518 



OF SECRETION 



Fig. 142. 



Fig. 143. 



-N3 



1. Angular lobules in a state of anaemia, as they 

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

 terlobular spaces; 3, interlobular fissures ; 4, intra- 

 lobular veins, occupying the centres of the lobules ; 

 5, smaller veins, terminating in the central veins. 



1, 1, Rounded lobules in first stage of hepatic 

 venous congestion, as they appear on the surface 

 of the liver; 2, 2, interlobular spaces and fissures. 



may manifest itself in several ways. The whole substance may be congested ; 

 in which case the lobules present a nearly uniform dark colour throughout 

 their substance, their centres being usually more deeply-coloured than the 

 margins. An appearance more frequently offered after death, however, is 

 that represented at Fig. 143, and termed by Mr. Kiernan the first stage of 

 Hepatic Venous congestion. In this, the isolated centres of the Lobules alone 

 present the colour of sanguineous congestion ; and the surrounding substance 

 varies from a yellowish-white, yellow, or greenish colour, according to the 

 quantity and quality of the Bile which 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 exact 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 congestion, 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 sur- 

 rounding 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. 144).* 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 accumula- 

 tion 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 

 portions of the lobules are of deeper colour than usual, and form a continuous 



* 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 

 Cyclop, of Anat. and Physiol., vol. iii. pp. 185, 186. 



