ABNORMAL ANATOMY OF THE LIVER. 



191 



The irritation of abscess causes the effusion 

 of lymph and adhesion to the abdominal pa- 

 rietesor to the adjoining viscera ; ulceration fol- 

 lows, and the contents of the cyst are discharged 

 through the artificial opening. The situations in 

 which the matter escapes from the cavity of the 

 abscess are various. 1. It may burst externally, 

 making its way either between the ribs or up- 

 wards towards the axilla. In a case observed 

 by Dr. Macnaught the abscess pointed at the 

 epigastrium and was opened by the surgeon in 

 attendance. 2. It may become adherent to the 

 diaphragm and burst into the pleura. 3. It may 

 cause adhesion between the serous membrane 

 of the liver and of the diaphragm, and between 

 the latter and the pleura pulmonalis, and the 

 matter may escape into the lung and be 

 coughed up, as in the case already detailed, 

 which occurred to Dr. Munro. 4. In rare cases 

 the pus has been effused into the cavity of the 

 peritoneum. 5. The abscess may become adhe- 

 rent to the stomach, duodenum, or colon, and 

 the matter be discharged into the alimentary 

 canal. A well-marked case of abscess dis- 

 charging its contents into the stomach occurred 

 to myself in the case of a woman who has 

 since perfectly recovered. About two pints of 

 matter were vomited by the patient. In a simi- 

 lar case observed by Dr. Macnaught the patient 

 recovered. In two other cases, where the 

 matter was poured into the intestines, the 

 patients died. 6. Abscess has been seen to 

 open into the gall-bladder, and the pus to be 

 conveyed thence through the ductus comrnunis 

 choledochus into the duodenum. 7. In one 

 case the matter was discharged into the vena 

 cava; and in another, 8, described by Dr. 

 Smith, into the pericardium ; and in a case 

 detailed by Dr. Graves,* the abscess opened 

 both into the stomach and pericardium. 



Besides the preceding form of abscess, which 

 is idiopathic in its origin, abscess may occur in 

 the liver from external injury, as from a blow. 

 The inflammation attending upon this injury is 

 . much slighter than that which gives rise to 

 idiopathic abscess; the collection of matter is 

 generally smaller, and terminates either by dis- 

 charging its contents or by absorption. 



The second variety of abscess in the liver, 

 that in which numerous purulent collections 

 exist, depends for its cause upon the occurrence 

 of wounds or of surgical operations. The suc- 

 cession of abscesses in the liver from wounds, 

 particularly of the head, has long since been 

 admitted as a well-established fact, for the 

 explanation of which numerous theories have 

 been invented. Theory, however, has now 

 yielded before facts, facts, too, of the most 

 interesting and satisfactory kind, for which 

 pathology is indebted to the genius and indus- 

 try of Cruveilhier. The experimental re- 

 searches -j- of this excellent author, published 

 in 1826, enabled him to establish a law of the 

 utmost importance in the consideration of the 

 phenomena of disease, viz. that " tout corps 



* Dublin Medical Journal, January 1839. 

 t Recherches sur la siege immed. de 1'inflamma- 

 tlon. Nouv. Bibl. Med. vol. iv. 



etranger introduit en nature dans le systeme 

 veineux determine lorsque son elimination par 

 les emonctoires est impossible des absces visce- 

 raux entierement semblables a ceux qui suc- 

 cedent aux plaiesetaux operations chirurgicales, 

 et ces absces sont le resultat d'une phlebite 

 capillaire de ces memes visceres."* These 

 experiments consisted in the introduction of 

 metallic mercury into the veins of an animal, 

 say of the lower extremity. In the course of 

 twelve, eighteen, or twenty-four hours the animal 

 experienced much difficulty of breathing, and 

 soon expired. Upon inspection globules of the 

 mercury were found in the lungs. If a smaller 

 quantity of mercury were introduced the animal 

 would live for several days or weeks, and upon 

 examining the lungs at different periods the 

 globules were at first seen to be surrounded by 

 a red induration and afterwards by pus. This 

 experiment was varied by pouring the mercury 

 into the medullary cavity of a bone with pre- 

 cisely the same results ; in one instance he 

 placed a single globule in the medullary cavity 

 and found it again at the end of a month in 

 the lungs, divided into several minute globules, 

 each of which formed the centre of a small 

 tuberculous abscess. Cruveilhier then injected 

 a small quantity of mercury into one of the 

 omental veins of a dog the subject of umbili- 

 cal hernia; the dog was killed in the third 

 month after the operation, being reduced to a 

 state of marasmus. Upon inspection the liver 

 was found filled with small abscesses, each 

 surrounding a small globule of mercury. Having 

 by means of these experiments satisfied himself 

 that the lungs were the barrier to all foreign 

 matters introduced into the general circulation, 

 as was the liver of those admitted into the 

 abdominal circulation, he proceeded to another 

 series of experiments. Opening a vein in the 

 hinder extremity of a dog he introduced into it 

 a long piece of stick, which gave rise to 

 phlebitis and the secretion of pus. The pus 

 thus produced being carried into the circulation 

 excited, in the first instance, abscesses in the 

 lungs, and, secondly, in the liver. Upon 

 these facts and upon a multitude of excellent 

 observations Cruveilhier founds his opinion that 

 abscess in the liver from wounds and surgical 

 operations is always preceded or accompanied 

 by purulent collections in the lungs, and 

 always results from the same cause, viz. from 

 capillary phlebitis, consecutive upon phlebitis 

 in the neighbourhood of the wound, and im- 

 mediately produced by the irritative action of 

 globules of pus brought from the diseased veins 

 to the capillaries of the structures in which the 

 secondary suppuration is developed. 



In every case of secondary abscess in the 

 liver, following wounds of the head, or after 

 amputation or operations upon bones, Cruveil- 

 hier has found phlebitis of the vessels situated 

 in the structure of the bones. Hence he esta- 

 blishes an important general proposition, that 

 " le phlebite des os est une des causes les 

 plus frequentes des absces visceraux suite des 

 plaies et des operations chirurgicales dans 



Anatomic Pathologiquc, liv. xi. 



