ACUTE YELLOW ATROPHY OF THE LIVER 443 



poisonous substances that initiate the tissue changes, but also 

 toxic substances that accumulate because of the disorganiza- 

 tion of the liver and kidney cells, and which are possibly 

 similar to the toxic substances most prominent in uremia 

 and in acute yellow atrophy, for eclampsia seems to stand 

 intermediate between these two diseases, encroaching upon 

 the characteristics of each. Acid intoxication, which un- 

 doubtedly exists to a greater or less degree in some cases of 

 eclampsia, is probably not usually the chief cause of the clinical 

 manifestations of the disease. The finding of minute quantities 

 of lactic acid in the blood, urine, and in the cerebrospinal fluid 

 (Fiith and Lockemann x ) is perhaps not of great significance, 

 for, as Wolf 2 rightly insists, similar amounts may be found in 

 other conditions associated with convulsions and partial as- 

 phyxia, or in partial starvation, such as results from the vomit- 

 ing of pregnancy. To be sure, Zweifel states that lactic acid 

 may be found in the urine and blood before the eclamptic 

 seizures have appeared, but, in any case, the anatomical changes 

 and clinical manifestations cannot be explained as due to the 

 action of the trifling quantities of sarcolactic acid found in the 

 blood of these patients. The excretion of these organic acids, 

 as well as the large proportion of unoxidized sulphur in the 

 urine, indicates that incomplete oxidation is an important feature 

 of eclampsia, and under such conditions a large number of 

 imperfectly known toxic substances may accumulate in the 

 blood and tissues. The defective oxidation is probably the 

 result of the injury to the liver-cells, which have such a promi- 

 nent oxidizing function. 



ACUTE YELLOW ATROPHY OF THE LIVER 



In this condition there is presented a striking picture of 

 autolysis, in that a large parenchymatous organ undergoes a 

 rapid reduction of size because of a solution of its structural 

 elements, while at the same time products of proteid digestion 

 (leucin, tyrosin, etc.) appear free in the liver, the blood, and the 

 urine. Because of these prominent features and their relation 

 to the questions of metabolism in general, and the function of 

 the liver in particular, acute yellow atrophy of the liver has 

 been the object of much greater interest and investigation than 

 its clinical importance would warrant, for it is a rare disease, 

 there probably being but about 500 cases reported in the litera- 

 ture, according to Best's figures. 3 



1 Cent. f. Gyn., 1906, p. 41. 2 New York Med. Jour., 1906 (83), 813. 



3 Thesis, University of Chicago, 1903. 



