[Reprinted from The Medical News, February 2, 1895.] 
DIMINUTIVE LIVER FROM AN INFANT.1 
By AUGUSTUS A. ESHNER, M.D., 
ADJUNCT PROFESSOR OF CLINICAL MEDICINE IN THE PHILADELPHIA 
POLYCLINIC. 
The liver that I have the privilege of presenting has 
been placed in my hands by Dr. R. E. Muller, of this 
city, who has also kindly furnished me with such clinical 
and pathologic data as were attainable. The specimen 
came from a male infant delivered at term with forceps, 
after a labor lasting forty-eight hours, and weighing 
seven pounds one ounce at birth. The mother was a 
German, thirty-two years old, with a justo-minor pelvis, 
who had led a dissolute life for many years, but denied 
that she had ever previously been pregnant. She had 
been in the habit of lacing tightly, even during the 
pregnancy. There was no history of syphilis or tuber- 
culosis. For the first two days of life the infant was fed 
on sugar-water, as the mother was unwilling to put it to 
breast on account of sore nipples. On the third day the 
child was given the breast, but it refused to nurse. It 
was then fed with sterilized milk sweetened with milk- 
sugar. Forty-eight hours after birth the face and chest 
of the child were observed to be icteric, and soon after- 
ward the conjunctivse and the extremities also. An effort 
was made to collect the urine for study, but without suc- 
cess. The stools had a greenish color on the second 
day. The child wasted rapidly, and died on the eighth 
1 Presented to the Philadelphia Pathological Society, January 
10,1895. y / - --- day of life. The umbilical cord had been carefully 
ligated, and the ligature had not fallen off. 
At the post-mortem examination it is said that no 
abnormality was found, save the general icteric dis- 
coloration of the tissues and the diminutive size of the 
liver. The ductus venosus was patulous. The dimen- 
sions and weight of the organ were not noted at the time 
of its removal, but after having been preserved in alcohol 
for some time the transverse diameter was found to be 
3/4 inches, the antero-posterior diameter 2% inches, and 
the vertical diameter inches; the weight was two- 
and-one-quarter ounces. 
The specimen appears to me a unique one. I have 
been unable to find a reference to a parallel observation. 
In conformation, in fissuration and lobulation, and in 
histologic structure it presents the appearances of a 
normal viscus, its only peculiarity, so far as I can dis- 
cern, consisting in its striking diminutiveness. Mal- 
formations of the liver are said to be, on the whole, 
rather uncommon. Ziegler states that the liver may be 
entirely absent, though rarely. Although the liver pro- 
gressively increases in size from the period of its first 
appearance in the process of development, its relative 
size, as compared with the weight of the body, begins 
early to diminish gradually and progressively. Thus, 
in the first month of fetal life the weight of the liver 
represents one-half of the entire weight of the body ; at 
birth the ratio is 1 : 18 or 20, and in adult life from 1 : 36 
to 40. In the specimen presented this ratio is 1 : 50. I 
have been unable to obtain any satisfactory figures as to 
the dimensions of the liver at various periods of develop- 
ment. At birth the organ is said to extend almost to the 
level of the umbilicus. The average figures for the 
adult liver are : For the transverse diameter, n inches; 
for the antero-posterior diameter, 7 inches; and for the 
vertical diameter, 2.5 inches. The weight of the adult 
liver is from fifty to sixty ounces. In this specimen the right lobe is the larger, as it should be normally at birth 
and thereafter. Until the fourth month of fetal life the 
two lobes are of about equal size, but after this the left 
is the smaller. The comparatively large size of the liver 
in the fetus is ascribed to the large supply of blood sent 
through the organ from the umbilical vein. 
I am at a loss for an explanation of the abnormality 
of size in the specimen presented. I am scarcely willing 
to make the tight lacing the active factor.