On acute yellow atrophy of the liver / by T. Grainger Stewart.

Date:
1865
Catalogue details

Licence: Public Domain Mark

Credit: On acute yellow atrophy of the liver / by T. Grainger Stewart. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    comatose. Labour commenced about eight o'clock; the waters came away about nine. She was delivered of twins, just as she was dying, at seven o'clock on the morning of the 12th. Autopsy.—The body was examined thirty-one hours after death. It was moderately well nourished. The skin was icteric and some- what dusky. There was considerable hypostatic congestion, but no subcutaneous extravasation of blood. The muscles were dry ; the blood dark and fluid. All the internal organs were jaundiced. There were patches of extravasation under the visceral layer of the pericardium, particularly over the left auricle, and towards the upper part of the left ventricle. The heart was moderately contracted, contained no clot, and very little blood. The muscular substance was somewhat pale; the valves were natural. The aorta was natural. The lungs were congested and somewhat cedematous, particularly at their lower and posterior parts. The liver was reduced to one-half its natural size; but, except being some- what flattened, it retained its ordinary form. It weighed 1 lb. 7£ oz. Its surface was not shrivelled. Beneath its capsule and throughout its substance there were numerous ecchymoses, and small patches of an ochre yellow colour, but the mass of the organ was of a dark reddish brown hue. The outlines of the lobules were not recognisable. The gall-bladder was contracted, and contained a little grey inspissated mucus. On microscopic examination of a scraping from a cut surface of the liver, a large quantity of debris and fatty matter, with cells in different stages of alteration, some full of oil globules, and con- taining a few bright ochre-yellow granules, and others full of dense granular matter, not fatty, were found. All the cells were considerably enlarged, and denser than natural. No natural cell was observed. The amount of bile pigment found both in the cells and debris was less than is usual in such cases. On examining sections, it was found that the cells in the outer part of the lobules were almost completely destroyed, while those towards the centre were larger, denser, and more opaque than natural, and the amount of oil was greater towards the margins, where the destruction of cells was taking place. The system of vessels and the fibrous stroma of the organ were not destroyed. It was easy to make sections, and the sections were easily washed without their giving way. In the sections a considerable amount of bile pigment was seen scattered about. Some demonstrations were made of the blood in the liver, but neither in it nor in the substance were any crystals or balls of tyrosin or leucine observed. The spleen was enlarged, weighed 8 oz., was soft and pulpy. There were some points of extravasation in its substance and beneath its capsule. The suprarenal bodies were somewhat enlarged and partially disorganized, but their microscopic structure was not ascertained.