Atrophy of the liver, independent of the marasmus senilis of the organ, appears in various forms. We first draw attention to two distinct forms which have not been remarked hitherto, and which, similarly to the hypertrophic affections, are the expressions of a constitutional malady, and have their immediate origin in anomalies of the blood. Owing to their distinctive coloring, they may be appropriately termed yellow and red atrophy.

A. Yellow Atrophy

This affection is characterized by the saturated yellow color, owing to a diffusion of bile throughout the tissue, by extreme flabbiness and pulpiness, loss of the granular texture, extreme rapidity in the reduction of size, which chiefly affects the vertical diameter, and consequently induces a flattening of the liver. It occurs chiefly in the the liver early years of life, during puberty, and in the prime; it is remarkable for the rapid course it runs, for extreme tenderness of the liver, nervous attacks, and jaundice; it terminates fatally with febrile symptoms of a disorganized state of the blood, irritation of the brain and its membranes, and hydrocephalic softening of the former, and with symptoms of exudation and suppuration generally, and especially of the mucous membrane, pneumonia, etc.

The blood contained in the large vessels of the liver, and even that contained in the trunk of the vena portae, is reduced in consistence, and of a dirty reddish-brown color; and the coats of the latter vessel are tinged with bile. This points to the fact that the portal blood itself contains such an excess of biliary constituents, that they are separated here, and still more in the capillaries, and thus fill the entire vascular and biliary system; the coats of the vessels and their cellular strata thus absorb bile by exosmosis, the true glandular tissue fuses, is lost in the biliary colliquation, and disappears. The immediate consequences of this condition are that the blood in the vena cava is infected and overcharged with bile, causing intense jaundice; when this has reached a certain point, the above symptoms terminate in a rapid consumption of the blood and in exhaustion. We commonly find biliary matter of a deep yellow color, or if the disorganized blood has exuded through the mucous membrane, a black tarry substance in the intestine.

B. Red Atrophy

This is distinguished from the former by its dark-brown or bluish-red color; the liver is gorged with blood, and presents a spongy elastic consistency; there is an absence of granulation, and a section offers an appearance of perfectly homogeneous texture; the organ is reduced in size, though its thickness preponderates over the other dimensions.

The disease is chronic, and is always accompanied by torpor of the abdominal ganglia, venous plethora of the abdominal viscera, and by the formation of brownish-black, or greenish-black, tarry bile, and faeces of a similar constitution. By itself it rarely proves fatal, though death may ensue from the marasmus brought on by the enduring congestion of the portal system. In addition to these two forms, we consider y. Laennec's cirrhosis in its advanced stage, a chronic affection which resembles acute yellow atrophy, but besides being chronic, is distinguished from the latter by the liver being firm, or, if flabby, very tough.

Granular liver is a variety of this species; it appears essentially as secondary textural degeneration, and although commonly treated of as atrophy, and from ignorance of the above described forms as the only variety of atrophy, we refer for a minute examination to a subsequent portion of this work. Finally, we have o. Atrophy of the liver from obliteration of the ramifications of the vena porta (vide, the acquired Lobular Form of the Liver, p. 103).