722 DISEASES OF THE LIVER. 



ADDITIONS TO THE REVISED EDITION OF 1880. 



SECTION I. DISEASES OF THE LIVEB. 



1. P. 666. 



Emboli from endocarditis and valvular disease of the heart are 

 frequent in the kidneys and spleen, but rare in the liver, which may 

 be partly due to the small size of the hepatic artery and the sharp 

 angle at which it originates, partly to the liver having no terminal 

 arteries, so that an hepatic embolus may occur without perceptible 

 effect. In pysemia from suppurations in peripheral portions of the 

 body, metastatic abscesses occur chiefly in the lungs, far more rarely 

 in the spleen, liver, or kidneys. If we believe that these metastases 

 result exclusively from emboli from detached and broken-down 

 venous thrombi, etc., which enter the right heart and thence pass 

 into the finer twigs of the pulmonary artery till they are arrested, 

 it is difficult to understand how some emboli pass through the pul- 

 monary circulation into the left heart, and thence with the arterial 

 blood into the liver, spleen, etc., and there cause abscesses ; but 

 the observations of 0. Weber render it probable that small emboli 

 may pass the lungs, or else clots, propagated from the pulmonary 

 arteries through the capillaries into the pulmonary veins, may break 

 up and cause new emboli ; but it is also possible that some me- 

 tastatic abscesses, like some pya3mic inflammations of serous mem- 

 branes, joints, or cellular tissues, are not due to emboli. Liver- 

 abscesses have been found where the most careful observers could 

 find no cause. 



2. P. 671. 



The human liver consists of small lobuli, about 1 mm. thick and 

 3 mm. long ; each lobule is connected with an hepatic vein by a short 

 branch 0.06 mm. in diameter. The periphery of the lobule is bound- 

 ed by the interlobular veins, while there is only a trace of intersti- 

 tial connective tissue. The latter is greatly increased in interstitial 

 hepatitis, but not in such a way as to give each glandular lobule a 

 special envelope, but to enclose whole groups of lobules of equal or 

 unequal size in a freely nucleated new connective tissue, making 

 islands of variable size. The connective substance of the lobules 

 soon participates in the proliferation from the circumference to the 

 centre. Most authors ascribe only a passive rdle to the liver-cells 

 themselves, as the changes subsequently occurring in them are due 

 to compression from the contracting connective tissue and impair- 

 ment of the circulation by obliteration of the vessels. To under- 



