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damage to their form. Microscopically, the softer masses were composed of fibrin, hepatic dect epithelium, pus corpuscles and a variable amount of bilirubin pigment.
The harder masses were made up of a hyalin looking material, in which traces of fibrin, pus corpuscles, etc., could be scen. In the ineshes of this material, appreciable quantities of bilirubin calcium were found. Bacteriologically nothing definite could be obtained, owing to the fact that an examination of the body could not be made until about twenty-four hours after death. B. coli commune was found in large numbers. With this organisın, however, numerous other extraneous bacteria were present.
The zones of a deep brown colur, iminediately surrounding the yellow areas, presented the following microscopic appearance. The areas of tissue nearest to the yellow masses were composed of young proliferating connective tissue and hepatic duct epithelium. The changes found were typical as regards a chronic inflammation of the walls of the hepatic duct and its ramifications,
Immediately outside this zone of newly-formed tissue, a narrow-band of degenerated hepatic parenchyma was found. Large quantities of bile pigment were deposited in this narrow band of newly-forined tissue and in and around the degenerated liver cells. Apart from these changes, the microscopic examination of the liver substance showed marked interlobular increase of connective tissue, and the presence of pronounced paracholia. The case is clearly one of infective cholangitis. The causal agent, in this particular case, would be difficult to prove. Usually the B. coli commune is found to be the root of the evil, but, as FRAENKEL and KRAUSE have recently pointed out, Streptococci, Pneumococci, and even the Typheid bacillus, may be agents at work in the production of different pathological conditions in the liver.
Cholangitis usually runs the course of a septic infection. Clinically, it behaves like a case of multiple abscess of the liver. Pathologically, however, the lesions would appear to be distint. The following are points of agreement and difference :—
They agree in the following points
1. There is general congestion of the liver in the early stages. 2. There is general enlargement of the liver.
3. There is the presence of pns.
They differ, however, as follows:- Multiple Abscess of the Liver.
1. A hepatic parenchyma change. 2. There is initial necrosis.
3. Necrosis is followed by pus.
4. Areas of necrosis are ill defined.
5. Walls of abscesses are rugged and rotten
in appearance.
6. The pus is usually amiebic.
Infective Cholangitis.
1. A hepatic duct change.
2. There is inflammation.
3. Inflammation is followed by pus.
4. Areas of pus confined in hepatic ducts.
5. The walls are well defined and not
necrotic.
6. The pus in usually bacteriological.