THE LIVES. 695 



formed into a crumbly, cheesy mass, owing to the complete 

 absence of newly formed blood-vessels. 



MICROSCOPICAL STUDIES ON ABSCESS OF THE LIVER. 

 BY J. C. DAVIS, M. D.* 



Abscess of the liver is due in most, if not in all eases, to an inflammatory 

 process in some of the organs of the abdominal cavity, from which the radi- 

 cles of the portal system take their rise, excepting, of course, those cases 

 which are due to a parasitic origin (Echinococcus). Abscess of the liver 

 seems to follow only embolism in the portal vein. These embolisms are due 

 to transported particles of pus or shreds from the wall of some pus-cavity, 

 which, being carried into the portal system, produce either suppurative phle- 

 bitis in the porta liepatis the so-called pyle-plilebiiis or suppurative process 

 in any part of the liver in which an embolus may have lodged. The question 

 why pus or tissue in suppuration, if transmitted into a healthy tissue, should 

 again produce suppuration, cannot be satisfactorily answered. We know that 

 pyasmia, which is invariably due to a primary suppurative process on the outer 

 surface of the body, or in an internal organ, is very commonly accompanied 

 by multiple abscess in the liver. The conclusion that such abscesses are 

 mainly produced by embolism of pus gains ground, if we consider the fact 

 that pyaemia will never ensue unless suppurative phlebitis be present in the 

 neighborhood of the primary suppuration. 



My microscopical studies are made on sections from a case of pyaamia. 

 Sections from this liver, if viewed with a power of one to two hundred diame- 

 ters, exhibit innumerable foci of inflammation. Some are yet in the earliest 

 stage, and others in full suppuration. All inflammatory foci have their seat in 

 the interstitial tissue, built up by the relatively small amount of connective 

 tissue, which heretofore has been called " Glisson's capsule." Some consist 

 merely in a slight infiltration of this tissue, others occupy its whole amount 

 between several lobules, while others are produced by both involution of the 

 interstitial tissue and the lobules themselves. Lastly, there are inflammatory 

 foci in which no distinction between interstitial connective and epithelial tis- 

 sue of the lobule is possible, but all look granular with a low power, which 

 means that there have already formed, or are forming, small abscesses. 



The origin of abscess of the liver is evidently the same as that of plastic 

 interstitial hepatitis and miliary tuberculosis of the liver, although the termi- 

 nation is entirely different in the three kinds of inflammatory process. In the 

 process termed plastic interstitial hepatitis, the termination consists in a new 

 production of dense, fibrous connective tissue, the result being that which we 

 call cirrhosis of the liver. In tuberculosis the inflammation leads to a com- 

 plete loss of blood-vessels in certain territories, with the result of shrinkage 

 of the inflammatory elements originating from all the tissues in a circum- 

 scribed territory. They become separated and isolated, thus producing that 

 which we call a tubercle or a dry abscess. 



H. Chr. Mliller has demonstrated that, in cirrhosis, not only the interstitial 

 connective tissue and the capillary blood-vessels are transformed into inflam- 



* Abstract of the author's paper. Archives of Medicine, August, 1879. In accordance 

 with the nomenclature adopted in this book, the term "protoplasm" is changed into " bio- 

 pi OS8OU." 



