ABNORMAL ANATOMY OF THE LIVER. 



187 



stale of the organ they are more obscure, as 

 may easily be inferred when we perceive such 

 distinguished authorities as Miiller and Cru- 

 veilhier, from want of making the liver the 

 subject of especial investigation, deceived by 

 such appearances. That Cruveilhier has actu- 

 ally mistaken the uncongested patches seen on 

 the surface of a congested liver for the lobules, 

 is clearly proved by a succeeding paragraph : 

 " Du reste, le volume des grains glanduleux 

 presente beaucoup de varietes suivant les indi- 

 vidus, et ce volume est tout-a-fait independant 

 du volume du foie lui-meme. Les medecins 

 qui s'occupent d'anatomie pathologique ont sou- 

 vent note ce development, sous le litre d'hepar 

 acinosum. II est une maladie caracterisee par 

 la coincidence de 1'atrophie du foie, qui est 

 reduit a la moietie, au tiers de son volume, et 

 du development considerable des grains glan- 

 duleux." Now the hepar acinosum is without 

 question a liver in the second stage of hepatic 

 venous congestion, and presents several varie- 

 ties in the precise form of the uncongested 

 patches. 



Starting with erroneous data such as these, 

 what can be expected as the result of an expe- 

 rimental injection of the liver made by Cru- 

 veilhier, those who are thoroughly informed 

 upon the exact anatomy of this organ will have 

 no difficulty in anticipating; but to those who 

 are only imperfectly acquainted with it, his con- 

 clusions must appear startling : " Le foieainsi 

 injecte soumis a divers agens chimiques a pre- 

 sente les resultats suivans : 1, 1'mjection bleue, 

 c'est-a-dire celle de la veine cave, avail pene- 

 tre dans la partie centrale des grains glandu- 

 leux, partie qu'on appelle substance jaune du 

 foie. Au milieu de la partie centrale etait 

 1'injection jaune, c'est-a-dire 1'injection du 

 canal biliare. Autour de 1'injection bleue, 

 etait 1'injection rouge, c'est-a-dire, 1'injection 

 de la veine porte, et de 1'artere hepatique, 

 qui occupait toute la substance dite rouge 

 du foie. 11 suit de la que chaque grain 

 glanduleux presente un appareil vasculaire 

 ainsi dispose: 1, au centre, un canal biliare ; 

 2, sur un plan plus excentrique, un cercle vas- 

 culaire forme par les ramifications de la veine 

 hepatique ; 3, un cercle vasculaire concen- 

 trique au precedent, forme par les ramifications 

 de la veine porte et de 1'artere hepatique." 

 Thus in the centre of his lobule, Cruveilhier* 

 found the yellow colour of the ducts, most 

 probably effused and colouring the whole of the 

 yellow portion of his lobule. Next came a 

 circle of blue, and then a circle of red, formed 

 conjointly by the portal vein and hepatic ar- 

 tery. Now we have shewn that the centre of 

 Cruveilhier's lobule is an uncongested patch 

 formed by the contiguous margins of several 

 adjoining hepatic lobules, and having an inter- 

 lobular space for a centre ; -where, therefore, 



* These injections were not made by Cruveilhier 

 himself, but by his assistant M. Bonami, as we are 

 informed by M. Dujardin, in his paper "sur le 

 foie, &c." The material used for the purpose was 

 spirit varnish, and the results were not always suc- 

 cessful. 



could we expect to find the yellow but in the 

 interlobular space, and diffused immediately 

 around it, so that the colouring matter would 

 obscure the red injection of the portal vein and 

 artery of that immediate point. Around the 

 uncongested patch and in the congested sub- 

 stance we should find the intralobular veins of 

 ihree or four or five surrounding hepatic lo- 

 bules, (hence the variable size of Cruveilhier's 

 lobules,) embracing by a kind of zone the 

 yellow centre ; and externally to the vein, the 

 surrounding interlobular fissures would display 

 the red injection of the portal vein and hepatic 

 artery. 



4. Dlsoj'ders of biliary excretion. Bil- 

 iary congestion may be produced by various 

 causes ; the most frequent is temporary thick- 

 ening of the mucous lining of the ducts from 

 inflammation or capillary congestion ; this will 

 simply diminish the calibre of the ducts or 

 produce a complete stricture. The obstruclion 

 may endure for a shorler or longer period ; 

 the swelling of the membrane may subside 

 and the tube be restored to its original dimen- 

 sions, or it may become chronic and be a per- 

 manent impediment to the free current of the 

 bile. Another cause of congestion of the bile- 

 ducts is hepatic venous congestion, which acts 

 by producing pressure upon the lobular biliary 

 plexus and interlobular ducts. This is usually 

 a chronic cause. Congestion of the bile-ducts 

 may likewise depend upon the impaction of a 

 gall-stone in the larger biliary ducts or ductus 

 choledochus, obliteration of one of the ducts 

 by the pressure of a tumour, disease of the 

 pancreas, or thickening of the mucous mem- 

 brane of the duodenum. In each of these 

 cases the ducts are loaded with bile, which 

 gives a yellowish or greenish hue to the whole 

 substance of the liver. Biliary congestion in a 

 chronic form is usually accompanied with more 

 or less of hepatic venous congestion. 



When one of the bile-ducts is obliterated or 

 obstructed by a biliary concretion, the ducts 

 become dilated above the constriction, and 

 considerable reservoirs are formed in the sub- 

 stance of the organ. If the impediment exist 

 in the ductus choledochus, the gall bladder 

 becomes greatly distended as well as the biliary 

 ducts. The irritation caused by the pressure 

 of the bile has given rise to inflammation and 

 ulceration of the coats of the gall-bladder or 

 of the ducts, and the bile has been effused into 

 the peritoneal cavity and produced death. 

 When the cause of the obstruction is a biliary 

 calculus of moderate size, the pressure of the 

 column of the bile will sometimes force it on- 

 wards into the duodenum, and thus remove 

 the impediment. In other cases, when the 

 obstruction occurs in the cystic duct, the bile 

 ceases to enter the gall-bladder, the sac be- 

 comes thickened and diminished in size, and 

 filled with a colourless viscid mucus. 



5. Diseases of the parenchyma, The 

 diseases of the substance or parenchyma of the 

 liver may be referred to the following heads : 

 a, inflammation ; b, hypertrophy ; c, atrophy ; 

 d, softening ; e, induration ; j, fatty degene- 



