Disseminated lobular necrosis of the liver with jaundice (hepar necroticum cum ictero of Curschmann and H. Oertel) : and a case of acute hepatic atrophy in secondary syphilis / by F. Parkes Weber.

Frederick Parkes Weber

Date:: 1909

Credit: Disseminated lobular necrosis of the liver with jaundice (hepar necroticum cum ictero of Curschmann and H. Oertel) : and a case of acute hepatic atrophy in secondary syphilis / by F. Parkes Weber. 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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$girl aged 17), and A. Sezary (IdOH, a woman aged 25), each in one case; hut always with negative results. Moreover, three apes of the genus Macacus were inoculated with pieces of the liver, spleen and bone- marrow from I’ischer’s case, hut likewise with negative result, though later on a positive result was obtained in these same a))es by inoculation with syphilitic condylomata lata. Altogether, up to the ])resent time, fatal acute hepatic atro[)hy has been recorded in about fifty-three or iifty-four cases of secondary syphilis. This brings us to the (piestion of i\\Q pathoyeny of jaundice and acute hepatic atrophy in cases of secondary syphilis. That there is some connexion between the liver affection and the syphilis one can hardly doubt, and it is quite possible that in many of the cases published as examples of idiopathic acute yellow atrophy of the liver a preceding syphilitic infection has escaped detection. Many still think that acute atrophy of the liver cannot he connected with syphilis, and they are therefore less likely to search for evidence of the latter. It is probable that the icterus gravis, accompanied by acute hepatic atrophy in these cases, is to be regarded as an exaggeration of benign “ icterus syphili- ticus ” ; and that the jaundice in such cases is really causally connected with the syphilis is evidenced by the cases (already referred to) in which persons whose earliest syphilitic exanthem was accompanied by jaundice became again jaundiced when they suffered from a secondary syphilitic relapse. Amongst the theories that have been, or may be, suggested to explain the occurrence of mild or grave jaundice and acute hepatic atrophy in secondary syphilis are the following: (1) That the jaundice is of nervous origin (“ emotional jaundice”) and due to the mental worry and anxiety connected with the syphilitic infection; (2) that the jaundice is due to syphilitic enlargement of lymphatic glands, pressing on the extra-hepatic bile-ducts ; (3) that the jaundice is due to venous congestion ; (4) that the jaundice is due to a specific duodenal catarrh obstructing the bile-flow; (5) that the jaundice is due to a kind of syphilitic exanthem or erythematous swelling of the lining of the bile- ducts, analogous to the cutaneous roseola of secondary syphilis; (6) that the jaundice is due to obsti’uction of some kind in the biliary canaliculi ; (7) that the hepatic atrophy is due to a specific change in the small blood-vessels; (8) that the hepatic atrophy is brought about in someway by the local presence and local action of spirochaetes in the liver ; (9) that the hepatic atrophy is due to toxins [)roduced else\\ here in the body by the vital or metabolic activity of spirochaetes and carried to the liver$