ADDITIONS TO THE REVISED EDITION OF 1880. 723 



stand the anatomical changes and the course of the disease, it is well 

 to divide the course into two stages. In atrophy following hyper- 

 semia, as well as in that of cirrhosis, the slight elevations are the 

 remnants of the liver-substance ; as Klebs says, the only difference 

 is that in vascular atrophy the atrophic parts surrounding the ele- 

 vations are red, in the connective-tissue atrophy pale or tendinous. 



3. P. 681. 



In cirrhosis, when (edema of the legs occurs, it does not usually 

 come till after the ascites, as its chief cause is the compression of 

 the vena cava ; but cases do occur where swelling of the legs ap- 

 peared so early that it seemed simultaneous with the ascites, or the 

 patient even asserts that it preceded. JBamberger asserts that he 

 has not unfrequently found the umbilical vein open and permeable 

 to a fine sound. Hoffmann observed one case of cirrhosis with 

 caput medusae and no ascites, where there was no ligamentum teres, 

 but the umbilical vein was dilated to 8 mm. 



In regard to brain-symptoms in liver-affections, A. Flint, JrSs, 

 paper, read before the International Medical Congress of 1876, 

 shows that jaundice is due to prevention of the escape of bile which 

 has been formed ; but the nervous symptoms are due to the non- 

 separation of cholesterin from the blood. The one is arrest of ex- 

 cretion, the other of secretion. 



Dr. Eugene Dupuy says, " Strong irritation of the liver while 

 the cerebrum is exposed will produce anaemia of the convolutions ; " 

 and J. Frank says that " in man grave diseases of the liver do give 

 rise to inflammation of the right ear." 



4. P. 684. 



As pylethrombosis and pylephlebitis rarely occur primarily, they 

 are usually accompanied by symptoms of the original disease. 

 There are two entirely different forms : 1. An obstructing, obliter- 

 ating form, where the thrombus tends to organization, and the phle- 

 bitis has the character of an adhesive inflammation ; 2. An infec- 

 tious, metastatic, or suppurative form, where the thrombus softens 

 and fluidifies, or the phlebitis is suppurative, and the pulpy remains 

 of the thrombus are mixed with the blood. It is evident that, in 

 the first form, there is more or less portal congestion ; in the sec- 

 ond, so-called metastases develop in the liver, or there may be 

 general blood-infection. There may be a union of the two forms, 

 when the thrombi which were at first obstructing become fluid. 



Bamberger considers the physical examination valuable in diag- 



