CIRRHOSIS OF THE LIVER. 671 



irtisson's capsule, accompanies the hepatic vessels and traverses the 

 parenchyma of the liver. In this form of inflammation there is neither 

 free exudation, suppuration, nor formation of abscesses. The inflam- 

 matory process rather consists in a proliferation of the tissue above 

 named, by the formation of young connective-tissue elements from 

 those already existing. While the connective tissue of the liver in- 

 creases, its parenchyma proper is more and more displaced. In the 

 later stages of the disease the neoplastic tissue undergoes a cicatricial 

 retraction, which strangulates and partly destroys the parenchyma of 

 the liver. The blood-vessels and bile-ducts not unfrequently become 

 impervious throughout a considerable extent, and a large part of the 

 liver-cells atrophy and die. 



Alcohol is the irritant which most frequently induces interstitial 

 hepatitis. Hence English physicians give granular liver the vulgar 

 name of " gin-drinker's liver." Corresponding to the extent to which 

 alcohol is used by the sexes and at different ages, the disease is more 

 frequent in men than in women, and is very rarely seen during child- 

 hood. Even the apparent exceptions support the rule. Thus Wun- 

 derlich found typical cases of the disease in two sisters aged eleven 

 and twelve years ; but on careful inquiry it was found that both of 

 them were great schnapps-drinkers. 



The use of alcohol, however, is not the only cause of interstitial 

 hepatitis, and all persons affected with this disease, who deny the ha- 

 bitual use of liquor, are not to be regarded as secret topers. Simple 

 congestive hypersemia, which so often occurs in heart-disease, has fre- 

 quently been blamed as a cause of cirrhosis ; but, according to JBam- 

 berger's numerous observations, this is probably an error, which was 

 due to the atrophic form of nutmeg-liver being confounded with cirrho- 

 sis. We are unacquainted with the other causes of interstitial hepa- 

 titis. JSudd (as quoted by Bamberger and Henoch) says : " There 

 may be other substances, among the immense variety of matters taken 

 into the stomach, or among the products of faulty digestion, which, on 

 being absorbed into the portal blood, cause, like alcohol, adhesive in- 

 flammation of the liver." Sudd himself, however, terms this view 

 hypothetical. I have seen one case where biliary calculi caused chronic 

 interstitial hepatitis. In this case, which was fully detailed by Jjieber- 

 meister, most of the large bile-ducts were filled with stony concrements, 

 and the liver was most strikingly cirrhotic in character. 



ANATOMICAL APPEARANCES.* In the first stage, which we larely 

 see, the liver is increased in size, particularly in thickness ; its perito- 

 neal covering is slightly thickened and clouded; except some slight 

 elevations, the surface is smooth and even. On section, the parenchyma 

 is seen to be interspersed by a vascular, succulent, grayish-red mass, 



