190 



ABNORMAL ANATOMY OF THE LIVER. 



congestion is also frequently present, and tinges 

 the substance of the organ with a variable hue 

 of yellow, green, &c. Portal observes that the 

 liver of patients who have died of scurvy is 

 often so much softened that it appears in a 

 state of decomposition, has a reddish brown 

 colour, and resembles the lees of red wine. 

 Baillie remarks that softening of the liver is 

 not uncommon in old persons, that it ap- 

 proaches in consistence to the texture of the 

 spleen, and is of a brownish red colour. 



e. Induration of the liver is occasionally 

 attendant upon hypertrophy or atrophy of the 

 organ, but it may also exist with a normal size 

 of the liver without other apparent change than 

 the brownish red tint which it receives from 

 venous congestion, or the various shades of 

 yellow, green, or brown induced by biliary 

 congestion. The density and hardness acquired 

 by the liver in a state of atrophy are sometimes 

 truly astonishing. In a case detailed by Mor- 

 gagni the organ resisted the knife, and several 

 such instances are to be met with among the 

 writings of the older pathologists. 



,/'. Fatty degeneration of the liver. Upon 

 referring to the section upon the chemical 

 analysis of the liver, it will be observed that a 

 certain proportion of oily matter is one of its 

 natural constituents. Under the influence of 

 diseased action this quantity is greatly aug- 

 mented, and increases to such an extent as 

 completely to take the place of the normal 

 structures. Vauquelin has published an analy- 

 sis of a fatty liver, from which the quantity of 

 oily matter present may be fairly estimated 

 thus; in 100 parts he found, 



Oil 45 



Parenchyma 19 



Water. . , 36 



100 



The fatty matter is usually distributed equally 

 through the organ, being apparently infiltrated 

 into the cellular texture of the parenchyma. At 

 other times it is deposited in a mass or forms se- 

 veral collections in different parts of theliver. The 

 fatty liver is greasy upon the surface, and when 

 cut into has the appearance of a section of 

 yellow soap. The vessels seem pressed upon 

 and are scarcely perceptible, while the greasy 

 deposition is divided into angular masses by a 

 coarse and compressed cellular tissue. 



Fatty liver is generally consistent and solid 

 in its texture, but sometimes the fat exists 

 almost in a fluid state. Portal has observed 

 the liver quite white and softened almost to the 

 fluidity of melted fat, where no hepatic sym- 

 ptoms existed during life; and he particularly 

 records the case of a woman suffering under a 

 severe form of syphilis in which this condition 

 of the liver existed. 



From the name which has been given to this 

 disease by pathologists, fatty degeneration, we 

 might be led to infer that the texture of the 

 organ was actually converted into this oily sub- 

 stance. This, however, is quite inconsistent 

 with our knowledge of pathological phenomena. 

 The fatty deposition is obviously an undue 



secretion of a normal constituent, but whether 

 resulting from irritation from whatever cause, 

 or from absence of vital energy, is a question 

 upon which I am unwilling, without further 

 investigation, to hazard an opinion. With 

 regard to the causes of fatty liver Andral 

 observes, " Les causes sous 1'influence des 

 quelles le foie devient le siege d'une secretion 

 de matiere grasse sont encore inconnues. On n'a 

 e"mis qu'une hypothese lorsq'on a dit que la 

 degeneration graisseuse du foie etait le produit 

 d'une irritation de cet organe. Car on pourrait 

 tout aussi bien soutenir que cette degeneration 

 graisseuse, loin d'avoir ete precedee par un etat 

 d'irritation du foie, est survenue parceque la 

 nutrition de cet organe est devenue moins 

 active; et cette derniere hypothese serait d'au- 

 tant plus soutenable, qu'elle se deduirait d'une 

 grande loi de 1'economie en vertu de laquelle, 

 toutes les fois qu'un organe tend a s'atrophier, 

 une matiere grasse vient a se secreter autour de 

 cet organe ou a la place meme de ses mole- 

 cules."* 



Fatty liver is most frequently observed in 

 persons who have died from scrofulous tubercles 

 in the lungs; in those, says Andral, in whom 

 the blood has not been efficiently arterialised, 

 and in whom the pulmonary exhalation is 

 greatly diminished. Can it be, he inquires, 

 from the absence of the due separation of 

 hydrogen from the lungs that this compound of 

 hydrogen, fat, becomes deposited in the paren- 

 chyma of the liver? This question is well 

 deserving the attention of pathologists, and its 

 solution might lead to important information. 

 The disease has also been observed in some 

 cancerous disorders and in dartrous diseases of 

 of the skin. 



g. Pus. Abscess in the liver occurs in two 

 principal forms, either as a single abscess of 

 large size inclosed in a cyst, or as numerous 

 small collections of matter, bounded by the 

 substance of the liver or diffused amongst its 

 lobules. In the first form it constitutes idio- 

 pathic abscess of the liver, a disease of tropical 

 countries, and rare in our temperate climates. 

 Abscess is generally preceded by acute inflam- 

 mation and more rarely by chronic inflamma- 

 tion, and attains an enormous size, engrossing 

 the whole of the right lobe and sometimes con- 

 verting the entire organ into one huge cyst. 

 The cyst may be thin or thick, and more or less 

 organised. Andral and Louis conceive that 

 its internal surface is analogous to a mucous 

 membrane. The quantity of pus contained in 

 one of these abscesses varies from a few ounces 

 to several pints. My friend Dr. Macnaught, 

 who has seen much practice in the West Indies 

 during a residence of twenty-two years in 

 Jamaica, has observed that abscess in the liver 

 occurs more rarely in the West than in the East, 

 and, moreover, that this disease aftects the Euro- 

 peans and not the Negroes. During the whole 

 of his experience he never saw a single case of 

 abscess in the liver in the Negro, and among the 

 white population of his district only four well- 

 marked instances. 



* Anatomie Pathologiquc, vol. ii. p. 597. 



