 

 fatty matter. Mr. Bowman surmises, in a 

 similar manner, that it arises from excess of 

 carbon, (which it is the chief office of the 

 liver to throw off from the system,) accumu- 

 lating in consequence of imperfect respiration. 

 But these conjectures are too exclusive in their 

 bearing. Fatty liver occurs in non-phthisical 

 subjects, whose respiration is naturally per- 

 formed^ Explanations of this class obviously 

 fail to account for the unequal frequency of 

 the fatty change in the phthisis of climates so 

 closely similar as those of Paris and London ; 

 and leave unaccounted for the greater ten- 

 dency of phthisical Frenchwomen than 

 Frenchmen to the peculiar change. 



(2.) The liver we have described is the 

 " fatty liver," per eminentiam. But undue 

 deposition of fat forms a not unimportant 

 feature in other morbid states of the gland. In 

 cirrhosis, for instance, as particularly shown 

 by Gluge||, HallmannT, and Valentin**, accu- 



* Briglit's Hosp. Rep. vol. i. p. 114. 



t De la Phthisic, p. 115, ed. 1. 



j Anat. Pathol. t. ii. p. 598. 



This condition of the liver is comparatively very 

 rare, as we have elsewhere observed, (Physical 

 Diagnosis of Diseases of the Lungs, p. 215.) in 

 the phthisical population of this country. Of the nu- 

 merous tuberculous subjects we have opened within 

 the last four years, (1845,) not one presented this 

 morbid state to any marked amount. 



I] Op. cit. 



f De cirrhosi hepatis. Berol. 1839. 



** Repertorium, 1840. 



mulation of fat, either free or in vesicles, is as 

 perceptible a character of the disease, as obli- 

 teration of the ultimate bile-radicles and blood- 

 vessels and atrophy of the lobular structure. 

 But we do not believe, with Gluge, either that 

 this fat-deposition is the solitary element of 

 the diseased state in cirrhosis; or that the 

 "fatty" state of the liver already described (1) 

 is the first stage of cirrhosis. On the other 

 hand there can be no question that the true 

 history of this common disease is, in respect 

 of its fatty element at least, yet undetermined. 



(3.) There exists a third form of fatty condi- 

 tion of liver, of which we have as yet but 

 little experience, but which may not be passed 

 over in silence. We have now some three or 

 four times found minute crystals of choles- 

 terin among the hepatic cells, (gathered toge- 

 ther in sufficient quantity to render the nuclei 

 of these obscure,) in portions of the gland, of 

 pale fawn tint, flaccid, fragile, and rather greasy 

 in look and feel. In one of these cases the gall- 

 bladder was greatly distended with deep- 

 coloured but quite fluid bile. 



(b.) Pancreas. The proper texture of this 

 organ is sometimes infiltrated with fat, in such 

 manner as to give it the aspect of being com- 

 posed of that substance*, a condition per- 

 fectly distinct from that of mere accumulation 

 of fat between its lobules. 



(c.) Mamma. The acini of the mamma 

 are said to be found by Dupuytren similarly 

 affected ; the observation, we think, requires 

 repetition; certain it is, at least, that in fatty 

 hypertrophy of the organ the acini continue 

 distinguishable. 



(d.) Kidney. The kidney is subject to dif- 

 ferent species of fatty change, which have been 

 confounded by writers under the general title 

 of "fatty degeneration or transformation." 

 First : in certain cases of atrophy of the renal 

 textures dependent on cyst-formation, or on 

 chronic pyelitis (either of calculous or simple 

 inflammatory origin), abundant accumulation 

 of fat takes place in the cellular tissue sur- 

 rounding the kidney and underneath the cap- 

 sule, and encroaches on its proper substance. 

 Secondly : unnatural development of fat may 

 take place amid the tissue of the kidney in 

 connection with similar atrophy, sometimes 

 perhaps as the cause, more frequently as the 

 effect of this morbid change. Thirdly : the 

 kidney, in very rare instances, acquires the 

 colour and many of the properties of " fatty 

 liver," greasing paper, &c. In a remarkable 

 case recorded by M. Pascal f, the quantity of 

 oil present was so considerable that it exuded 

 from the organ under pressure, almost as from 

 a sponge. No particular symptoms appear to 

 have occurred in connection with this state ; 

 but its symptoms and minute anatomy both 

 require investigation. Fourthly : M. Gluge J, 

 some years since, taught that one variety of 

 alteration, found in the kidneys of persons cut 

 off with the symptoms of Bright's disease, was 



* Lobstein, Anat. Path. pi. ix. fig. 1. 

 f Journal Hebdomad. 2e serie, t. xii. p. 347. 

 1833. 

 t Op. cit. Zweites Heft, S. 130. 1841. 



