Volume 2

A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A system of gynecology and obstetrics / by American authors ; edited by Matthew D. Man and Barton Cooke Hirst. Source: Wellcome Collection.

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

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    The force and frequency of the foetal heart-beats demand attentive observation, and in the event of the appearance of signs of impending death pregnancy must be prematurely interrupted. 3Mi(jnant Jaundice.—yellow atrophy of the liver is a rare complication of pregnancy. Carl Braun ‘ observed the condition only once in 28,000 pregnant women (1857-63); Spaeth* saw the disorder only three times in 14,061 pregnant women. The rarity of the aflec- tion renders the view improbable that pregnancy exercises a very strongly ])rcdisposing influence. A large contingent of the ca.ses recorded, however, is afforded by pregnant women. Out of 143 cases of acute yellow atrophy of the liver in which the diagnosis was veri- fied by autopsy, Thierfelder* demonstrated the coexistence of preg- nancy in 30. In 69 cases recorded by Legg, pi’cgnancv was ascer- tained to exist in 25.* Three principal views are held with reference to the nature of this disease 1. That it is the local expression of a general infection, especially aided in its development by the kidneys and nervous system. The agent of infection may be .specific, the result of a typhous process or of puerperal .sepsis. 2. That it is an essential primaiy disease of the liver, characterized by liypertemia, exudation, and necrosis. 3. That it is due to the resorption of bile and to the solution of the hepatic cells by these raattci’s retained in the blood. Thierfelder has shown that essentially different morbid states—cirrhosis, chronic fatty degeneration of the liver, comj)ression of the bile-ducts by tumoi’s, puerperal fever, relapsing fever, typhus, pho.sphorus-poisoning—having in common the single symptom of the stasis of the hepatic secretions and excretions, may under certain conditions terminate in acute yellow atrophy. Lomer sugge.sts the jilausible hypothesis that pregnancy su])- plies the ncce.ssary conditions for the di.ssoliition of the blood-corpuscles and the hepatic cells by the retained bile acids. Morbid Anatomy.—The liver is ochi’e-colorcd, .shrunken to one half its volume, and flaccid. On section no traces of its lobular .struc- ture are visible. Micro.scopical examination reveals total destruction of the acini and hepatic cells. In the place of the glandular eleinent.s, tilt-globules, fine granular detritus, crystals of leucin and tyrosin, are noted. The .spleen is enlarged and the kidneys show acute inflamma- tory changes. Extensive ecchymoses are observed in the meninges, under the skin, pericardium, and in the gastric mucous membrane. All the ti.ssues are .stained with bile. The blood shows profound disorgan- ization, Avith the solution of the red corpuscles. * Loc. cit., p. 848. ’ Wiener merl. Wochenachr., 1854, p. 757. ^ Ziemssen's llandbuck, 1878. ‘Lomer: loc. cit., p. 181.