V 



584 GALL-BLADDER. 



The pathological deductions depend upon the following facts: 

 Each lobule is a perfect gland ; of uniform structure, of uniform 

 colour, and possessing the same degree of vascularity throughout. It 

 is the seat of a double venous circulation, the vessels of the one 

 (hepatic) being situated in the centre of the lobule, and those of the 

 other (portal) in the circumference. Now the colour of the lobule, as 

 of the entire liver, depends chiefly upon the proportion of blood con- 

 tained within these two sets of vessels ; and so long as the circulation 

 is natural the colour will be uniform. But the instant that any cause 

 is developed which shall interfere with the free circulation of either, 

 there will be an immediate diversity in the colour of the lobule. 



Thus, if there be any impediment to the free circulation of the 

 venous blood through the heart or lungs, the circulation in the hepatic 

 veins will be retarded, and the sublobular and the intralobular veins 

 will become congested, giving rise to a more or less extensive redness 

 in the centre of each of the lobules, while the marginal or non-con- 

 gested portion presents a distinct border of a yellowish white, yellow, 

 or green colour, according to the quantity and quality of the bile it 

 may contain. "This is 'passive congestion? of the liver, the usual 

 and natural state of the organ after death;" and, as it commences 

 with the hepatic vein, it may be called the first stage of hepatic-venous 

 congestion. 



But if the causes which produced this state of congestion continue, 

 or be from the beginning of a more active kind, the congestion will 

 extend through the lobular venous plexuses "into those branches of the 

 portal vein situated in the interlolular fissures, but not to those in the 

 space?, which being larger, and giving origin to those in the fissures, 

 are the last to be congested/' In this second stage the liver has a 

 mottled appearance, the non-congested substance is arranged in isolated, 

 circular and ramose patches, in the centres of which the spaces and 

 parts of the fissures are seen. This is an extended degree of hepatic- 

 venous congestion; it is "active congestion" of the liver, and very 

 commonly attends disease of the heart and lungs. 



These are instances of partial congestion, but there is sometimes 

 general congestion of the organ. " In general congestion the whole 

 liver is of a red colour, but the central portions of the lobules are 

 usually of a deeper hue than the marginal portions." 



GALL-BLADDER. 



The Gall-bladder is the reservoir for the bile ; it is a pyriform sac 

 situated in a fossa, upon the under surface of the right lobe of the liver, 

 and extending from the right extremity of the transverse fissure to its 

 free margin. It is divided into a body, fundus, and neck ; the fundus 

 or broad extremity in the natural position of the liver is placed down- 

 wards, and frequently projects beyond the free margin of the liver, 

 while the neck, small and constricted, is directed upwards. This sac 



