ABNORMAL ANATOMY OF THE LIVER. 



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nor is any hardness or swelling perceptible in 

 the region of the liver." Kiernan, who has 

 observed several cases of this disease, informs 

 me that the symptoms are sudden jaundice, 

 depression of the powers of the system, and 

 speedy dissolution ; upon dissection he found 

 complete absence of bile in the biliary ducts, 

 the mucous membrane of which appeared 

 bleached. 



b. Alterations in the physical properties of 

 the bile. The changes to which the bile is 

 liable are in no wise referable to any particular 

 alteration in the liver. In cases where this 

 organ has been considerably diseased, the se- 

 cretion of the bile has been found natural and 

 healthy; and in other cases, where a slight de- 

 gree of congestion was all the apparent patho- 

 logical derangement, the secretion has assumed 

 a morbid appearance, or has been deficient or 

 superabundant in quantity. Gall-stones are 

 sometimes found in the gall-bladder without 

 any admonitory symptoms during life, and 

 icterus may be a frequent and even a fatal 

 malady without any obstruction appearing in 

 the course of the biliary tubes after death, or 

 without any satisfactory indications of diseased 

 action in the liver. " I have been sometimes 

 astonished," says Andral, " on seeing the 

 enormous quantity of bile which distended the 

 alimentary canal in cases where the slightest 

 degree of congestion existed in its coats, and 

 when the liver appeared in no wise altered." 

 Nay, it has been proved both by observation 

 and experiment that the bile is materially 

 changed in appearance, quantity, and consist- 

 ence by the mere alteration of diet. Experi- 

 ments made upon living animals have long 

 since shewn that bile taken from different indi- 

 viduals is capable of producing very different 

 effects upon the animals into whose bodies it 

 has been introduced; thus some will give rise 

 to a trifling irritation, while others will occasion 

 more or less serious symptoms and even rapid 

 death. Some bile may be touched and even 

 tasted without inconvenience, while other bile, 

 precisely similar in appearance, will produce 

 pustular eruptions and ulcerations upon the 

 tongue and upon the lips. " Here then," says 

 Andral, " are serious changes in the bile which 

 are wholly imperceptible to the investigation 

 of anatomy." 



The colour of the bile differs very consi- 

 derably, being sometimes hardly distinguish- 

 able from serum, and at other times presenting 

 a variable tint of amber, orange, green, brown, 

 olive, and even black. In consistence it is 

 equally various, being one while limpid and 

 diffluent, and another while black, viscous, and 

 grumous. 



b. Alterations in the chemical properties of 

 the bile. In chemical composition, the altera- 

 tions in the bile are not less numerous than in 

 its physical properties. In fatty liver the bile 

 has been found composed almost wholly of 

 albumen and water. Under other circum- 

 stances the natural constituents are greatly 

 altered in their relative proportion. 



The formation of biliary calculi may be re- 

 ferred to disproportionate secretion of the na- 



tural elements of the bile, the increased quantity 

 of certain of its constituents giving rise to the 

 deposition and accretion of these substances in 

 a form corresponding with the cavities in which 

 they are produced. Gall-stones have been 

 found in the smaller biliary ducts in the sub- 

 stance of the liver, in the excretory ducts both 

 within and external to the organ, and in the 

 gall-bladder. They have also been met with 

 inclosed in a cyst, formed most probably by 

 the obliteration of one of the hepatic ducts, 

 and adherent to the organ or suspended from it 

 by a pedicle. Malpighi found gall-stones in 

 the small biliary ducts and considered them as 

 petrified lobules. The size of biliary concre- 

 tions is very various, being sometimes exceed- 

 ingly small, and at other times of considerable 

 bulk. When small they are generally numerous ; 

 I have counted upwards of a hundred, and in- 

 stances are recorded where more than a thousand 

 were found in the gall-bladder. When they 

 are large they are few in number, and frequently 

 single. I have seen the gall-bladder filled with 

 three, two, and even one large calculus. A 

 large oval gall-stone now before me equal in 

 size to a pigeon's egg I removed from the 

 ductus choledochus. Their form is equally 

 various with their size and other physical cha- 

 racters. I have now before me gall-stones with 

 a flattened shape, triangular, and tuberculated 

 on the angles and on the surface ; others have 

 three equal facettes with sharp or flattened or 

 rounded angles ; others again are irregular in 

 their outline and would seem to be moulded 

 to the canals and cavities from which they have 

 been withdrawn. Being stained by the colour- 

 ing matter of the bile, their colour varies with 

 the predominant tint of the secretion in which 

 they have been formed, hence some are reddish 

 brown or black ; others are yellow, and others 

 again white; some are mottled yellow and 

 black, or white and black with various shades 

 of green. 



In chemical composition there are, according 

 to Andral, five principal varieties of biliary 

 concretions; they are, 1. of yellow colouring 

 matter; 2. of resin; 3. of cholesterine ; 4. of 

 picromel ; 5. of phosphate of lime. The first 

 kind appears very ill founded, for yellow is a 

 prevailing tint among gall-stones, and is the 

 mere pigment by which cholesterine and the 

 other substances are coloured. By far the 

 largest proportion of gall-stones are formed of 

 cholesterine, either pure, when it presents a 

 white semitransparent mass beautifully cystal- 

 lized in its interior, or variously tinted with 

 brown, yellow, or orange, and radiating from 

 the centre towards the circumference or from 

 a small central nucleus. The smaller calculi 

 also exhibit upon fracture the same radiated 

 appearance. The gall-stones of resin and 

 picromel may be classed together and consi- 

 dered as biliary concretions formed of inspis- 

 sated bile probably accreted through the agency 

 of cholesterine. The calculi of salts of lime 

 are less frequent ; they are found in the gall- 

 bladder or in the ductus communis choledochus. 

 I have observed them to present two varieties, 

 firstly, incrustations of phosphate of lime upon 



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