728 SPORADIC DISEASES. 



" when it commences witli inflammation or congestion, the course 

 which leads to atrophy is as follows : — Fibrinous exudation takes 

 place ; this occupies the portal canals, and extends even into 

 their minute ramifications, so that the very lobules may be 

 separated by the exudation. Livers in this early stage are much 

 enlarged, are firm and tough — sometimes very tough — the ex- 

 ternal surface, perhaps, merely uneven, with commencing granu- 

 lations, and the capsule more or less thickened and opaque. On 

 section there is found considerable vascularity, an amorphous, 

 albuminous exudation, tailed or spindle-shaped cells and fibro- 

 cellular tissue separating the lobules. In more advanced stages 

 the fibrous tissue is more decidedly developed. Subsequent to 

 the formation of new fibrous tissue, contraction follows, with 

 constriction of the vessels lying in the course of the new tissue, 

 impediment to the circulation in the small branches of the portal 

 veins, starvation and wasting of the tissue by them." — (See 

 Eeynolds' System of Medicine, vol. iii. page 345.) 



(2.) According to this view it is supposed that the fibrous 

 tissue is hypertrophied and condensed, rather by a degenerative 

 action than by one which can be termed inflammatory. Dr. 

 Handheld Jones says — " The change seems to be of a similar kind 

 to that which produces cartilaginoid induration of the capsule of 

 the spleen, stiffening of the valves of the heart, and contraction 

 of its orifices, which can scarcely be regarded as an inflammatory 

 origin. We are confirmed in this view by having often observed 

 various minor degrees of condensation and thickening of the 

 Glissonian sheaths, in cases where there was no trace of inflam- 

 matory action, as well as by a circumstance which has hitherto 

 heen quite unexplained — that is, that the spleen, albeit exposed 

 to the backward pressure of the blood, retarded in the splenic 

 vein, does not become distended in the way that one would 

 expect, but is often, on the contrary, small and soft. In such 

 spleens we have often observed very many of the nuclei throw- 

 ing out fibres, which is certainly not the natural metamorphosis ; 

 and hence it seems not improbable that in this way, owing to 

 increase of fibrous tissue in its substance, the parenchyma of 

 the spleen is less distensible than usual, and has a contrary 

 tendency to shrink and collapse." 



(3.) Cirrhosis is attributable to degeneration of the secreting 

 tissue, independently of inflammation, arising from an unsuitable 



