169 



stances not be accounted for by individual differences in 

 the condition of the walls of the vessels belonging to the 

 portal system ; nay, more, to individual differences in the 

 development, nutrition, and innervation of the muscular 

 tissue of the intestines ? These relative individual differences 

 of bone, tissue, cell, organ, membrane, and vessels, which 

 are admitted by all competent authorities, really form the 

 foundation of all sound views in pathology, and the more 

 they are recognised and appreciated, the more will the art 

 of medicine acquire scientific exactitude and increased 

 usefulness to humanity. In the words of Sir James Paget, 

 " Better treatment will follow better diagnosis, and better 

 diagnosis will certainly follow a more exact pathology." 

 Professor Thierfelder, of Rostock, says : " The predisposition 

 to habitual hepatic congestion is often inherited, and may 

 then appear in the same families for many generations. 

 It must obviously be admitted that there may exist a 

 similar predisposition towards a menstrual hyperaemia of the 

 liver. A somewhat analogous condition is suggested also 

 in that form of hyperaemia due to obstruction. In certain 

 affections, for instance, it is not always the liver, but 

 frequently the kidneys or the mucous membrane of the 

 digestive apparatus, that constitute the organ in which the 

 results of over-distension of the entire venous system first 

 of all and most distinctly appear ; and with reference, 

 moreover, to the degree of the alterations in the liver, the 

 separate cases present varieties which are by no means 

 invariably proportionate to the extent of the obstructions to 

 the circulation, in consequence of which, as is stated by 

 Botkin, the susceptibility of the liver to the effects of an 

 increased venous pressure cannot be the same in all 

 individuals." 



