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1908-9.] Changes in Liver and Kidney after Chlorofornn 
Fraenkel (4), Marthen (5), and Cohn (6) further describe the appearance 
of a yellow pigment in the kidneys and liver of patients who died apparently 
as a consequence of having been anaesthetised with chloroform administered 
through the respiratory passages. 
There is considerable difference of opinion as to the cause of the 
degenerative change; some authors (Junkers (7) and Strassmann (8)) con- 
sidering that it is due to the toxic action of the drug on the cells them- 
selves, others to a primary destructive action on the red corpuscles. 
(Nothnagel (9) and Ostertag (10) ). 
In the paper referred to above, Stiles and McDonald describe in detail 
the post-mortem appearance of tissues removed from a child who died four 
days after an operation under chloroform ansesthesia. 
The changes consisted in extensive degeneration of liver and kidney 
tissue. In the case of the liver, the cells throughout the organ were 
markedly changed and vacuolated, but the most complete degeneration 
appeared to have taken place in the centre of the lobules. The cells contained 
droplets of oil, which were clearly demonstrated by staining with Sudan iii. 
Droplets of oil were also found in the hepatic veins. The kidney showed 
intense fatty degeneration, which was almost universal throughout the 
organ. 
Stiles and M‘Donald then made a series of observations upon rabbits, 
and to obtain a full action of the drug upon the tissues the chloroform was 
injected subcutaneously. 
Here again they found marked fatty changes in the liver cells, most 
marked in the central and intermediate zones of the lobules. The cells 
were seen to be occupied by numerous minute droplets which showed no 
tendency to coalesce, and many in the centre of the lobules were completely 
disorganised. 
In the kidneys the changes were less marked, and varied from cloudy 
swelling in the cells of the convoluted tubules and ascending loops of Henle 
to well-marked fatty change in these tubules and the collecting tubules. 
No fat was observed in the vessels, and it was noted that the glomeruli 
showed no change. The authors then examined similar tissues obtained 
from animals which had inhaled chloroform vapour for varying times. 
They found the changes to be similar to those observed after injection of 
the drug, but somewhat less marked. 
Doyon (13) also describes the histological changes in the liver after 
chloroform had been administered experimentally by the mouth and 
hypodermically. In both instances he found necrosis of the liver cells. 
