CIRRHOSIS OF THE LIVER. 695 



amount and density of the fibrous investing membrane wbich. 

 envelops the gland, surrounding the hepatic vessels and accom- 

 panying them all through the hepatic structure. It is rarely 

 brought under our notice until the changes have made very 

 considerable advances, often not at all during life, or only when 

 certain mexplicable or ill-understood conditions and pheno- 

 mena, associated with some other illness, have drawn attention 

 to the condition of the liver, which consists essentially in a 

 fibroid hypertrophy of the enveloping fibrous capsule, passing 

 also between the true cell-structures. These latter, in the 

 early stages, may seem swollen — a condition exhibited in 

 common with the interconnective-tissue, tending to give the 

 entire structure affected a perceptible increase in volume. 

 This, however, shortly disappears ; the hepatic lobules, from 

 steady pressure and want of nutrition, gradually shrink, and 

 ultimately appear as dark-brown spots scattered amongst the 

 gradually increasing and indurating fibroid connective-tissue. 



Over the surface of the organ the capsule assumes a tense, 

 sometimes almost cartilaginous, character, rough and somewhat 

 nodulated from the traction exercised upon it by the indu- 

 ration of the attached interconnective-tissue, the edges at 

 the same time losing their fine attenuation and becoming 

 rounded. From this extra development of fibroid tissue all 

 through the gland, very important and serious changes take 

 place in the vascular and other conduits. The portal and 

 hepatic vessels are encroached upon, and their lumen materially 

 altered. This constringing action in the former inducing inani- 

 tion, atrophy, and pallor, the obstructed portal vessels prevent- 

 ing a free circulation of the blood from the abdominal viscera, 

 resulting in impairment or stagnation of the blood-flow in the 

 abdominal veins, tends to prevent absorption, and favours the 

 accumulation of fluid in the peritoneal cavity. 



By the excessive development of the fibroid tissue, the liver- 

 cells and lobules become much changed; some not at first 

 destroyed, and appearing as brown spots scattered amongst the 

 newly-formed tissue, ultimately lose their original character, 

 and seem to be taken possession of by fatty molecules ; while 

 the minute bile-ducts, by the retention of the secretion, appear 

 as yellow markings, and give a somewhat jaundiced tinge to 

 the parts. 



