626 OF SECRETION. 



rounding the interlobular spaces ; so that the non-congested substance here 

 appears in the form of circular or irregular patches, in the midst of which the 

 spaces and fissures are seen (Fig. 236).* Although the Portal as well as the 

 Hepatic venous system is thus involved in this form of congestion, yet, as 

 the obstruction evidently originates in the latter, the term given by Mr. Kier- 

 nan is still applicable ; and it is important to distinguish this appearance from 

 that next to be described. The second stage of Hepatic venous congestion very 

 commonly attends disease of the heart, and other disorders in which there is 

 an impediment to the venous circulation; and in combination with accumu- 

 lation in the biliary ducts, it gives rise to those various appearances, which 

 are known under the name of dram-drinkers' or nutmeg liver. The other 

 form of partial congestion arises from an accumulation of blood in the Portal 

 veins, with a reverse condition of the Hepatic or intralobular veins ; in this 

 condition, which Mr. K. designates as portal venous congestion, the marginal 

 portions of the lobules are of deeper colour than usual, and form a continuous 

 network, the isolated spaces between which are occupied by the non-congested 

 portions (Fig. 237). This is a very rare occurrence ; having been seen by Mr. 

 K. in children only. These differences fully explain the diversity of the state- 

 ments of different anatomists, as to the relative position of the so-called red 

 and yellow substances ; for it now appears, that the red substance is the con- 

 gested portion of the lobules, which may be either interior or exterior, or 

 irregularly disposed ; whilst the yelloiu is the non-congested part, in which 

 the Biliary plexus shows itself more or less distinctly. 



828. Another very interesting form of Pathological change in the aspect of 

 the Liver, which the knowledge of the structure of the Lobules enables us to 

 comprehend, is that to which the name of Cirrhosis has been given. This 

 has been erroneously attributed to the presence of a new deposit, analogous to 

 that of Tubercular matter ; but it is really due to Atrophy and partial Con- 

 gestion in the Liver itself. It is described by Laennec as usually presenting 

 itself in small masses, varying in size from a cherry-stone to a millet-seed, 

 and scattered through the substance of the Liver. When these are minute, 

 and closely set, they impart what appears at first to be a uniform brownish- 

 yellow tint to the divided surface of the Liver; but when the tissue is more 

 attentively examined, their separation becomes evident. These small masses 

 are not distinct lobules in a variable state of hypertrophy (as supposed by 

 Cruveilhier) ; but small uncongested patches, composed of parts of several 

 adjoining lobules, and having one or more interlobular spaces for a centre ; 

 and the biliary plexuses of these, being filled with bile, give them their yellow 

 colour. On the other hand, there is an atrophy, more or less complete, of 

 the portions of the substance of the liver intervening between them ; so that 

 the bulk of the whole organ is much diminished, very commonly to one-half, 

 and sometimes to one-third, of its original size. 



829. The application of the Microscope to the Hepatic Cells, in various states 

 of disease, has afforded many facts of great interest. The fatly fiver, which 

 is often found in the bodies of persons who have died from diseases obstructing 

 the pulmonary circulation, has been shown by Mr. Bowmant to depend 

 upon the presence of a large quantity of fatty matter in the interior of the 

 cells ; which frequently appear as if gorged with it. This would seem to 

 be occasioned by the want of elimination of the fatty matter through the 

 respiratory process ; and the consequent accumulation of it in the Blood, by 



* This very common aspect of the Liver, which presents numerous modifications, has been 

 a source of givat |>rr|>lr\iiy in those who have studied the minute anatomy of this organ, and 

 has even led Anatomists of the highest eminence into serious errors. See Cyclop, of Anat. 

 and Physiol., vol. iii. pp. 185, ISO. 



I Medical Gazette, January 1S42. 



