In the first, the liver had the typical appearof what is called the 'gin drinker's liver.' It was three-fourth the size of the natural organ, rounded, purplish white in appearauce, with It was hard nodular projections on its surface. and tough, so that hardly any impression could It was adherent be made on its substance. by old adhesions to the diaphragm which were elongated and extended septa-like between it and the abdominal vault. The glisson's capsule could not be detached, but was found on section to send partitions in the form of white streaks from its under-surface. Lying in the interstices were the lobules, each shrunk and of a yellow colour. The gall-bladder was empty. The appearance of the liver in the other case was exactly the reverse. It was atrophied, doubled up in the hollow of the diaphragm, and so soft that in attempting to remove the organ, its thin capsule ruptured and peeled off from its substance, and the whole liver looked like lumps of fat attached to a thin membrane. There were patches of extravasation under The gallthe capsule on its under-surface. bladder contained some dirty grey fluid. The small size of the liver in both instances indicated atrophy. Whilst in one the morbid process was of slow and chronic growth?in the other, it was a rapid one. One was hard and tough from fibrosis, or thickening of the fibrous tissue composing the glisson's capsule?the other was soft from acute degeneration, or what is commonly called the acute yellow atrophy. The lobules in cirrhosis of the liver have ultimately a tendency to undergo fatty degeneration as well, but the increased development of the fibrous tissue gives it the compact feel. Both have a tendency to destroy life by causing obstruction to the postal circulation. In one the system tries to adapt itself to the chronicity of the change by establishing recurrent circulation through the medium of systemic veins. The veins on the surface of the abdomen soon become prominent, but being unequal to the emergency, the passive congestion is relieved by effusion of fluid in the peritoneal cavity, and thus staying the fatal end. The stomach and bowels remain susceptible to inflammatory change, and dysentery often hurries away the victim or some blood-vessel ruptures in the stomach giving rise to licemetemesis. Jaundice is rare, though the secretion of bile is In fact, the abdominal not duly carried out. fluid remains surcharged with biliary ingredients, and by its partial absorption produces a slow form of blood-poisoning. In the acute yellow atrophy, the morbid change being of rapid growth, the system has no time for accommodation, and the first warning it gives of its presence is in the rupture of vessel and bloody vomiting. There is jaundice, but not often deep and well-marked, and the retenance
NOTES ON TWO CASES OF ATROPHY OF THE LIVER. By G. C.
Surg eon-Major,
Hoy,
m.d., f.r.c.s.,
Indian Medical Service.
On the same day I had post-mortem examinations of two cases of atrophic disease of the liver, which were dissimilar in their nature and
symptoms.
Both were paupers, admitted within a day's interval of each other, and died on the same day, one after 48 and the other within 24 hours after admission into the Sooree Charitable DispenThe first was a case of ascites in the last sary. stage of emaciation, with the abdomen full to distension with fluid, the veins prominent on the surface of the abdomen and diarrhoea. The distension had mechanically interfered with the free action of the lungs, and was causing dyspnoea from congestion. Considering the intemperate life he led, cirrhosis of the liver was diagnosed, and the symptoms becoming distressing, paracentesis was performed, and the smallest sized India rubber tube was introduced for free and continuous drainage of fluid. During operation He died the patient fainted away, but rallied. the next day from exhaustion. He came The second was also a beggar. He said he had been with vomiting of blood. feeling for some days an uneasiness over the epigastrium aud right hypochondrium, but suddenly he was tuken ill with hoemetemesis the night before, and had vomited a large quantity of blood. He was very weak, staggering and troubled with constant retching, and in my preout some dark coffee-ground sence brought stuffs. All that I could examine in him was his heart, which seemed to be healthy, though weak and quick. No bruit, or symptoms of His breathing was aneurism was detected. of asthma. character and the had wheezing, He was put to bed at once, and an stringent mixture was given with ether to treat his sympHe became unconscious in the course of toms. the day, and died the next morning.
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212
THE INDIAN MEDICAL GAZETTE.
tiou of bile rapidly produces its own deleterious influence producing death from coma. The rarity of investigating such cases has yet left their pathological nature a mystery. Is it a parenchymatous inflammation, or a fatty degeneration, or solution and absorption of the organ by the retention of bile, as some assert? I may be permitted to remark that, judging from analogy, there is no such sequela observed in any other organ in the body, in which inflammation is attended with such rapid atrophy. An organ inflamed increases in bulk by interstitial effusion, and shews greater activity of circulation, whereas in acute atrophy the appearance of the organ is just the reverse. It is reduced in bulk, soft aud flabby in texture and exsanguine. Frerichs has observed a deposit of pale yellow structure round the circumference of each lobule, but it has not been corroborated by others, and I can add to it my feeble negative testimony. On the contrary, each lobule is held so feebly together that they This want of fall out by their own weight. cohesion?diminution of the size aud bloodless condition of the liver indicate necrotic change. The appearance, on first sight, conveys an impression of death or necrosis of liver?a condition which is simulated in other organs by the tying of their nutritive vessel. I think this view is more consistent with the -post-mortem appearance of the organ and the symptoms That primarily it is not observed before death. a fatty degeneration will be evident from the fact that, on microscopic exmination of the biliary cells, they were not found surcharged with fat granules or globules, though I doubt not these appear ultimately as nature's attempt to remove a decaying tissue from the system. The absence of leucine and tyrosine was probably owing to the rapidly fatal termination of the case.
[July,
1885.
NOTES ON TWO CASES OF ATROPHY OF THE LIVER. By G. C.
Surg eon-Major,
Hoy,
m.d., f.r.c.s.,
Indian Medical Service.
On the same day I had post-mortem examinations of two cases of atrophic disease of the liver, which were dissimilar in their nature and
symptoms.
Both were paupers, admitted within a day's interval of each other, and died on the same day, one after 48 and the other within 24 hours after admission into the Sooree Charitable DispenThe first was a case of ascites in the last sary. stage of emaciation, with the abdomen full to distension with fluid, the veins prominent on the surface of the abdomen and diarrhoea. The distension had mechanically interfered with the free action of the lungs, and was causing dyspnoea from congestion. Considering the intemperate life he led, cirrhosis of the liver was diagnosed, and the symptoms becoming distressing, paracentesis was performed, and the smallest sized India rubber tube was introduced for free and continuous drainage of fluid. During operation He died the patient fainted away, but rallied. the next day from exhaustion. He came The second was also a beggar. He said he had been with vomiting of blood. feeling for some days an uneasiness over the epigastrium aud right hypochondrium, but suddenly he was tuken ill with hoemetemesis the night before, and had vomited a large quantity of blood. He was very weak, staggering and troubled with constant retching, and in my preout some dark coffee-ground sence brought stuffs. All that I could examine in him was his heart, which seemed to be healthy, though weak and quick. No bruit, or symptoms of His breathing was aneurism was detected. of asthma. character and the had wheezing, He was put to bed at once, and an stringent mixture was given with ether to treat his sympHe became unconscious in the course of toms. the day, and died the next morning.
-
212
THE INDIAN MEDICAL GAZETTE.
tiou of bile rapidly produces its own deleterious influence producing death from coma. The rarity of investigating such cases has yet left their pathological nature a mystery. Is it a parenchymatous inflammation, or a fatty degeneration, or solution and absorption of the organ by the retention of bile, as some assert? I may be permitted to remark that, judging from analogy, there is no such sequela observed in any other organ in the body, in which inflammation is attended with such rapid atrophy. An organ inflamed increases in bulk by interstitial effusion, and shews greater activity of circulation, whereas in acute atrophy the appearance of the organ is just the reverse. It is reduced in bulk, soft aud flabby in texture and exsanguine. Frerichs has observed a deposit of pale yellow structure round the circumference of each lobule, but it has not been corroborated by others, and I can add to it my feeble negative testimony. On the contrary, each lobule is held so feebly together that they This want of fall out by their own weight. cohesion?diminution of the size aud bloodless condition of the liver indicate necrotic change. The appearance, on first sight, conveys an impression of death or necrosis of liver?a condition which is simulated in other organs by the tying of their nutritive vessel. I think this view is more consistent with the -post-mortem appearance of the organ and the symptoms That primarily it is not observed before death. a fatty degeneration will be evident from the fact that, on microscopic exmination of the biliary cells, they were not found surcharged with fat granules or globules, though I doubt not these appear ultimately as nature's attempt to remove a decaying tissue from the system. The absence of leucine and tyrosine was probably owing to the rapidly fatal termination of the case.
[July,
1885.
