192 



ABNORMAL ANATOMY OF THE LIVER. 



lesquelles ces os out e"te interesscs."' The re- 

 moval of haemorrhoids and operations upon the 

 uterus are sometimes followed by abscess of 

 the liver, a circumstance which is easily expli- 

 cable upon the principles so clearly demon- 

 strated by this author. 



An excellent instance of secondary abscess 

 of larger size than usual has been kindly fur- 

 nished to me by my friend and colleague Mr. 

 Rutherford Alcock, who, from his official posi- 

 tion in Spain and Portugal during the recent 

 struggles, has had much experience in injuries 

 to the 'head. A man received a bayonet wound 

 in the scalp, and died upon the fourteenth day 

 after his admission into the hospital. Upon 

 inspection there was observed thickening of the 

 dura mater and a small quantity of matter 

 upon the pia mater. No pus was discovered 

 in the lungs, but a large abscess was found 

 occupying the greater part of the right lobe. 

 A statistical report from a work upon gun-shot 

 wounds by the same author is also interesting. 

 " Of scalp wounds, with and without abrasion, 

 there were sixty-one; two only died, and one 

 only presented disease of the liver; the other 

 died from an attack of erysipelas." 



The pathological changes which take place 

 in the liver in these cases are, in the first 

 instance, effusion of blood and lymph and 

 induration around the inflamed vein ; secondly, 

 a secretion of a yellow concrete pus into the 

 ninute veins and among the lobules, giving to 

 the liver, as Cruveilhier remarks, a granite-like 

 appearance. In the next place the pus collects 

 into small abscesses lodged in irregular cells, 

 which increase in size by continued secretion 

 and by communication with other cells. All 

 these collections of matter are surrounded by a 

 congested circle, which gives them a peculiar 

 and characteristic appearance. After having 

 existed for some time Cruveilhier has observed 

 that the pus becomes converted into a concrete 

 mass, very closely resembling the matter of 

 scrofulous tubercle. 



h. Tubercle in the liver is a disease of rare 

 occurrence, and has seldom been observed 

 independently of the existence of similar depo- 

 sitions in the lungs and other organs of the 

 body, and of general indications of a scrofulous 

 diathesis. When present, it exists in the form 

 of small rounded tubercles, generally numerous, 

 and varying in size from that of a millet-seed to 

 a hazel-nut. They are composed of the soft 

 cheesy or curdy deposit which is characteristic 

 of this disease, and have a tendency to a 

 brownish colour. The tuberculous matter is 

 deposited in the tissue of the lobules by infil- 

 tration, and the lobules immediately surround- 

 ing the tumours are compressed and congested. 

 The obstruction to the circulation in the organ 

 being general on account of the number of the 

 tubercles, the entire liver is more or less con- 

 gested. 



i. Scirrhus. Carcinoma affects the liver 

 under a variety of forms, but appears most 

 frequently as tubercles of different size and 

 consistence. These tubercles are more fre- 

 quent than those of scrofulous origin, and are 

 generally accompanied by symptoms denoting 



a cancerous diathesis, and by the existence at 

 the same time of similar tumours in other parts 

 of the body. In their earliest development in 

 the liver nearly all carcinomatous tumours pre- 

 sent the same characters, resembling small, 

 whitish, semi-opaque patches, occupying the 

 tissue of one or of several of the lobules. As 

 they increase in size they put on certain peculiar 

 appearances, which have gained for them a 

 subdivision into species and varieties. I do 

 not intend in this place to enter into the ar- 

 rangements proposed by authors, but will briefly 

 describe the most striking varieties that have 

 fallen beneath my own examination. The sim- 

 plest of these tumours has been termed scir- 

 rhous tubercle, a name which appears particu- 

 larly applicable from its resemblance in cha- 

 racters and structure to the same form of tu- 

 mour occurring in other parts of the body. 

 Commencing like the carcinomatous tumour 

 generally in a semi-opaque patch, the outline of 

 the lobules is for some time distinctly percep- 

 tible through its area, but at a later period the 

 centre of the patch becomes quite opaque, and 

 presents a cartilaginous hardness ; nd creaking 

 sound when divided with the knife. The cir- 

 cumference is gradually diffused in the sur- 

 rounding textures, and the progressive increase 

 of the tumour seems to take place by the se- 

 cretion of a milky albuminous fluid into the 

 meshes of the lobular venous plexuses. The 

 circulation in these plexuses is at first unim- 

 peded, but by the increase and induration of 

 the secretion it is gradually arrested, and the 

 vessels obliterated The obliterated vessels 

 give rise to the appearance of small cells, in 

 which the carcinomatous matter is deposited, 

 and the larger arese are produced by the tissue 

 of the capsules of the lobules variously dis- 

 torted from their original form by the increased 

 deposition. As the tumours become more and 

 more large, white lines, formed by compressed 

 cellular tissue, are observed radiating from the 

 centre towards the circumference. When seen 

 upon the surface of the liver, the scirrhous 

 tubercle appears flat, or very slightly depressed 

 towards the centre. In a preparation of this 

 form of tubercle now before me, the whole 

 tumour is slightly raised above the surface; it 

 presents no central depression, is Cartilaginous 

 in appearance, and has an irregular outline. 

 Its section is dense and hard like cartilage, 

 with no appearance of vessels, and of that 

 pearly and semitransparent whiteness which 

 is generally observed in scirrhous tubercle, 

 particularly in the variety which this prepara- 

 tion illustrates. Sometimes these tubera ate 

 small and very numerous, of a yellowish or 

 brownish colour, and have a great activity of 

 increase; the cells in which they are contained 

 are thick and of larger size, and the albumi- 

 nous secretion less firm than in the preceding 

 variety. Occasionally they are reddened in the 

 centre by the effusion of blood, from the con- 

 gestion of unobl iterated vessels, and some- 

 times by the continuation, through the tumours, 

 of dilated vessels, which supply them with 

 nutrition. In their enlarged state they fre- 

 quently coalesce and give rise to an irregular 



