This disease, although by its name it is connected with a definite lesion in the liver, is really a general one, due to a morbid poison in the blood. In some cases the poison seems to be septic in its character, the disease coming on in the course of septic infection, especially in the puerperal state or in erysipelas, but generally no definite poison can be traced. Several observers have sought to connect the disease with certain forms of microbes (Klebs, Zander, etc.). In connection with its origin from a morbid poison it is interesting that phosphorus produces changes so similar that some observers have suggested that acute yellow atrophy is always due to poisoning with phosphorus. This view, however, is not tenable.
Although at post-mortem examination the liver is nearly always reduced in size, yet in some cases it is found enlarged, and there is reason to believe that in the earlier stages it is generally enlarged. The enlarged liver is of a brownish yellow or bright yellow colour, either generally or in streaks and patches. In these parts the cells are enlarged and full of fat granules. Although this is a true fatty degeneration, yet the fat is in comparatively large drops.
In the further stages the liver is found smaller than normal, and its tissue is soft and flabby. The capsule is often wrinkled from the atrophy of the substance of the organ, and the organ flattens out by its own weight, its thickness being greatly diminished. The diminution in size often affects the left lobe especially. On cutting into the organ the section abows usually different shades of colour. The predominating tint is yellow, varying from the colour of gamboge to a dark yellowish brown. Mixed with this, however, there is tissue of a red colour forming the red substance of Zenker. Where the colour is yellow the tissue is softest, but the red parts are the most atrophied, the red substance arising by the absorption of the degenerated hepatic cells.
Fig. 407. - From liver in acute yellow atrophy. The hepatic cells form irregular chimps. There are numerous pigment crystals of similar shape to the crystals of hsematoidin (Fig. 34, p. 115), and of a similar deep red colour, but smaller, x 350.
On examining the yellow tissue under the microscope, it will hardly be recognisable as that of the liver (see Fig. 407). There are no proper hepatic cells, but instead irregular masses containing fat drops and granular debris, with here and there rhombic crystals of a reddish brown colour. The Crystals of pigment have the characters of those of haematoidin and bilirubin. Sometimes Leucine is found in opaque clumps, white in colour and generally stratified. Acicular crystals of Tyrosine are also found.
The red substance does not present the abundant fatty debris; that has been cleared away, and there is now a fibrous material visible, merely sprinkled with fat granules. In the red substance there are evidences of new-formation in the form of glandular-looking processes, which has been taken to indicate an attempt at regeneration of the lost hepatic substance, beginning in the capillary network of the hepatic ducts.
Besides the changes in the liver, there are lesions of a somewhat similar character elsewhere, especially in the epithelium of the kidneys and the muscular fibre of the heart. The symptoms are those of a general disease.
Fkekichs, Dis. of liver, Syd. Soc. transl., 1858-61; Klebs, Handb. i., 1869; Zenker, (very complete articles) D. Arch. f. klin. Med., x., 166, 1872; Coats, Brit. Med. Jour., 1875, i.; Ashley, Liverp. Med. Chir. Jour., 1883; Zander, (Microbes) Virch. Arch., lix., 1874; Tomkins and Dreschkeld, Lancet, 1884, i., 606; Boinet et Boy-Teissier, Rev. de Med., 1886; Cornil et Brault, (Phosphorus poisoning) Jour, de l'anat. et de la phys., 1882; Ossikowsky, Wien. med. Wochenschr., 1881; Meder, Ziegler's Beitriige, xvii., 143; Marchand, ibid., 206.