Apatite

“ Ictrogen has the unusual property of acting much like phosphorus. It causes yellow atrophy of the liver, and produces the following symptoms:—Intense jaundice; at first enlargement of the liver, afterwards contraction; somnolence, fever, paralysis. The urine contains albumen and the constituents of the bile. After death there is found to be parenchymatous degeneration of the heart, kidneys, muscles, and liver. If the animal has suffered for some time the liver may be cirrhotic. ”

“ The liver is the most complicated gland in the body (Figure X.) . The bile duct (b.d.) branches again and again, and ends at last in the final pits, the lobuli (lb.) , which are lined with secretory epithelium, and tightly packed, and squeeze each other into polygonal forms. The blood supply from which the bile would appear to be mainly extracted, is brought by the portal vein, but this blood is altogether unfit for the nutrition of the liver tissue; for this latter purpose a branch of the coeliac artery, the hepatic serves. ”

“ Poisoning by phosphorus, antimony, arsenic, and other metals sets up an acute fatty degeneration of the liver. Pregnancy, lactation, and suppuration also have the same effect, but to a slighter and less permanent extent.
PATHOLOGICAL ANATOMY.—Fatty liver agrees with amyloid liver in that the fatty deposits increase the size and weight of the organ. The surface is smooth, the peritoneal investment unaltered, and the margins rounded. Sometimes the organ is merely increased in thickness, sometimes in diameter. It has a greasy feel and cuts like a mass of fatty tissue. ”

“ Circulation in the liver is disordered, gastro-duodenal catarrh results, with accompanying jaundice, that is sometimes intense. A sense of fullness and pain over the hepatic region is not uncommon. Small, brownish patches upon the skin, known to the laity as “liver spots,” are frequently seen. The bowels are constipated, the stools lacking in bile, and, consequently, clay-colored, hard, and sometimes coated with mucus, here and there streaked with blood. ”

“ A disorder of the liver by itself, i.e. unassociated with diseases of other organs, is comparatively uncommon. A failure in the secretion of bile is evidenced more or less by the well known icteric symptoms. Jaundice is often caused by an obstruction in the hepatic ducts. In such cases it is worse than useless to urge the liver to an extra formation of a secretion which can find no outlet. But other cases, in which the discoloration of the skin is in general incomplete, may be due to torpidity, congestion, or chronic inflammation of the organ. ”

“ Monotony of food should be guarded against. Wonderful results are sometimes got from a sea- voyage.
Hepatitis.—During the whole course of an attack of dysentery, and for months thereafter, the condition of the liver must receive the most careful attention. We may not be able to prevent abscess of this organ; but if pain and swelling seem to suggest it as threatening we can try by means of full and repeated doses of ipecacuanha, emetine, saline aperients, rest, low diet, fomentations, dry cupping, and similar measures to avert what, to say the least, is a very grave complication. ”

“ If, for example, we closely examine cases of acute hepatitis without jaundice, we find they are those in which only a portion of the liver is affected. It matters not whether it be one lobe or two, the surface or the centre of the organ, the disease is invariably circumscribed; and there is enough hepatic tissue left in a sufficiently normal condition to prevent the constituents of the bile accumulating in the blood, and producing jaundice. ”

“ Lung obstruction in the trouble called Emphysema, Chronic Pneumonia, etc., may cause it. The cut section of a liver shows an appearance like a nutmeg, due to a deeply congested central vein and capillaries. In a later stage the liver is contracted, central liver cells are shrunk and the connective tissue is increased.
ACUTE YELLOW ATROPHY. (Malignant Jaundice) .—This is fortunately a rare disease. There is rapid progress, and it is fatal in nearly all cases. The liver is very small and flabby. The symptoms are many and are hard to differentiate. You must depend upon your physician. ”

“ Lesions. In fatty degeneration the liver is enlarged, pale, bloodless, yellowish, its cut surface exudes an oily fluid which smears the knife, and it is so light that it floats on water. If scraped and the material drawn across a sheet of paper it forms a transparent oily stain. Under the microscope the liver cells are seen to be enlarged and to have their protoplasm and nuclei replaced by fat or oil. If due to obstruction in the heart or lungs the degeneration is greatest toward the centre of the acinus, if due to an infectious disease it is usually greatest towards its periphery. ”

“ Liver disorders affect thousands of American children from infancy to adolescence. More than 100 different types of liver diseases, which attack these young people, have been identified. These diseases can be inherited or acquired from infection, poisons, injury, or such diseases as cystic fibrosis, anemia, leukemia, kidney or intestinal disease and glandular disorders. Infants can be born with a damaged liver or with biliary atresia, a disease characterized by abnormally-formed bile ducts. Some disorders can result in cirrhosis of the liver. ”

“ The action of the liver is not, however, simply to assist the kidney; there are certain special substances which are taken care of by the liver and which are never gotten rid of through the kidneys. The first of these are the broken-down blood pigments. We have already seen that after the red corpuscles become worn out they are decomposed in the spleen and the hemoglobin carried to the liver where the iron and other usable parts are saved and the useless remainder is passed on into the bile to be conveyed out of the body. ”

“ In severe cases there occurs copious and generally bloody diarrhœa, also icterus. The next stages are anæmia, emaciation, epistaxis, ascites, enlarged spleen, and cachexia, to which the patient finally succumbs. In general the course of the disease is very chronic and irregular; in winter and spring there is generally improvement, in the summer and autumn the patient gets worse. At post-mortem the bile-ducts are enlarged and thickened, there is interstitial hepatitis with enlargement of the liver, but not to such an extent as in hypertrophic cirrhosis. ”

“ The contraction and shrinking of the fibroid hyperplasia as the disease advances causes the projection of the hepatic tissue in minute rounded elevations which give a peculiar uneven appearance to the surface of the organ. The fibroid growth gives a remarkable hardness to the liver which resists even the edge of a knife. The hepatic cells are the seat of fatty and pigmentary degeneration. Inflammation and tumefaction of the kidneys, and ascites are common features of the malady.
Symptoms. The general symptoms are as in parenchymatous hepatitis with a more tardy development. ”

“ Though both liver and gall-bladder must be very much affected in this disease, yet Dr. Moseley is of opinion that nothing can be depended upon from an inspection of them after death. Some symptoms there are in common with inflammations of the liver, but none of those which distinguish it from other diseases. It never terminates in suppuration of the liver as the hepatitis sometimes does, though it is frequently carried off by an enormous secretion of bile. ”

“ If the disease continue, each spot will suppurate, and the different parts will become softened and broken down, in the same order in which they were previously solidified.
The liver frequently becomes the seat of secondary inflammation. In the early stage, brownish-red spots may be observed scattered through its substance. These, as they extend, assume a bluish or slate-colour; and the structure of the liver thus affected is found to have lost its consistence, and to be very easily broken down by pressure. Every part affected here, as in the lungs, proceeds rapidly to suppuration ”

“ In catarrhal jaundice it is in most cases the bowel that is at fault, the liver acting properly, but unable to get rid of all the bile produced. The liver suffers, however, from several diseases of its own. Its fibrous or connective tissue is very apt to increase at the expense of the cellular elements, destroying their functions. This cirrhotic process usually follows long-continued irritation, such as is produced by too much alcohol absorbed from the bowel habitually, the organ gradually becoming harder in texture and smaller in bulk. ”

“ Again reabsorption of bile may be determined by a lessening of the normal fullness and tension of the hepatic capillaries as when the aorta is mechanically compressed by abscess, neoplasm, ingesta, or otherwise, just behind the diaphragm (Heidenham, Brunton) . The cause is the same in both cases, namely, the want of balance between the fullness and tension of the bile ducts, and the hepatic blood vessels. There is increased fullness of the hepatic biliary ducts, or decreased plenitude of the hepatic capillaries and lymphatics. ”

“ The fatty liver is well known to be a liver containing in its substance more than the normal amount of fat; a morbid condition intentionally induced in certain animals for the purpose of gain. In man the liver often becomes surcharged with fat, giving rise to obstruction of the liver. The term, obstruction, conveys an idea of the disease arising from this cause. The liver secretes bile, which, in order to reach the duodenum, flows through a small duct. ”

“ The spleen has on its surface patches or even plates, or one great plate, of firm fibrinous deposit, often cartilaginous in density, sometimes calcareous; and we can rarely fix the time of these occurrences by any symptoms. It is not always so with the liver. We are acquainted with a perihepatitis which is acute, attended by pain in the right side, a febrile movement, and, if the inflammation reaches the under surface of the organ, by jaundice, and have learned to combat this with cups and opiates, the latter in rather free but not heroic doses, and to expect recovery in a few days. ”

“ In the spleen, which is usually enlarged and indurated, the pigment is chiefly in the vicinity of the arteries and veins, the tissues about which may be absolutely black, and in both stroma and pulp innumerable cells are found filled with blood-corpuscles and blood-pigment in all stages of transformation to melanin. The color of the organ may be of a deep reddish-brown, or in very chronic states gray or even a dark olive. In the liver the dark granules are chiefly at the periphery of the lobules, fixed within the connective-tissue elements and leucocytes, not in the liver-cells themselves. ”

“ How often, among the symptoms of that disease, do we see it ourselves, and find it confirmed by others, that the bile is unnatural, either in quantity or quality? Green bile is often found in the gall bladder and ducts, and the action of a brisk purgative, especially of calomel, will often dislodge morbid secretions from the liver, and from the bowels, and the consequence of such free evacuations, is seen in the restoration of the healthy functions of the liver, and along with it a frequent disappearance of that formidable array of symptoms which so closely simulate hydrocephalus. ”

“ As a rule there is a little jaundice, as there is a decrease in the production of bile, instead the skin takes on an earthy, sallow tint. There is generally ascites, swelling of the feet and legs, which increases until the abdomen and the lower extremities become of an enormous size. The nutrition of the body suffers, the skin is dry and harsh. The blood is altered in quantity, and coagulates quickly. ”

“ If the pain be attended with weight in those who have abscess in the liver, it is an indication that the fleshy part of the liver is affected; but if the pain be acute the matter is rather in the coats, and we must burn the part thus:—Having strongly heated slender, knobbed cauteries, we apply them a little above the loins at the extremity of the liver, making an eschar. ”

“ A thickening of the coats of the common bile-duct by inflammation or increased action of their vessels so as to prevent the passage of the bile into the intestine, in the same manner as the membrane, which lines the nostrils, becomes thickened in catarrh so as to prevent the passage of air through them, is probably another frequent cause of jaundice, especially of children; and generally ceases in about a fortnight, like a common catarrh, without the aid of medicine; which has given rise to the character, which charms have obtained in some countries for curing the jaundice of young people. ”

“ The tissues of the body are more or less deeply stained with bile. The pathological change on which the jaundice depends has been variously stated, but the most probable explanation is that which refers it to mechanical obstruction of the bile-ducts, either by catarrhal swelling or fatty degeneration of the epithelium. Notwithstanding the prominence of the hepatic symptoms, acute atrophy of the liver is probably only one element in a constitutional morbid complexus. ”

“ Whether in order to produce this tinge, the bile circulates or not with the blood, is of no consequence; it is incontestible that it is occasioned by affections of the liver; now the numerous cases in which it takes place, prove how much this viscus is often affected; there is certainly no gland in the animal economy so frequently. 4th. Shall I speak of organic affections? compare in the examination of bodies, those of the liver, with those of all the other organs of the same class, and you will see that there is no one equal to it in this respect ”

“ The number of parasites varies greatly: sometimes there are but few, and they are only discovered on post-mortem examination; in other cases the bile ducts are crammed with them, as many as six or seven hundred or even a thousand being present. The distended bile ducts always show chronic peripheral inflammation, which steadily becomes aggravated, producing pericanalicular atrophying sclerosis. This condition is followed by change in and disappearance of a certain quantity of hepatic tissue, and by various forms of vascular and secretory disease. ”