PATHOLOGY OF SECOND STAGE OF CIRRHOSIS CASES. 107 



the disappearance of the glandular substance of the 

 organ. The trunk of the hepatic artery is generally 

 dilated, and its capillary network far more extensive 

 than in its normal condition. The bile- ducts at the 

 periphery of the globules are in a great measure oblite- 

 rated by the pressure of the newly formed connective 

 tissues. The walls of the gall-bladder are thickened, 

 and adhering to the neighbouring structures, and its 

 contents are in most cases scanty and liquid and of 

 a pale orange or yellow colour. In extreme cases of 

 cirrhosis, when the secreting and circulating functions 

 are almost or entirely destroyed, nature makes a grand 

 and munificent effort to prolong life by establishing a 

 collateral circulation. 



The late Dr. Kiernan, who was the first to discover 

 the true nature of cirrhosis, has left on record several 

 interesting cases of the kind. In one where the liver 

 had diminished to more than one-half its normal size, 

 he discovered on injecting it that a collateral venous 

 circulation had been established by way of the dia- 

 phragm. 



In another case, that of a woman who had been 

 tapped " ninety times," he found upon injecting the 

 liver that the same kind of collateral circulation had 

 been established. The circulation through the liver had 

 been impeded by the development and deposit of dense 

 " areolar tissue " every floodgate, in fact, was blocked up 

 and hermetically sealed, and the greater part of the blood 

 of the portal vein had found a new channel through dilated 

 vessels upon the surface of the organ and through the 

 diaphragm, and from thence into the general circulation. 

 In this case there -were numerous bands of adhesion 



