Lectures on nutrition, hypertrophy, and atrophy : delivered in the Theatre of the Royal College of Surgeons, May 1847 / by James Paget ; reported by William S. Kirkes.

  • James Paget
Date:
1847
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Credit: Lectures on nutrition, hypertrophy, and atrophy : delivered in the Theatre of the Royal College of Surgeons, May 1847 / by James Paget ; reported by William S. Kirkes. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    their progress towards the healthy state, suggested that some of the strangely thick- ened, porous, and heavy skulls, preserved without histories in most museums, be- longed, in life, to those who had had mollitics ossium in one of the forms which had been described. All this part of the lecture would be unintelligible without the specimens by which it was illustrated : and it is the less necessary to insert it, because much of what was said is embodied in the 2d volume of the Catalogue of the Pathological Mu- seum of the College, just published, pp. 16 to 25.] The last example of fatty degeneration to which I shall refer is that observed in the liver. The condition of the hepatic cells in this disease has been so well known since Mr. Bowman's discovery of the fatty parti- cles within them, that I need not at all describe the morbid changes characteristic of the affection : nor need I do more than state that the fatty degeneration of the cells is found, not only in that which is called especially the fatty liver, but in many examples of cirrhosis of the large, pale, heavy, and indurated brawny liver ; and of some other affections not yet admitting of exact description, but commonly referred to under the vague names of nutmeg-liver, granular liver, and so on. Omitting these points, I will only offer reasons for rejecting the explanation of the disease which seems generally admitted, and which is, that the fatty liver is one actively discharging its office as vicarious to the lungs, secreting the hydrogen and carbon which the lungs, by reason of some defect of their structure, cannot discharge. The arguments against this account of the disease are these :— 1. The connection between fatty liver and disease of the lungs is not general. In many who die phthisical, the liver is healthy. In many who have no disease directly ob- structing the function of the lungs, the liver is fatty. I may refer to the last three cases of fatty liver that I have examined. One was an osteoid tumor, with only small masses of osteoid disease in lungs otherwise quite healthy : another was a cancer of the breast and spleen, with healthy lungs : the third was a case of delirium tremens with sound lungs. And many of you will at once con- firm this statement. But, 2dly, there is no evidence that the fatty liver does excrete an unusual quantity of carbon and hydrogen ; for the fajces of patients with this disease have not yet, I believe, been examined. And .'idly, if the carbon and hydrogen supposed to be formed in extra quantity in the liver be not in the fieces, then the lungs would only be damaged by the excessive formation of those elements in the liver. For the function of the liver, at least in the warm-blooded animals after birth, is pre- paratory to that of the lungs. Of all the bile secreted, only 1-11th at most passes off with the faeces, and this fractional portion does not contain those principles in which most of the carbon and hydrogen are com- bined. The rest is reabsorbed, and re- absorbed that the greater part may be excreted by the lungs. The contrast be- tween the foetal meconium and the bile of the young child indicates this very plainly. Meconium contains all the principles of the bile ; for while respiration is comparatively inactive, all, or nearly all, the bile is ex- creted directly. But the fseces of the young child, like those of the adult, contain only the resinous and colouring matters of the bile, and perhaps some of its fat. The rest of the bile is reabsorbed, not because it is really less an excrement than it is in the foetus : it is reabsorbed and combined with oxygen, and so excreted indirectly, as car- bonic acid and water, with the advantage of contributing to the maintenance of animal heat. So, then, the connection of the tiver with the lungs of the warm-blooded animal after birth is, that the former prepares material for the function of the latter. It would be a strange compensation, if the function of the former were to be increased, while that of the latter is diminished by disease. And, lastly, all the conditions of the fatty liver show that it is an inactive organ—one which is discharging less than its ordinary function, and the less the more general the fatty degeneration of its cells. In proof of this we have the analogy of all fatty degene- rations, the absence of nuclei in the fatty cells, the absence of all appearance of the colouring matter of bile in them, the large size of the liver indicating a tardy or ob- structed removal of its cells, the paleness and defective supply of blood, and the fre- quent coincidence of other morbid changes such as would naturally hinder the proper activity of the organ. Wilson and Ooilvv, 57, Skinner Street, Snowhill, London.
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