HEPATITIS. 441 



Induration or Schirrus is another species of disorganiza- 

 tion to which th« liver is subject, and insomuch as regards 

 the firmness of substance of the gland, one of a nature 

 directly the contrary of the former. The liver, maintaining 

 its normal colour, feels firm, tough, leathery, alias schirrous, 

 as we technically term it ; and is, interiorly, in an evident 

 state of condensation and vascular obliteration. This morbid 

 alteration I believe to consist in the formation and subse- 

 quent spreading and coalition of 



Tubercles. — Next to the lungs, the liver appears to be 

 the most frequent seat of these formations. When present, 

 the surface of the gland feels uneven or tubercular to the fin- 

 gers : a circumstance explained the moment its substance is 

 cut into, by the exposition of various globular masses of 

 grayish or yellowish matter, which we recognise as tubercles ; 

 though we are, in a general way, incapable of detecting their 

 existence during life, and almost as much in the dark in 

 regard to their nature and origin when we have discovered 

 them. 



The observant Mr. Abernethy, speaking of these forma- 

 tions, — remarks, " There are certain organs which, under 

 diseased action, seem to produce but one, or scarcely any- 

 thing else but one, kind of morbid structure. It is an 

 infusion of something into the interstitial parts, in larger or 

 smaller masses, and this we call tubercles. The newly- 

 formed matter, however, may be so extensively deposited that 

 solidity is given to the whole, in which case it constitutes 

 schirrus. To use the language of Mr. Hunter, however, 

 tubercles are to be considered rather a disease in than of a 

 part; for, notwithstanding their presence, the gland will 

 secrete bile : indeed, livers may be greatly diseased, and yet 

 make very good bile. I have seen numerous instances 

 of it.^' 



Suppuration or Abscess of the liver I believe to be very 

 uncommon ; at least, it has proved so in my practice. The 

 origin of it appears to be, the same as in the lungs, suppurated 

 tubercles ; though abscess may and will be very likely to 

 arise from mechanical injury. 



