Diseases of the Substance of the Liver.— Among these may be considered: (1) Simple atrophy; (2) acute yellow atrophy; (3) fatty liver; (4) cirrhosis, and (5) abscess.
Simple Atrophy of the Liver occurs in cases of starvation or inanition from long-continued disease. Pressure atrophy is found in cases of deformities of the chest, in which the ribs are pressed inward against the liver, as a result of tight lacing and the substance of the organ does not change very greatly in atrophy, though the individual liver cells are smaller than nor mal and usually somewhat pigmented. The shape of the liver is often peculiar. In the case of deformities of the chest, the pressure exerted by the ribs may cause deep grooves in the surface of the liver, or there may be a single transverse furrow at the lower margin of the ribs where this is pressed against the organ.
The function of the liver is probably not seriously impaired in any of these cases, though some disturbance undoubtedly occurs.
Acute Yellow Atrophy is a disease in which the liver is decreased in size, often to a re markable degree. It is soft and on transverse section the substance is of a light yellow color with mottled areas of reddish or purplish hue, the latter being portions in which the substance is congested or in which hemorrhages have taken place.
Changes are found also in various other tis sues of the body. showing that acute yellow atrophy is not wholly a disease of the liver but a general infection or intoxication, having its most marked manifestations in the liver.
Symptoms.—After a period of indefinite di gestive disturbances, acute jaundice and marked nervous symptoms set in. The patient also be comes delirious, and sometimes comatose. In the course of 10 days or two weeks the disease in a large percentage of cases terminates fatally. The treatment consists in stimulation or other measures called for by the general condition.
Fatty Liver.— There are two varieties of fatty disease of the liver, that known as infil tration and that termed fatty degeneration. In the former there is a deposition of fat in the liver cells, similar to that which is found in the subcutaneous tissues in ordinary obesity.
In the latter the liver cells undergo destruction with formation of fat. Fatty infiltration may be the result of excessive supply of nutriment as in ordinary obesity, .and is also found in certain states of general weakness and wasting, particularly in association with diseases of the lungs. In the latter cases, the cause is to be found in the deficient consumption of fat, owing to diminished oxygenation. Fatty de generation may be caused by various infectious diseases, but is more particularly the result of poisoning with phosphorus, arsenic, mercury and other poisons.
In fatty infiltration, the liver is enlarged, lighter than the normal organ in specific gravity and in color, and on section with a knife the increased fat is indicated by an oily character of the cut surface. In fatty degeneration the liver is usually diminished in size and the sub stance is of a friable softened character.
Cirrhosis of the Liver is the most frequent and important of the diseases of this organ. It is essentially a replacement of normal liver tissue by connective tissue, causing more or less hardening.
The causes of cirrhosis of the liver are numerous, though one in particular occupies a very prominent position on account of its fre quency. The cause referred to is over-indul gence in alcohol, especially raw spirits, whence the terms alcoholic liver, gin drinker's liver, etc. It must not be supposed, however, that alcohol is the invariable cause. Over-eating, gouty con ditions, syphilis and various other infectious diseases may he followed by cirrhosis entirely like that caused by alcohol. It has been noted in the description of congestion of the liver that a form of cirrhosis (cyanotic induration) results from long-standing congestion. Some times cirrhosis of a peculiar type is caused by obstruction of the biliary ducts. This produces a stagnation of the bile and an irritation of the substance of the liver that terminates in the formation of connective tissue.