DISEASES OF THE LIVER. 



blood : on the one hand, because it sometimes comes very early, at 

 others very late, without any corresponding change in the other symp- 

 toms of congestion ; secondly, because in some cases of cirrhosis, and 

 hi all the cases of atrophic nutmeg-liver that we have observed, in spite 

 of the excessive compression of the hepatic vessels, there has been no 

 enlargement of the spleen, or it has been only slightly enlarged. 

 Probably the swelling of the spleen depends, partly at least, on a 

 process similar to that affecting the liver. But, that part of the splenic 

 enlargement is due to obstruction of the flow of blood, is shown by the 

 constant diminution in size of the spleen, when a haematemesis, from 

 rupture of the capillaries of the stomach, has facilitated the escape of 

 blood from the spleen. 



As the veins of the peritonaeum also, particularly those of its visceral 

 folds, empty into the portal vein, we may readily understand the occur- 

 rence of ascites, which is the most apparent symptom of cirrhosis. We 

 may refer to the chapter next to the last of the previous section, where 

 the increased lateral pressure in the veins of the peritonaeum was 

 shown to be the most important cause of serous transudations into the 

 abdomen. As rupture of the capillaries of the peritonaeum occasion- 

 ally occurs, in some cases, we find small quantities of blood mixed with 

 the transudation. In other cases, there are flocculi of fibrin in the 

 fluid, which tend to prove that, while the inflammation is going on in 

 the liver and its vicinity, small quantities of free exudation are formed. 

 The ascites, which forms a symptom of cirrhosis of the liver, is particu- 

 larly extensive ; hence in it, more frequently than in any other form of 

 abdominal dropsy, we find the blue veins over the abdomen, oedema of 

 the lower extremities, genital organs, and abdominal walls, resulting 

 from compression of the vena cava and iliac veins, as well as the super- 

 ficial gangrene of these parts that we have previously described. 



Now that we have mentioned chronic gastric and intestinal catarrh, 

 gastric and intestinal haemorrhages, haemorrhoids, enlargement of the 

 spleen, and, lastly, ascites, as the almost constant symptoms of cirrhosis, 

 and as the mechanical results of compression of the branches of the 

 portal vein, it may be asked how we explain the exceptions, where 

 these symptoms do not exist, or are insignificant. We shall first re- 

 mark that, occasionally, in spite of advanced cirrhosis, the branches of 

 the portal vein remain quite pervious, so that, according to the obser- 

 vations of Foerster, in some cases, they may be traced a considerable 

 distance in the cadaver. But, besides this, the escape of blood from 

 the stomach, intestines, spleen, and peritonaeum may be facilitated, and 

 the congestion in these organs avoided, by the. blood seeking other 

 passages, and the development of a collateral circulation. This may 

 result : 1. From the connection between the inferior mesenteric and 



