ABNORMAL ANATOMY OF THE LIVER. 



Fig. 44. 



Lobules in a state of portal venous congestion, as seen 

 on the surface of the. liver. The congested part oc- 

 cupies the margins of the lobules, the uncongested 

 portion their centres. After Kiernan. 



dullary and occupying the centres of the lo- 

 bules." 



The causes of congestion are all such as tend 

 to interfere with the circulation in the liver 

 or with the general circulation ; for in- 

 stance, impediment to the circulation of the 

 blood through the capillaries of the lungs, 

 diseases of the valves of the heart, aneurism, 

 &c. A slighter degree of obstacle produces 

 congestion of the hepatic veins only, the venous 

 turgescence being limited by the lobular ve- 

 nous plexus. If the obstruction be greater, the 

 lobular venous plexus itself is congested; if 

 the cause continue, the congestion extends 

 through the interlobular fissures into the neigh- 

 bouring lobules, and in a more advanced de- 

 gree the congestion spreads itself throughout 

 the whole of the lobules, and becomes general. 

 From the liver the congestion extends to the 

 alimentary canal, and gives rise to intestinal 

 haemorrhages, haemorrhoids, ascites, &c. 



The variety of appearance in the vascularity 

 of the lobules in congestion, and the constancy 

 of its occurrence, have deceived those patholo- 

 gists who maintain the existence of two sub- 

 stances, and the difference of position and form 

 of the congested and uncongested portions has 

 given cause for the diversity of opinion with 

 regard to its situation. For a perfect elucida- 

 tion of these difficulties, physiology is indebted 

 to the genius and perseverance of Kiernan. 

 The mode in which the attention of this author 

 was drawn to the subject forms part of the his- 

 tory of hepatic congestion, and deserves to be 

 detailed in his own words. " My attention," 

 he observes, " was first directed to the anatomy 

 of the liver by the study of the admirable works 

 of M. Andral. In the first organs I examined 

 I found the small branches of the hepatic veins 

 ramifying exclusively in the red, and those of 

 the portal vein in the yellow substance. I 

 concluded that the liver was composed of two 

 venous trees, a portal and an hepatic tree, the 

 former having a cortex of yellow, the latter of 

 red substance ; and with M. Bouillaud, I thought 

 it probable that the red substance was the organ 



185 



of the function imagined by Bichat. I next 

 ascertained the lobular structure, and concluded 

 with Ferrein, that the red substance was me- 

 dullary and the yellow cortical. Subsequent 

 dissections, in which I found branches of both 

 the portal and hepatic veins ramifying in the 

 red substance, tended to unsettle the opinions I 

 had formed respecting the anatomy and physio- 

 logy of the two substances, and these opinions 

 were finally overturned by the examination of 

 a liver in which I found the branches of the 

 portal vein alone ramifying in the red, and 

 those of the hepatic veins in the yellow sub- 

 stance. The only conclusion that could be 

 drawn was, that the red colour resulted from 

 congestion ; that it was medullary, occupying 

 the centre of each lobule, when the hepatic, 

 and cortical forming the circumference, when 

 the portal vein was congested." 



M filler, in the eleventh figure of plate 11 of 

 his admirable work on the glands, has made a 

 singular error with regard to the structure of 

 the liver, and the arrangement of the ultimate 

 biliary ducts. In the description of this figure 

 he says, "Segmentum hepatis Sciuri junioris, 

 microscopic simplici visutn. Observantur fines 

 ductuum biliferorum elongati, seu cylindri- 



Fig. 45. 





A part of Mutter's \\thfigure of plate 11, which he 

 considers to represent the distribution and arrange- 

 ment of the ultimate biliary ducts. The liver in 

 this section u in a state of hepatic venous conges- 

 tion in the second stage. The congested portion 

 corresponds generally with the central or hepatic part 

 of the lobules, and the uncongested portion with the 

 interlobular fissures, in which are situated the 

 branches of the portal vein. 



a, A small branch of the portal vein giving off 

 twigs to the various interlobular spaces. If these 

 twigs be continued so as to unite with each other, 

 the form of the lobules will be apparent; as at b, b. 

 The angles formed by the giving off of the twigs 

 from the portal vein are the interlobular spaces. 

 c, Irregularly oval patches of uncongested lobules ; 

 the dark spot in the centre is an interlobular space, 

 from which the portal vein radiates in various di- 

 rections, so as to surround the various lobules by 

 whose conjunction the space is formed, d, d, Lo- 

 bules entirely congested. In the centre of the lo- 

 bules of this section I have marked the situation of 

 the intralobular vein, although it may not be appa- 

 rent, or but slightly so, in the congested liver. The 

 small spaces, e, e, generally mistaken for intraio- 

 bular veins in this form of congested liver, are in- 

 terlobular spaces. 



