444 METABOLIC ABNORMALITIES, AUTOINTOXICATION 



The etiology of the disease is quite unknown, but it is very 

 probably not a specific one, for we find that numerous forms of 

 intoxication may lead to a condition closely resembling acute 

 yellow atrophy, 1 particularly phosphorus poisoning, chloroform 

 poisoning, puerperal eclampsia, and some cases of septicemia 

 (especially with the streptococcus 2 ), arsenic poisoning, and 

 mushroom poisoning. It seems probable that any poison which 

 does not directly cause death, but which causes a severe injury 

 to the liver-cells without at the same time destroying the auto- 

 lytic enzymes, so that the cells die and undergo rapid autolysis, 

 may produce a condition identical with or similar to acute yel- 

 low atrophy (Wells and Bassoe 3 ). In the typical cases of the 

 disease, of "idiopathic" origin, the poisonous agent probably 

 comes from the alimentary canal, as indicated by a preliminary 

 period of gastro-intestinal disturbance that usually precedes 

 the onset of the disease, and secondly by the fact that the liver 

 seems to receive the chief effect of the poison. Whether these 

 hypothetical poisons are produced by abnormal fermentation and 

 putrefaction in the alimentary tract, or by a specific organism 

 elaborating its poison in this location, is quite unknown. Bac- 

 teriological studies of the disease have so far given inconstant 

 and non-instructive results. In the countries where phosphorus 

 poisoning is common (especially Austria) there has been found 

 much difficulty in distinguishing in many cases the results of 

 phosphorus poisoning from acute yellow atrophy of the liver, 

 and many have contended that there is no real difference ; i. e., 

 that phosphorus, as well as unknown poisons, may cause acute 

 yellow atrophy. The present trend of opinion, however, seems 

 to favor the view that there is a primary liver atrophy which is 

 different from that caused by phosphorus or other known 

 poisons in several essential respects. 4 



Phosphorus Poisoning. Between phosphorus poisoning 

 and "primary " hepatic atrophy the following chief differences 

 may be discerned : Phosphorus produces a general injurious effect 

 upon all the organs of the body, the liver merely showing the 

 most marked anatomical changes, which at first consist of a 

 fatty metamorphosis of the liver, due to migration of the body fat 



1 It is to be borne in mind that the color is yellow only during the earlier 

 stages, " red atrophy," occurring later, but the name acute " yellow atrophy " 

 has come through usage to apply to the disease as a whole. 



2 Babes, Ann. Inst. Path. Bucarest, vol. 6. 



3 Jour. Amer. Med. Assoc., 1904 (44), 685. 



4 See Anschiitz, Arb. a. d. Path. Inst. Tubingen, 1902 (3), 230; Paltauf, 

 Verb. Deut. Path. Gesell., 1903 (5), 91; Kiess, Berl. klin. Woch., 1905 (42), 

 No. 44a, p. 54. 



