ABNORMAL ANATOMY OF THE LIVER. 



189 



year. The patient died with jaundice and 

 ascites. The liver, a portion of which I pos- 

 sess, presented a fine specimen of granulated 

 cirrhosis; it " was diminished to one-half its 

 natural size, and Mr. Kienran on injecting it, 

 discovered that a collateral venous circulation 

 hud bten established by ivay of the diaphragm." 

 In another case in a woman who had been 

 tapped ninety times, Kiernan upon injecting 

 the liver found that the same kind of collateral 

 circulation had been formed. The circulation 

 through the liver had been impeded by the 

 developement of condensed cellular tissue, and 

 the greater part of the blood of the portal vein 

 had made its way through dilated vessels upon 

 the surface of the organ to the diaphragm, and 

 from thence into the general venous circulation. 

 In this case there were numerous bands of ad- 

 hesion between the liver and diaphragm, arid 

 between the intestines and the walls of the 

 abdomen, and these also were traversed by 

 large veins conveying blood from the portal 

 vein into the general venous current. 



With regard to the pathological nature of 

 the disease many opinions have been enter- 

 tained by different writers. Laennec, dazzled 

 by an ingenious theory deduced from his ob- 

 servations upon the nature and progress of 

 scrofulous tubercle, saw in the mottled and 

 granular section of cirrhosis only a " morbid 

 deposit," a special accidental tissue existing in 

 the two states of crudity and softening. But 

 I quote the words of this author as detailed by 

 Ferrus,* for while he errs in his speculations 

 with regaid to the nature of the disease, he 

 draws an excellent picture of its general cha- 

 racters and appearance. " Les cirrhons ex- 

 istent dans 1'etat de erudite' et de ramollisse- 

 ment. Dans le premier de ces etats elles 

 presentent un tissu d'une couleur fauve plus 

 au moins foncee, qui quelquefois tire un peu 

 sur le verdtttre; on ne peut s'en faire une 

 meilleure idee qu'en la comparant a celle 

 qu'off'rent les capsules surrenales chez 1'adulte. 

 Ce tissu, quoiquefort consistant, a une sorte de 

 flaccidite que je ne puis mieux comparer qu' a 

 celle de certains fongus, ou d'un cuir mou. 

 Le tissu des cyrrhoses est d'ailleurs compact, 

 assez humide et tres-delie. On n'y distingue 

 aucune trace de fibres, quoiqu'il presente en 

 certains cas des divisions en forme de squames. 

 Les cyrrhoses piennent en se ramollissant une 

 couleur plus brunatre." 



" M. Laennec admet trois sortes de cyrrhoses : 

 1. cyrrhoses en masses; 2. en plaques; 

 3. en kystes. Lorsqu'il existe, dit-il, des 

 cyrrhoses dans le foie, elles forment ordinaire- 

 ment de petites masses dont le volume ne 

 surpasse jamais celui d'un noyau de cerise, et 

 quelquefois egale a peine celui d'un gros grain 

 de millet. Ces masses sont toujours extreme- 

 ment nombreuses, et tout le tissu du foie en 

 est paroeine. Leur petitesse fait que lorsqu'on 

 incise un foie dans lequel il en existe un grand 

 nombre, son tissu parait an premier coup d'oeil 

 homogene et d'une couleur jaune fauve. Mais 

 ,si on examine plus attentivement le tissu hepa- 

 tique, on s'aperf oil facilement qu'il est rempli 

 * Dictionnaire de Medecine, Art. Foie. 



d'une innombrable qu.intite" de corpusculeg 

 assez semblables, pour 1'aspect a ces lobules 

 de graisse durcie et rousseatre que Ton trouve 

 communement dans le tissu cellulaire sous- 

 cutane de la cuisse et de la jambe des sujets 

 attaques d'anasarque. Ces petites masses sont 

 quelquefois unies tres-intimement au tissu du 

 foie ; mais assex souvent elles en sont separees 

 par une couche mince de tissu cellulaire qui 

 leur forme une enveloppe tenue, et alors ils se 

 detachent assez facilement. La surface exte- 

 rieuredufoiedevientfletrie,rugueuse,et ratatinee 

 a-peu-pres de la meme maniere qu'une pomme 

 fletrie." 



Bouillaud* considers this condition of the 

 liver a dissociation of the two natural elements 

 of the organ : " les masses jaunes fauves con- 

 stituant le tissu accidentel, appele cirrhose, ne 

 sont autres chose que les granulations secre- 

 toires se desorganisant graduellement par 1'eH'et 

 de 1'obliteration du lacis vasculaire, et de 

 1'obstacle a la circulation hepatique qui en 

 resulte." We have already combatted the ex- 

 istence of two substances, and further remark 

 upon this subject must be quite unnecessary. 



Andral f sees, in the cirrhosis, atrophy of the 

 red substance and hypertrophy of the yellow 

 substance. Of all modern authors, Cruveilhier 

 approaches nearest to the true condition of the 

 organ, but from his misapprehension of the 

 exact nature of the lobules, even his opinion 

 cannot be accepted without limitation. Cirrho- 

 sis, says this author,^ is " atrophie du plus 

 grand nombre des grains glanduleux, et hyper- 

 trophie avec coloration jaune des grains glandu- 

 leux restans." Now cirrhosis is undoubtedly 

 a partial atrophy of the liver with hypertrophy 

 of the cellular structure ; complete atrophy of 

 some of the lobules, partial atrophy of others, 

 and biliary congestion without atrophy or hy- 

 pertrophy of the rest. Those small yellow 

 grains varying in size from a millet-seed to a 

 pea or to a hazel-nut, are not distinct lobules 

 in a variable state of hypertrophy, but small 

 uncongested patches composed of parts of 

 several adjoining lobules, and having a single 

 or several interlobular spaces for a centre. 

 Hence it is, as we have before shown, that Cru- 

 veilhier has observed the " partie centrale de 

 chaque granulation repond au radicule biliare, 

 et consequemment est souvent teinte en jaune 

 et que la partie excentrique repond a 1'element 

 vasculaire et conseqi.emment est plus rouge 

 que la partie centrale." 



d. Softening of the liver may accompany any 

 of the changes resulting from acute inflamma- 

 tion. The degree of softening is very variable, 

 the organ having at one time a simple abnormal 

 degree of friability when pressed by the hand, and 

 at others constituting a pulpy mass scarcely re- 

 tained in its formby thecellular framework of its 

 vessels andGlisson's capsule. Softening may be 

 unaccompanied by any marked change in the 

 bulk of the organ, but is always associated with a 

 variable intensity of venous congestion. Biliary 



* Memoirc de la Socicte Mtdicale d'Emulation. 

 t Anatomic Fathologique, vol. ii. p. 585. 

 j Anatomic Descriptive, vol. ii. p. 568. 

 $ Anatomic Pathologique, livraison 12. 



