Interstitial Hepatitis; Sclerosis of the Liver; Cirrhosis.
DEFINITION.—The terms interstitial hepatitis and sclerosis of the liver express the nature of the malady: they signify an inflammation of the intervening connective tissue, resulting in a sclerosis—an induration of the organ. The term cirrhosis, now so largely in use, was originally proposed by Laennec48 because of the yellowish tint of the granulations, from the Greek word, [Greek: chirros], yellow. As Laennec's theory of cirrhosis was erroneous, having regarded these granulations as new formations, the word is a very faulty one, and hence it would be preferable to use the term sclerosis, since a similar change in other organs is thus designated, as sclerosis of the kidney, sclerosis of the lungs, etc. It is also called in England gin-drinker's liver, hobnail liver. Carswell49 first described the anatomical changes with accuracy, and illustrated them with correct drawings. The following year Hallmann50 confirmed the truth of Carswell's descriptions, and contributed a good account of the morbid anatomy; and subsequently French, German, and English authorities added new facts, which will be set forth in the further discussion of the subject.
48 Traité de l'Auscultatlon médiate, tome ii. p. 501.
49 Illustrations of the Elementary Form of Diseases, fasciculus 10, plate 2.
50 De Cirrhosi hep., Diss. Inaug., Berolini, 1839, quoted by Thierfelder.
CAUSES.—Sclerosis of the liver is, conspicuously, a disease of adult life and onward. Except the congenital example mentioned below, the earliest age at which the disease has occurred, so far as I am able to ascertain, is four years—a case reported by Wettergreen51 of hypertrophic sclerosis, in which neither a syphilitic nor paludal cause could be ascertained. Cayley52 reports a case in a child of six; Murchison,53 Frerichs,54 Griffith,55 one each at ten. After this period the increase relatively to age is rapid. The majority of cases occur between thirty and fifty years. Yet Virchow56 has given the details of a congenital example. According to Förster, of 31 cases of cirrhosis, 16 were between forty and sixty years. The preponderance of cases in the male sex is very decided. Of Bamberger's 51 cases, 39 were men, 12 were women; of Frerichs' 36 cases, 20 occurred in men and 16 in women—a larger proportion of women than any other author records; of 12 cases observed by myself, only 1 was a woman. Nationality does not affect the production of cirrhosis, except as regards the personal habits of the people. This disease is comparatively uncommon in wine- and beer-drinking countries, and frequent amongst a spirit-drinking people.57 The great etiological factor is the abuse, the habitual use, of spirits, and hence the number of cases observed in North Germany, England, Scotland, and the United States. Murchison affirms that he has never seen a case produced in any other way. Even in children of tender years the abuse of spirits can usually be traced. Nevertheless, there are instances of the disease the origin of which cannot be referred to alcoholic excess. The congenital cases, as that narrated by Virchow, and the instances occurring in children and adults not given to spirits in any form, indicate that there are other pathogenetic influences which may bring about a sclerosis of the liver. Virchow58 was one of the first to illuminate the subject of visceral syphilis and to demonstrate the occurrence of sclerosis of the liver from syphilitic infection. Very often the syphilitic cachexia coincides with alcoholic excess. There can be no doubt that chronic malarial poisoning causes, or powerfully predisposes to, cirrhosis. I have submitted elsewhere pathological evidence on this point,59 and the Italian physicians, who have the opportunity to obtain accurate data, maintain that malarial toxæmia does bring about this state. It is probable that the overgrowth of connective tissue is induced by the repeated congestions of the malarial attacks, and by the obstruction due to catarrh of the bile-ducts which so often occurs in the febrile paroxysms.
51 Hygeia, 1880, quoted by London Medical Record, March 15, 1881.
52 Transactions of the Path. Society of London, vol. xxvii., 1876, pp. 186, 194.
53 Clinical Lectures, loc. cit.
54 Clinical Treatise, etc., Syd. Soc. ed., by Murchison.