J94 



ABNORMAL ANATOMY OF THE LIVER. 



Sometimes these tumours present a certain de- 

 gree of consistence, but as they increase in 

 size they become more and more softened and 

 pulpy. Baillie describes a large tumour in 

 the liver which he considers scrofulous from 

 being softened in the centre, and containing a 

 fluid resembling pus; this is most probably 

 a tumour of the kind I am now describing. 

 Another tumour, of which he expresses himself 

 at a loss to understand the nature, soft, of a 

 brownish colour, and of about the size of a 

 nut, appears to be also referable to the same 

 species. 



The second and third varieties of the tubera 

 diffusaof Farre present characters resembling this 

 disease. V. 2. " Tubera, elevated at the surfaces 

 of the affected organ, encysted, or having dis- 

 tinct cells, formed by the growth of a fungus, 

 which separates in flakes, and is composed of 

 a fine reticular texture, containing an opaque 

 white fluid." V. 3. " Tumours rising with a 

 regular swell from the surfaces of the affected 

 parts and yielding to the touch, composed of a 

 very delicate reticular texture, pulpy in its 

 consistence, varying in its colour even in the 

 same subject, charged with an opaque fluid, 

 and growing from cysts or cells." 



Cruveilhier considers the venous capillary 

 system as the seat of origin of carcinoma, par- 

 ticularly of the form which I am now consi- 

 dering ; hence he observes, " Ayant exprime 

 d'une coupe faite a un foie cancereux une ma- 

 tiere d'un blanc-rougeatre, encephaloide qui 

 se moulait a la maniere du vermicelle, et qui 

 pouvait acquerir en se tordant une grande lon- 

 gueur, j'apercus sur cette coupe un orifice plus 

 considerable que les autres ; j'incisai cet orifice 

 et je parvins dans un vaisseau tres volumineux 

 qui me parut etre une des ramifications de la 

 veine porte. Alors je dissequai avec beaucoup 

 d'attention cette veine, et je ne fus pas peu 

 etonne de voir que cette veine, depuis les plus 

 grandes jusq'aux plus petites divisions, etait 

 remplie par cette matiere encephalo'ide, adhe- 

 rente aux parois et tout-a-fait semblable a celle 

 qu'on exprimait par les coupes faites an foie. 

 II me fut facile de suivre les ramifications ex- 

 tremement dilatees de la veine jusque dans 

 1'areoles des coupes. L'alteration etait bornee 

 a la veine porte, les veines hepatiques et leurs 

 ramifications etaient parfaitement saines."* 



/. Fungus h&mutodes is the term applied to 

 all carcinomatous tumours which have a ten- 

 dency to the unnatural development of new 

 vessels and to effusions of blood into their tissue. 

 In the same organ, hard and cartilaginous 

 scirrhous tumours may exist with those of a 

 softer texture, and of a medullary form, and 

 both of these may be mingled together in the 

 soft, elastic, and bleeding mass which consti- 

 tutes fungus hnematodes. The tumours of 

 fungus hsematodes are often of very large size, 

 and by their frequent hemorrhagies give rise to 

 extreme symptoms and the speedy death of the 

 patient. Farre arranges this form of carcinoma 

 among his tubera diffusa, of which it forms the 

 fourth variety, which he thus defines : " Tu- 



* Anatomie Pathologique, liv. 12. 



mours elevated at the surfaces of the liver and 

 inclining to a round figure ; pulpy in their con- 

 sistence, being charged with a thick and opaque 

 fluid, variegated in their colour, chiefly white 

 mingled with red, the former prevailing in their 

 incipient, the latter in their advanced stages, 

 composed of a very vascular and reticular tex- 

 ture, attached either to distinct pouches or to 

 the substance of the liver, and so unlimited 

 and rapid in its growth as to burst or destroy 

 the peritoneal tunic of this organ and to pro- 

 trude in the form of a bleeding fungus." 



m. Melanosis. Melanosis exists in the liver, 

 as in other structures of the body, 1st, as a 

 melanic secretion infiltrating the cellular struc- 

 ture of the organ, and giving a diffused general 

 blackness to the substance of the lobules; 2d, 

 as a morbid tissue composed of an areolar cel- 

 lular network, in which the black carbonaceous 

 matter is deposited ; or 3dly, as a melanic 

 pigment accompanying carcinoma or tubercle, 

 and imbuing the abnormal tissue with its pe- 

 culiar colour. The colour of melanosis in the 

 liver varies from a deep chocolate-brown to a 

 rich black. Sometimes it is diffused in patches 

 through the substance of the organ, at other 

 times it exists in the form of rounded circum- 

 scribed tubercles of variable size and number. 

 Laennec considers melanosis as an accidental 

 tissue without analogue among the animal tis- 

 sues ; he classes it with cancerous degenera- 

 tions, and describes it as existing in his two 

 favourite conditions of crudity and softening. 

 But the researches of Cruveilhier have shewn 

 that in many instances melanosis is to be re- 

 ceived as a mere pigment, resembling the pig- 

 mentum nigrum of the choroid, which impresses 

 its peculiar colour upon natural and morbid 

 tissues, and he has also proved, in opposition 

 to the view entertained by Laennec, that the 

 softened state or state of infiltration very fre- 

 quently precedes the more dense and encysted 

 form. Melanosis rarely exists in the liver with- 

 out being at the same time found in various 

 other structures of the body, as in the brain, 

 eye, lungs, heart, spleen, kidney, mucous mem- 

 brane, muscles, skin, &c. 



6. DISORDERS OF FUNCTION. The principal 

 function of the liver bein,.; the secretion of bile, 

 we shall have to consider under this head the 

 changes which may occur in the secretion of 

 this fluid and in the fluid itself, in consequence 

 of derangement of function in the organ. These 

 disorders may be divided into three kinds: 



. Suppression of the bile. 



b. Alterations in the physical properties of 

 the bile. 



c. Alterations in the chemical qualities of 

 the bile. 



. Suppression of secretion of the bile, like 

 suppression of urine, occasionally occurs in 

 the liver. This disease appears to have been 

 known to Darwin,* who calls it " paralysis of 

 the secretory vessels" of the liver; the patients, 

 he says, " lose their appetite, then their flesh 

 and strength diminish in consequence, there 

 appears no bile in their stools nor in their urine, 



* Zoonomia, vol. ii, p. 5. 



