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Show DISEAS 0F TIIE LIVER, SPLEEN, AND LYMPIIATICS. TABLE II. Fiu. 1.--Rul Atrophy oft/Ir L/rrr. (Vim/Win.) Case-"Y. T,, aged iii}. In Gui/‘5 Ionp/(rrl, Lon/low. IIistor ' and symptoms: \Vas exposed in the open air, had lived rather hard, and [SECTION VI I. Fm. 3.-Ani}/lm'rl um] Fr/f Mdunimp/zom's qff/ir Ito/lit Lobp, Iii this case no dropsical effusion had taken place. The bile secreted was imperfect. In the two first cases (Figs. 1. 2) there was as 'itcs; (ll-i), portions of convex surface covered \Vlfll peritoneum. became very poor. Forthe last four months his appetite had failed; about a month ago perceived that his legs had swelled and his abdomen became tumid. IIad lost fiesh. Afte ‘admission the abdomen was distended and fluctuation very evident. The lower extrmnities whole structure was changed into small rounded inasscs, vai‘vinL" somewhat in color. The secretion in the gall-bladder contained but anasarcous; countenance sallow; conjunctive slightly tinged with little bile and was chicfiy an albuminous iluid. yellow; bowels open; pulse rather weak. Every part oftheabdomcn tender on pressure. \Vas completely broken down. Died 10' days after entering the hospital. I'ost mortcm: \Vhole body slightly ieiloiiiatoiis. Abdomen swollen and fluctuating. No effusion in pleu 'al 'avity; slight effusion in pcricardial cavity. Lungs partially but firmly adhered to the ribs and the diaphragm. Both lungs iiidurated, portions congested, some loaded with serum. Heart healthy, valves sound. A quantity of serum in abdominal *avity. The intestines atrophie but otherwise not much affected. The liver contracted and throughout of a morbid nature, apparently by deposition of minute portions of a yellow substance. The surface, covered by a very fine peritoneum. thinner than usual, presented a rough, granular, uneven surface, of a light-colored red and grayish yellow. A cut surface, of less red, but more yellowish color. The organ was rounder, thicker, but smaller than usual. The gall-bladder opaque and thick, containing a small quantity of bile. The common duct pcl'vious but contracted at its entrance into the duodenum to an exceedingly small orifice. Spleen small and flaccid, light-colored, its capsule of *artilaginous density, small but iiatu 'al in structure, but of a light color internally. (A B), portion of convex surface covered with peritoneum; (b), acute margin; (0), cut surface; (D), fundus 0f gall-bladder. Fm. 2,-Iiirlaratirr III/[)Ci‘fI'tlllfl‘lj, it‘ll/i clung/c of Me Structures Into Fri! «out (Mimic/tire Tissue (F), portion of convex surface of the right lobe near the acute margin; (g), cut surface. obliteratcs the lobular boundaries, and the organ assumes a uniform Yellowish-white appearance, and is rather soft. The volume of the organ is then increased whilst its spec. g 'avity is diminished. All its sharp borders become rounded, and the surfaces readily take the imprint of the ribs. The anterior border becomes very blunt and reaches the un'ibilieiis. Such massive infiltration naturally leads to ameinia of the organ. Ii absorption of the fat by the veins or lymphatics can alone bring the impregnated tissue back to its normal condition, and that only by very powerful action of the heart. "Then this takes place the fat molecules coalesce and form ‘ather dark brownish, large fat globules. Amyloid degeneracy very much resembles the fatty infiltration as regards the localityin lobules. The substance with which the organ becomes impregnated is an albuminoid, and has, however, much similarity with vegetable starch in its chemical reaction. The earliest infiltration takes place in the hepatic artery region. The interlobular spaces at first remain, comparatively speaking, free. It begins in the smaller arteries and passes upon the cells which SHI‘I‘OuIid the capil- laries. Gradually, as the di: 'asc advances, the region of the central vein is more and more involved, and lastly only does it affect the cells in the portal-vein region. The whole liver, in this condition, contains double its quantity of albuminates, which cause its incr use in volume and specific g ‘avity. The organ has a palish red color. Its tissue becomes transparent in th 2 affected portions, and is of the consistence of beeswax. The quantity of blood in the organ depends on the quantity of the amyloid infiltrate. Of course the more the infiltration the less blood in the organ, and the less can the organic function be carried on; the quantity of bile is diminished, and of course nutrition is endangered. The *apillz'u‘ics may remain fora long While perfectly permeable to the blood. Combined fat and ainyloid infiltration are frequent, although their morbid causes may not be the same. True hypertrophy, that is, actual increase of its glandular normal tissue, can only exist in few 1iartly-ilestroyed but rebuilt structures. Augmentation of many of its elements are products of compensatory hypertrophy when portions ofthc organ are destroyed (mechanically) and the individual lobules increase in size to balance the loss of the functional structure in the other parts of the organ. In leukaunia and diabetes mellitus, or in persons living in hot climates a. long while -very likely living high and having but little exercise a species of hypertrophy or ‘athcr a form of cellular infiltration takes place. In the portal-vein region the cells are swelled, and assume by treatment with iodine a red color, which would indicate the presence of a greater quantity of glycogen. The middle or arterial region is in- filtrated with fat, the central zone nearly normal. Atrophic condition of the liver is a very frequent disease of the organ; for every disturbance of the processes of digestion. if existing for any length of time, will at once diminish the quantity of blood in the portal vein; and when insufficient absorption be associated with disturbed digestion-which is gene 'ally the case- a diminished quantity of arterial blood in the arterial circulation will ensue, and atrophic condition of the liver will follow. Atrophy from lo ‘al disturbances in the hepatic circulation is also common. The morbid altc ‘atioiis in the organ will correspond to the causes of the atrophy. Lack of alimentation from strictures of the alimentary passages and organs, when no other constitutional diseases, inflammations. or fever exist. will cause a state of general atrophy of the tissues ofthc liver. The organ may shrink to one-half its normal size (especiallythc lobules). the capsule becomes flabby and wrinkled, the cells reduced in size and impregnated with yellow and brown pigment granules. The other structures of the liver are not near as much involved. The prepi'uideraiice of the latter over the almost obliterated cellular constituents gives the organ a denser consistence than Fm. 4.-Ano//u/I/ 1)l'lI/I‘)tl'l'({/fllll off/1c ir/io/i' Li'i'cr. l'atient died with dropsical effusion preceded bv icterus. The (K L), convex surface of the liver covered with peritoneum; (l in), cut surface; (K M), thickened acute margin. Ftus. 5, (3. Both figures representparts ofthc liver of II., a patient in Guy's Hospital, London. Itwas hardened and changed througln out its whole texture-an alteration having taken placciill the parenchyma and in the secreting structures. ,1»an ' accompanied the diseased state of the organ. The power of secretion was sinncwhat preserved, so that the g: ll-bladder was inodcratelv filled with vcllow bile. ' ‘ Fm. 5.-I'art of right lobe covered with opaque adventitious membrane. (a), convex surface; (b), acute margin, thickened and rigid; (c), galbbladder; (1)), cut surface. Fro. (L-«l'art of same lobe, to show the internal structure. The substance of the organ is here seen to be composed of two textures: the one cutting evenly, almost without any trace of peculiar structure; the other, in small rounded masses like enlarged or congregated (Id/if. Both are intersected bybands ofthickencd cellular membrane. Some of the vessels are seen divided transversely. This was evidently a compli ated lesion, of ainyloid change with infiltration with lymphoid cells into the interlobuh r tissue, causing some compression of the lobular cells and infiltration and connective tissue formation in the 'apsule of (i'li'u‘oii, and extending upon the surface forming fibroid pseudo membranes. Infilt ‘atioii with pigmentai‘y substances and congestive hyperwmia is seen in Fig. 5, whilst in Fig. ‘3 infiltration with biliary pigment in the granular structure is plainly visible. usual, and may be mistaken for an induratcd liver. Vi'rc/ioir desig- nates one form of atrophy of the hepatic pareuchyma, produced by permanent venous stasis in troubles of the heart and lungs, as TU, (drop/1y. This constant static congestion, which is always followed by venous dilatation, superinduces thickening of the peri vascular structures and compression ofthc parcnchymatous tissue by the great quantity of the blood in the veins. This over-quantity of blood gives thcorganaredappearance,which,insoinecascs,becomcsdark brown. The atrophy involves chiefiy the region of the venous congestion- the cent 'al-veiii portion-the lobular cells decay, and in the shriveled elements blood pigment, red, brown, yellow, becomes Inost prominent. Lymphastasis and dilatation ofthc lymphatics are here, as everywhere, associated with venous congestion. Of course near the larger venous trunks the destruction of the cells is greater than in such where the vessels are smaller, and upon the surface of the liver deep furrows will indicate the lines of disintegration, corresponding to the course. of the dilated veins. The uneven surface often misleads into assuming that a granular state existed in the organ, especially as in this form of atrophy development of connective tissue often takes place in many parts where the liver cells were obliterated. YcUm/i "'IV‘I'I'IA a rare form ot'srgffrnfii‘r/ atrophy, is cha ‘acterizcd by distinctive anatomical features ofthc morbid change as well as clearly defined clinical symptomsofpernicious icterus. Itis an acute process, and the decrease of volume of the organ may take place in a very short period, to oncrthird of the normal. After death of the affected person the liver is found to have Ochcdiiigly shrunk in its thickness, very soft and flabby, aml its capsule perfectly shrivclcd. (Zrn/i‘cr.) Section shows a mottled appearance of red and yellow, the red portions surrounding the yellow, which form islands. The yellow portions are of a very bright tinge, very soft and spongy, and raised above the red portions, which are firmer, sometimes very dense and tough. The yellow substance forms the primary alte ‘ation, the red secondary or later stage. In the early stages the lobular structurc is still plainly recognizable in the absolutely aincmic and highly icteric yellow tissue. The large venous trunks in the lobiilcs are then the only blood vessels filled with blood, the interlobular small vessels are utterly bloodless, and mostly oblite ‘ated and replaced by interlobular connective tissue. Very many glandular cells are fatty (legcne ‘atcd. \Vhen this degeneration becomes generzl the cha 'acteristic lobular structures disappcarmore and more, and the whole lobularccll structure turns into a fatty mass, unequal in the different portions ofthc lobule in the extent of alteration. Both fat molecules and blood de- tritus-ha‘moglobin, ha-iiiatoidin, bilirubin are diffused in a fibrous structure in which but few cellular elements are, to be found. More and more are the cellularelements wiped out by tat-metamor]ihosis and only remnants of the parencliyma are noticeable near larger vascular branches, and even these are full of pigmentary granules. Eventually, when the person thus affected lives long enough for a partial regeneration of the affected liver tissue, strings of connective tissue and numerous rows of peculiar cclls make their appearance; the fat accumulation slowly disappears, massive invasion oflymphoid cells and pigmentary matter now Illkt‘h'ltlllt‘t‘. and highlyprotoplastic, finely granular cells with many prOcesscs are formed. They are very likely the newlydbrming parcnchymatoiis cells. From extensive destruction in such an organ as the liver no one ever recovers, but when this form of lesion exists only in a small part of the liver there is now and then a partial rcgcne ‘ation of the destroyed tissue and formation of cicatricial structure. wholly unfit for function. (‘ircumscriln'd atrophies of the liver from mechanical injuries and local pressure, exerted upon parts ofthc organ lbycloths.stays,g1rdlcs, belts, or displacements and enlargements of neighboring tissues, etc., are vcrv common. These atropliic forms are usually found upon parts of the organ and noticeable by the change of shape and surface of the |