THE LIVER. 



601 



with obliteration of the bile duct is of occasional occurrence. 1 In 

 adults it seems in many cases to be directly dependent upon the contin- 

 ued ingestion of large quantities of strong alcoholic liquors. It very 

 rarely occurs as a result of beer drinking. There are many cases of cir- 

 rhosis for which no cause can be discovered. 8 It is probable that in cer- 

 tain cases at least a degeneration of circumscribed areas of liver paren- 

 chyma precedes and probably determines the new formation of connective 

 tissue ; the lesion would then be more properly considered a replace- 

 ment hyperplasia than as strictly inflammatory. 3 



Welch 4 has described the occurrence of small circumscribed areas of 



FIG. 366. GUMMA OF LIVER. 



a. Cheesy centre ; ft, fibrous periphery : c, small-celled peripheral infiltration ; d, portions of live lobules. 

 The drawing is somewhat schematic. 



fibrous tissue in the liver, replacing liver cells and containing coal pig- 

 ment. This rare lesion he has called cirrhosis hepatis anthracotica. 



Syphilitic Hepatitis. Chronic interstitial inflammation of the liver 

 very frequently results from syphilitic infection, either congenitally or 

 in the later stages of the acquired form. It may occur in a diffuse man- 

 ner, new connective tissue being formed either between the lobules, or 

 within them between the rows of liver cells. The new tissue may be 

 rich in cells, or dense and firm. This form is frequently seen in chil- 

 dren, and cannot be distinguished, either macroscopically or micro- 

 scopically, from similar forms of interstitial hepatitis from other causes. 



1 See Rolleston and Jlayne, British Med. Jour., 1901, vol. i., p. 758, bibliography. 



2 For a study of experimental cirrhosis of the liver see v. Ileukdom, Ziegler's Beitr., 

 Bd. xx., p. 221, 1896, bibliography. Also Wells, Tr. Chicago Path. Soc., March 9th, 

 1903. 



3 For a study of the gennicidal capacities of the liver and the possible relationship of 

 latent or subinfection to cirrhosis see Adatni, Jour. Am. Med. Assn., December 16th 

 and 23d, 1899, bibliography. 



4 Welch, "Cirrhosis hepatis authracotica," Johns Hopkins Hospital Bulletin, vol. 

 ii., p. 32, 1891. 



