PATHOLOGY OF SECOND STAGE OF CIREHOSIS. 105 



most cases a diarrhoea now sets in, which sooner or later, 

 terminates farther suffering by death. 



In other cases the fatal termination is induced by 

 inflammation or congestion, and sedema of the lungs ; at 

 other times it occurs under symptoms of acholia ;* when 

 the sufferer becomes deeply jaundiced, the skin studded 

 with purple spots or bruises, delirium, convulsions ; and 

 finally, a deep coma closes the scene. 



Such is a general outline of the chief symptoms which 

 characterize the second stage, and closing scene of 

 cirrhosis. 



ANATO - PATHOLOGICALLY. In this the second stage 

 the disease differs in many important respects. The 

 liver now is reduced in size, particularly the left lobe, 

 which is often found shrivelled up into a small mem- 

 branous appendage. Semi-globular knobs of unequal 

 size and form are thickly scattered over its 

 surface. The serous envelope is thickened and 

 tough ; numerous bands of connective tissue pass from 

 it to the neighbouring organs, such as the diaphragm, 

 colon, stomach, and spleen. Upon making a section of 

 a cirrhotic liver, the surface presents a cartilaginous 

 hardness and leathery tenacity. The knife grates, " as it 

 were," in cutting through it. Broad and narrow lines of 

 connective tissue surround the granulations, and send 

 streak-like processes into their interior. These granu- 

 lations are in most cases dark, or of a pale yellow. A 

 large portion of the hepatic'cells are destroyed, and their 

 remains are found in the form of small masses of 

 " brownish pigment " scattered through the filaments of 

 the newly formed connective " areolar tissue." Other 



* Bile-poisoning. 



