ACUTE YELLOW ATROPHY OF THE LIVER 445 



from the fat deposits into the injured cells (Rosenfeld, Taylor) ; 

 subsequently the liver-cells disintegrate, the cytoplasm being 

 affected before the nucleus, and the liver may become smaller 

 than normal, although it is usually enlarged because of the fat 

 deposition. Typical acute yellow atrophy is characterized by 

 an early necrosis of a large proportion of the liver-cells, the 

 nucleus becoming unstainable while the cytoplasm is still little 

 altered in appearance, and fatty changes play a subordinate role 

 or are absent. As Anschiitz says, the poison seems to strike at 

 the life of the cell, its nucleus, while phosphorus attacks the 

 cytoplasm. Furthermore, the poison of yellow atrophy seems 

 to be very specific, for it attacks the other organs of the body 

 almost not at all, and within the liver it affects only the hepatic 

 cells proper, while the bile-duct epithelium and the stroma cells 

 are so little injured that they are able to proliferate greatly, this 

 proliferation being a prominent feature. There are also clinical 

 and chemical differences that will be discussed later, but yet, on 

 the whole, the resemblances of yellow atrophy and phosphorus 

 poisoning are so great that we have obtained much information 

 concerning the former by means of experimental studies of 

 phosphorus poisoning. 



Delayed Chloroform Poisoning. After chloroform narcosis 

 there occasionally develops a severe intoxication, with clinical 

 and anatomical findings very similar to acute yellow atrophy and 

 phosphorus poisoning ; l in point of the fatty changes the cases 

 usually resemble more the phosphorus poisoning. Some cases 

 of puerperal eclampsia also present such profound liver changes 

 that they are distinguished as eclampsia chiefly on the basis of 

 the convulsive manifestations, rather than on the ground of 

 anatomical changes. So, too, the hepatic changes in certain sep- 

 ticemias may resemble those of acute yellow atrophy to a greater 

 or less degree. 



Summary of Views on Btiology. From a review of 

 the literature and the study of a few cases, the writer has 

 reached the following understanding of the condition described 

 as acute yellow atrophy of the liver : The " atrophy " is due 

 entirely to autolysis of necrotic liver-cells by their own enzymes. 

 In the most typical cases of " primary " or " idiopathic " yellow 

 atrophy we have to do with a poison having a very specific 

 effect on the liver-cells, which destroys their " life " (i. e., stops 

 synthetic activities) without injuring their intracellular proteo- 

 lytic enzymes, and consequently autolysis occurs ; as the poison 



1 Complete review and literature by Be van and Favill, Jour. Amer. Med. 

 Assoc., 1905 (45), 691. 



