188 



ABNORMAL ANATOMY OE THE LIVER. 



ration ;g, pus; h, tubercle; i, scirrhus ; k, medul- 

 lary sarcoma; /, fungus haematodes ; m, melanosis. 



a. Inflammation. The tissue of the liver is 

 liable to inflammation, hepatitis, orthe lobular 

 hepatitis of some writers. The symptoms, like 

 those detailed in the consideration of inflam- 

 mation of the serous membrane, are severe and 

 prominent, and clearly indicative of the nature 

 of the disease. The pathologic appearances 

 are deep redness, softness, general congestion, 

 and enlargement of the organ from distension 

 with blood. This condition is but rarely ob- 

 served, from the circumstance of inflamma- 

 tion of the liver having no direct tendency to 

 cause death, but being rather the precursor of 

 the various other forms of disease which affect 

 the organ. All the changes which occur in 

 the liver are preceded or accompanied by in- 

 flammation acute or chronic, but more fre- 

 quently by the latter, and in most instances by de- 

 rangement of the venous circulation, and, occa- 

 sionally, of the biliary excretion, giving rise to a 

 complication of venous and biliary congestion. 



b. Hypertrophy of the liver is increase of 

 bulk of the organ, not depending, as in con- 

 gestion, upon the quantity of blood circulating 

 through it, but upon actual augmentation of 

 the tissues of which it is composed. This 

 state of enlargement of the liver may be gene- 

 ral, or it may be confined to a part, as to a 

 single lobe. Its predisposing cause is proba- 

 bly irritation of the mucous membrane of the 

 ducts which gives rise in the first instance to 

 retarded circulation and venous congestion, or 

 it may be impediment either in the circulation 

 through the heart, or through the rest of the 

 venous system ; or, again, it may depend upon 

 diminution of the general powers of the system, 

 as in a scrofulous constitution. The lobules 

 are always in a state of partial congestion, re- 

 sembling the second stage of hepatic venous 

 congestion ; the congested portion presents a 

 deep red tint, and the uncongested part is 

 ramose or convoluted in appearance, of a dirty 

 white, greyish, yellowish, or greenish hue, in 

 proportion to the condition of the biliary ap- 

 paratus and to the quantity of bile contained 

 within the liver. Sometimes the organ is pale, 

 and appears deficient in its supply of blood ; 

 at other times it has a generally diffused red- 

 ness, or the congestion may be greater in some 

 situations than in others. The consistence of 

 the liver in hypertrophy is equally variable 

 with its colour : sometimes it is softer than 

 natural, at other times it is dense and appa- 

 rently granulated, the uncongested part pro- 

 jecting from the surface, and the congested 

 portion sinking beneath its level. Hyper- 

 trophy of the liver is generally associated with 

 chronic disease of the lungs, scrofula, and 

 rickets, and often exists as a cause in ascites. It 

 has been observed fifteen, eighteen, thirty-five, 

 and even forty pounds in weight, and to have 

 produced the displacement of the other abdo- 

 minal viscera by its enormous size. 



c. Atrophy of the liver is a condition of the 

 nutritive functions of the organ whicli may 

 succeed chronic inflammation or even hyper- 



trophy ; it occurs more rarely than hypertrophy, 

 to which its comparative frequency has been 

 estimated by Portal as 5 to 95. The substance 

 of the liver diminishes in bulk, the lobules 

 become indistinct and variously congested, and 

 they appear intermingled and pressed upon 

 by the cellular structure with which they are 

 surrounded. Sometimes the proper structure 

 of the liver is entirely removed and replaced 

 by a loose or condensed cellular tissue. At 

 other times the entire substance of the organ 

 appears to have been absorbed by an enormous 

 abscess, which has evacuated its contents into 

 the intestinal canal, and the parietes have after- 

 terwards contracted and degenerated into an 

 atrophied mass. Lieutaud gives an account 

 of a liver that was shrivelled into a mass not 

 larger than his fist. Portal found the liver in 

 a case of ascites not bigger than an apple of 

 ordinary size. Partial atrophy of the liver 

 conjoined with hepatic venous congestion is not 

 an infrequent consequenceof the practice of tight 

 lacing. I have before me a very interesting speci- 

 men of this affection. The surface of the liver is 

 marked by deep fissures into irregular poly- 

 gonal divisions resembling very strikingly the 

 lobulated appearance of the foetal kidney. In 

 one situation the stages of this change are dis- 

 tinctly apparent ; a certain portion of the organ, 

 about half an inch in breadth, has become 

 partially atrophied from the pressure of two 

 adjoining and protuberant portions of the liver, 

 and in the lobulated portion the hepatic sub- 

 stance of this atrophied mass has been com- 

 pletely removed by absorption, leaving a kind 

 of condensed cellular cicatrix extending like a 

 septum for some distance into the organ. It 

 is in this way that many of the grooves and 

 fissures upon the convex surface of the liver 

 are formed. 



But the most interesting form of atrophy of 

 the liver is that which was named by Laennec 

 cirrhosis. In cirrhosis, the liver is diminished 

 in volume to the extent of one-half or one- 

 third of its natural bulk, the relative size of 

 the right and left lobes is destroyed, and the 

 surface is rendered shapeless by the projection 

 of a number of ridges or granular points. The 

 entire organ appears wrinkled and shrivelled, 

 and of a yellow or greenish colour, varying in 

 tint from a bright chrome to a yellowish or 

 greenish brown. Upon dividing it with a 

 knife it is observed to be more dense than 

 usual, and the surface of the section presents a 

 number of patches of variable size and of a 

 roundish form, which resemble granules; hence 

 this condition of the organ is named by the 

 French authors " foie granuleux." In an ad- 

 vanced stage it is accompanied with jaundice 

 and ascites, and is frequently preceded by some 

 disease, either of the lungs or heart. 



Kiernan is, I believe, the first pathologist 

 who distinguished the true nature of cirrhosis, 

 which he called atrophy of the liver. A very 

 interesting case of this disease occurred in St. 

 Bartholomew's Hospital, under the care of 

 Dr. Latham, in 1832, an account of which was 

 published in the Lancet in November of that 



