533 
of Edinburgh, Session 1874-75. 
because in poisoning with phosphorus the lesion is fatty infiltra- 
tion, and not degeneration (according to Niemeyer). There is then 
only an apparent, not a real similarity between the two conditions. 
Disintegration of the hepatic tissue has been occasionally observed 
to follow obstruction of the bile duct. Frerichs has recorded such 
a case, but he does not think that this result can be owing to re- 
tention of bile in the system; for in some cases where the bile 
duct was undoubtedly obstructed, disintegration of the hepatic tissue 
did not occur. But it should be remembered that the bile, though 
prevented from reaching the intestine, may yet be excreted by the 
urine. Hence in cases where the kidneys are acting rightly no 
poisonous effects need be produced. But if, owing to any cause, 
the urinary secretion be interfered with (as seems to have been the 
case in the instance Frerichs refers to), then the bile will accumu- 
late in the system, and produce its toxic effects. In cases of 
jaundice, Graves states* that he was always uneasy as to the issue 
when nervous symptoms showed themselves, — symptoms, moreover, 
which he remarked were often coincident with a diminished secretion 
of urine. 
But perhaps the most important bearing of the results of these 
experiments is upon acute yellow atrophy of the liver. In this 
disease there is a rapid fatty degeneration of the hepatic tissue, 
and of the epithelium of the kidney. In some cases the fatty 
change is universal through the whole of the liver substance, but 
in other cases the altered appearance is only seen in isolated 
portions. 
Now it seems clear from these experiments that the mere reten- 
tion of bile acids in the system will, if long enough continued, 
produce exactly similar changes in these organs. It may be pre- 
mature to argue from this that the appearances seen in acute yellow 
atrophy are invariably produced by biliary retention, but that they 
may be so produced is certainly true, and so far as these experi- 
ments go they point to that conclusion. 
Assuming this to be correct, it will be for consideration how far 
the jaundice, seen in this disease, may be the cause and not the 
consequence of the hepatic lesion, and whether the efforts of the 
physician should not be directed more strenuously than heretofore 
* Trousseau’s “ Clinical Medicine,” vol. iv. p. 305. 
