588 



OP SECRETION AND EXCRETION. 



ous congestion ; and the surrounding substance varies from a yellowish-white, 

 yellow, or greenish color, according to the quantity and quality of the bile which 



Fig. 158. 



Fig. 159. 



1, angular lobules in a state of Ancemia, as they 

 appear on the external surface of the liver ; 2, in- 

 terlobular spaces ; 3, interlobular fissures ; 4. inter- 

 lobular veins, occupying the centres of the lobules ; 

 5, smaller veins, terminating in the central veins. 



A, rounded lobules in first stage of Hepatic Venous 

 congestion, as they appear on the surface of the liver : 

 B, interlobular spaces and fissures. 



it contains. This accumulation of the blood in the hepatic veins, and the 

 emptiness of the portal plexus, seem due to the continuance of capillary action 

 after the general circulation has ceased, a circumstance to which we find an ex- 

 act parallel in the emptiness of the systemic arteries, and the fulness of the 

 veins, after most kinds of death. In the second stage of Hepatic Venous con- 

 gestion, the accumulation of blood is found not only in the intralobular veins, 

 but even in parts of the portal or lobular venous plexus. The parts which are 

 freest from it are those surrounding 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. 160). * 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. Kiernan 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 accumulation 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 con- 

 dition, which Mr. K. designates as Portal Venous congestion, the marginal por- 

 tions of the lobules are of deeper color than usual, and form a continuous 

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

 portions (Fig. 161). 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 yelfaw substances ; for it now appears that the red substance is the congested 

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



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

 been a source of great perplexity to those who have studied the minute anatomy of this 

 organ, and has even led Anatomists of the highest eminence into serious errors. See Mr. 

 Erasmus Wilson, in "Cyclop, of Anat. and PhysioL," vol. iii. pp. 185, 186. 



