696 THE LIVER. 



matory elements, but that the liver epithelia also share in the formation of 

 such elements, through the increase of the living matter in their "bodies. The 

 result of this is a recurrence of the formation of indifferent or medullary 

 corpuscles. All these corpuscles remain uninterruptedly connected with each 

 other, become spindle-shaped, and are partly transformed into basis-sub- 

 stance, so as to produce a considerable amount of fibrous or homogeneous, 

 dense connective tissue. Thus, the participation of the liver epithelia in the 

 inflammatory process fully explains why, in cirrhosis, many of the lobules are 

 so considerably reduced in size, while the newly formed connective tissue, 

 which very soon retracts, is so notably and greatly augmented. The objec- 

 tions which might be raised against Miiller's conclusions are based merely 

 upon hypothetical grounds viz.: that epithelia would never produce con- 

 nective tissue, and that, on the contrary, connective tissue never would pro- 

 duce epithelia. This objection falls to the ground in consideration of the fact 

 that, in the earliest stages of embryonal development, there are present indif- 

 ferent or medullary elements only, from which all future tissues must neces- 

 sarily arise. 



As to the origin of the inflammatory elements in tuberculosis of the liver, 

 direct observations are lacking. It is reasonable to conclude, however, that 

 in tuberculosis, just as well as in cirrhosis, the liver epithelia themselves 

 furnish a large amount of medullary tissue. I have met with a case of tuber- 

 culosis in the liver of a duck, in which some of the lobules were partly, 

 others entirely, transformed into yellow tubercles, evidently through the par- 

 ticipation of the epithelia in the production of indifferent elements. 



As to suppuration of the liver, my studies have led me to the convic- 

 tion that, although the inflammatory process commences in the interstitial 

 or connective tissue, soon thereafter the epithelia also become involved, 

 taking their part in the formation of indifferent or medullary elements. 



In the earliest stages of interstitial hepatitis, marked only by slight 

 changes of the connective tissue, we see with higher powers of the micro- 

 scope (1000-1200 diameters) that the bioplasson bodies the connective- 

 tissue cells are coarsely granular; the nucleus is hidden by the coarse 

 granules, or it is visible in the shape of a shining, homogeneous globule of 

 living matter. Globules of varying size are also scattered throughout the 

 fibrous basis-substance, and have evidently originated from particles of 

 living matter, which in the normal condition produce the living reticulum in 

 the basis-substance. Such formations appear in the largest number around 

 the blood-vessels, both arteries and branches of the vena porta. Next we 

 see that the fibrous basis-substance has completely disappeared, and is 

 replaced by a large number of partly shining homogeneous, partly nucleated 

 lumps, which are connected with each other by means of delicate threads. 

 (See Fig. 310.) 



In this stage the blood-vessels in the inflamed tissue are as yet recog- 

 nizable, although their endothelial walls are considerably thickened, the 

 endothelia themselves being engaged in an active new production of living 

 matter ; while the central lumen is first narrowed, afterward completely lost 

 and filled up with inflammatory elements. It is the same process of pro- 

 liferation which breaks down the portal veins, the hepatic arteries, and the 

 bile-ducts ; the same process which leads to the consolidation of the capil- 

 laries within the lobules and their transformation into inflammatory cor- 

 puscles. In foci of inflammation, where the process has advanced up to the 



