Liver Necroses and Streptococcus Infection. 119 



of small focal areas in the peripheral and mid-zones of the liver 

 lobules. In them only a few cells appeared to be affected and 

 seemed to be sporadically picked out in the midst of the liver 

 column. Debris or the ghosts of cells, was all that remained- 

 There appeared to be some edema in the involved area but evidence 

 of thrombosis in the neighboring sinuses was not always demon- 

 strable. In some instances a granular thrombus with fibrin 

 threads was present immediately about the lesion, and at times, 

 extended towards the central vein. Similar thrombi, however, 

 were also observed in areas not showing necrosis. 



Some liver columns appeared to show change antecedent to 

 necrosis. In them the cells showed a diminution of nuclear stain- 

 ing with an eosinophile character of the protoplasm. In the 

 vicinity of these again, thromboses were wanting. 



Other areas again showed much more advanced necrosis 

 involving not only focal areas but entire lobules or even several 

 neighboring lobules. In all of these instances the necrosis involved 

 the central and mid-zone, while some liver columns still persisted in 

 the vicinity of the portal sheath. In these larger areas thromboses 

 of the mixed fibrinous variety were common. The sinuses of the 

 affected areas were irregularly involved, but not constantly, the 

 central vein being most commonly plugged. These thromboses 

 extended into the sub-lobular vein. Thrombi of agglutinated red 

 blood cells were not observed. There was no inflammatory 

 reaction in the large areas of necrosis nor was there any attempt at 

 restitution either by connective tissue or liver cells. 



In 1906, Pease and Pearce 1 noted the occurrence of liver 

 necroses in horses, immunized against the streptococcus pyogenes. 

 In their cases the liver showed diffuse necrosis but they were unable 

 to demonstrate the nature of the process. Since then much 

 literature has appeared in the discussion of liver necroses, and the 

 condition has been described in a great variety of intoxications. 



In the absence of thrombi and a cellular reaction in many of 

 the early necroses observed in our cases, it would appear that 

 they have resulted by a direct intoxication by these streptococci. 

 The mixed fibrinous thrombi, developing in the blood channels 

 distal to the liver involvement, probably result from ferments 



1 Jour. Inf. Diseases, 1906, III, p. 619. 



