chap, xvii.] THE LIVER. 321 



abdominal wounds, and are usually easy to reduce. In 

 one instance of such protrusion the surgeon did not 

 find the reduction easy, so he placed a ligature round the 

 projecting part of the viscus, and then cut this obstinate 

 portion of the liver off. The patient recovered. 



From a reference to the relations of the liver, it 

 will be readily understood that an hepatic abscess may 

 open into the pleura, and in some cases, indeed, the 

 pus from the liver has been discharged by the bronchi. 

 Thus, it has been possible for a patient to cough up 

 some portion of his liver, although, of course, in a very 

 disintegrated and minute form. Hepatic abscess may 

 also readily open into either the duodenum or the trans- 

 verse colon. The liver is very frequently the seat of 

 the secondary abscess of pyaemia, and, according to Mr. 

 Bryant's statistics, abscesses in this viscus are more 

 common after injuries to the head, than after injuries 

 elsewhere. They are rare in pyaemia following affec- 

 tions of the urinary organs, and are equally rare in the 

 pyaemia after burns. The liver is more often the seat 

 of hydatid cyst than are all the viscera taken together. 

 The cyst may discharge itself externally, or into the 

 pleural or peritoneal cavities, or into any adjacent part 

 of the intestine. 



The gall bladder and the bile duct have been 

 ruptured alone without rupture of the liver. The 

 injury is rapidly fatal, owing to the escape of bile into 

 the peritoneal cavity. The gall bladder is often occu- 

 pied by gall stones. These concretions are composed 

 mainly of cholesterin, and vary in size from a hemp 

 seed to a hen's egg. Although the common bile duct 

 is only about three lines in width, it is remarkable to 

 note what comparatively large stones have been passed 

 along it Gall stones have suppurated out through the 

 anterior belly wall, and have been removed from 

 abscesses in the parietes. Thus Dr. Burney Yeo reports 

 a case where more than one hundred gall stones were 



