Chap, xvii.] THE LIVER. 319 



by its large size, its comparatively fixed position, and its 

 great friability of structure. Death, in such injuries, 

 usually ensues from haemorrhage, since the walls of 

 the portal and hepatic veins, being incorporated with 

 the liver substance, are unable to retract or to collapse. 

 The hepatic veins also open direct into the vena cava, 

 and being unprovided with valves, could allow of the 

 escape of an immense quantity of blood, if any retro- 

 grade current were established. It is possible for the 

 liver to be ruptured without the peritoneal coat being 

 damaged. Such injuries may be readily recovered 

 from. The liver presents, behind, a fairly extensive 

 non-peritoneal surface, at which rupture or wound may 

 occur without extravasation into the abdominal cavity. 

 From the relation of the liver to the right lower ribs, 

 it follows that this viscus may be damaged when the 

 ribs are fractured, and in some cases the broken ends 

 of the bones have been driven through the diaphragm 

 into the liver substance. Stabs through the sixth or 

 seventh right intercostal space, over the liver region, 

 would wound both the lung and the liver, would involve 

 the diaphragm, and open up both the pleural and peri- 

 toneal cavities. The intimate relation of the liver to the 

 transverse colon is illustrated by a case where a tooth- 

 pick, four inches in length, was found in the substance 

 of the liver. It had worked its way there, from the 

 colon, along an abscess cavity that connected the two 

 viscera. The relation of the liver to the heart may be 

 illustrated by a case still more remarkable. In this 

 instance, a loose piece of liver, weighing one drachm, was 

 found in the pulmonary artery. The patient had been 

 crushed between two waggons, the liver was ruptured, 

 and the diaphragm torn. A piece of the liver had been 

 squeezed along the vena cava into the right auricle, 

 whence it had passed into the right ventricle, and so 

 into the pulmonary artery. The heart itself was quite 

 uninjured. Portions of the liver may protrude through 



