A Contribution to the Study of So-Called Liver Death

So-called liver death has been the subject of considerable discussion in recent publications, and numerous observations have been made regarding the clinical course and possible etiology of these unfortunate disasters, which all too frequently follow surgical procedures on the gallbladder and bile tract. In a recent study of several postoperative deaths in patients suffering from gallbladder disease and coincident hepatic damage of long standing, we¹were struck by a peculiar and constant chain of symptoms and necropsy observations which suggested a pathogenesis for this rather obscure type of liver death. The first case we²observed was one of traumatic pulpification of the liver in a boy, aged 16 years, who died eleven days after an accident. The most striking clinical manifestations were oliguria (which progressed to anuria) and uremia associated with hemorrhages from all mucous surfaces. The symptoms were accompanied by a marked retention of blood nitrogen. At