382 



ABNORMAL ANATOMY OF THE LIVER. 



tance being connected by a vascular cellular 

 tissue, which is often of a dark colour, a con- 

 trast between this and the yellow substance of 

 the acini is produced. A similar relation of 

 the constituent parts of the liver exists in the 

 embryo of the bird ; in it the yellowish twig- 

 like ramifications of the biliary canals are seen 

 on the surface of the organ rising out of a 

 reddish vascular tissue." 



M. Dujardin, in an article entitled, " Re- 

 cherches Anatomiques et Microscopiques sur 

 le Foie des Mammiferes,"* has advanced some 

 opinions which he conceives will throw a doubt 

 over the labours of Kiernan. My space will 

 not permit an analysis of his paper, but it 

 will be obvious to all who may be disposed to 

 read it, that he has not advanced a single new 

 fact, but on the contrary has confessed the 

 most imperfect and inadequate means of ex- 

 amination. Thus, he observes, " with an in- 

 jection sufficiently fine we can inject the portal 

 vein as far as the capillaries which surround 

 the lobules." Therefore, according to him, the 

 interlobular veins are capillaries, and we need 

 not wonder that with such injection he gets no 

 further, but denies the existence of vessels in 

 the lobules altogether. The lobules, he says, 

 are composed of glutinous corpuscules or glo- 

 bules, which leave channels between them, 

 through which the corpuscules of the blood 

 pass without alteration ; at the same time by an 

 action analogous to the phenomena of absorp- 

 tion and assimilation in the lower animals, 

 these lobules separate from the serum the excre- 

 mentitious particles which are excreted upon 

 the surface of the lobule. The blood of the 

 portal vein is transmitted through the lobule 

 by a kind of ''filtration organique," and from 

 it the resinous matters of the bile are elimi- 

 nated ; the arteries, on the contrary, secrete the 

 alkaline substances, which in the first instance 

 dissolve the resinous substance, and afterwards 

 constitute the true agents of digestion. M. 

 Dujardin concludes his theoretical but inge- 

 nious speculations with an excuse for being 

 obliged to give them to the world in their pre- 

 sent imperfect state, and promises to renew his 

 researches with perseverance. I feel pleasure 

 in recording his promise, and have no doubt 

 that by better directed injections in the human 

 liver, using size and vermilion in place of oils 

 and varnish, he will be induced to modify 

 his views with regard to this most interesting 

 organ . 



PATHOLOGICAL ANATOMY OF THE LIVER. 

 If we consult the works of pathological writers 

 upon this subject, we shall observe at every step 

 of our progress the greatest ambiguity and dif- 

 ference of opinion to exist. The reasons for 

 this want of consent upon the true nature of 

 the diseases of so important an organ are not 

 to be ascribed either to want of talented ob- 

 servers or of excellent observations, but solely 

 to the ignorance which has hitherto prevailed 

 with regard to the exact anatomy of the organ. 

 I have shewn that the most celebrated authors 

 found it necessary in starting with their in- 



* Annales Fran^aises et Etrangeres d'Ana- 

 tom'e et Physiologie, 1838. 



quiries to establish for their guidance a theory 

 of the structure of the liver ; this theory was 

 based upon imagination or upon deceptive ap- 

 pearances ; and upon this frail basis the 

 crumbling superstructure of their pathological 

 deductions is supported. The hypertrophy or 

 atrophy of the white or of the red substance, 

 and the wild speculations of pathological 

 theorists, have now fallen into the shade before 

 the light which recent discoverits have thrown 

 upon the anatomy of the liver. Intimately 

 associated with that anatomy, and with the 

 knowledge of the distribution of the vessels, is 

 the explanation of the mode in which the 

 circulation is performed, and the elucidation of 

 the causes which may give rise to impediment 

 in its course ; in other words, the principles of 

 congestion. Indeed, so closely allied is that 

 condition with the natural circulation, that 

 Kiernan, in his paper upon the Anatomy and 

 Physiology of the Liver, has deemed it a part 

 of the subject to explain the various conges- 

 tions to which the organ is liable, and the 

 manner in which they may be imitated arti- 

 ficially. Upon this point we have, therefore, 

 precise information, and the history of con- 

 gestion we may regard with a feeling of satis- 

 faction. The same observations, with the exact 

 anatomy of the liver as a basis, have not as 

 yet been extended to its diseases ; our know- 

 ledge of these is therefore necessarily imper- 

 fect. Kiernan concludes his paper with a para- 

 graph of much importance to this branch of 

 pathology : " While engaged in the exami- 

 nation of the natural structure of the liver, I 

 have not been inattentive to the changes pro- 

 duced in it by disease ; and, with the permis- 

 sion of the Society, I propose submitting to its 

 consideration a paper on the morbid anatomy 

 of this organ." Now this was written in 1838, 

 and I trust that the time is not far distant 

 when the additional labours of that excellent 

 observer will be placed in the hands of the pro- 

 fession. 



In the arrangement of the diseases of the 

 liver I have adopted a physiological order, and 

 shall consider its morbid conditions under the 

 seven following heads : 



1. Diseases of the serous membrane. 



2. Diseases of the mucous membrane. 



3. Disorders of the venous circulation. 



4. Disorders of biliary excretion. 



5. Diseases of the parenchyma. 



6. Disorders of function. 



7. Entozoa. 



1. Diseases of the serous memb?-ane.The 

 serous covering of the liver, like serous mem- 

 branes in other parts of the body, is liable to 

 acute inflammation. The effects of this inflam- 

 mation are also similar; the capillary vessels 

 become over-distended and lose their power of 

 contraction ; coagulable lymph is effused upon 

 the surface of the organ, and causes its me- 

 chanical cohesion to the contiguous serous 

 membrane ; the coagulable lymph becomes 

 organised by the development of new capillary 

 vessels from the meshes of the old, and the 

 adhesions are traversed by vessels of larger 

 size, and constitute a permanent bond of 



