396 DISEASES OF THE GASTRO-INTESTINAL TRACT. 



tissue projecting into the cavity ; there is no trace of a mem- 

 brane. The contents of the cavity have an offensive, sickly 

 odor ; are thick and creamy like pus, or thin and reddish- 

 brown from the admixture of extravasated blood. 



Microscopically, this fluid is found to contain pus-cells, frag- 

 ments of degenerated liver-cells, shreds of connective tissue, 

 and red blood-corpuscles. The abscess-wall shows but little, 

 if any, inflammatory infiltration. 



Small metastatic abscesses, varying in size from a pin-head 

 to that of a walnut, are sometimes present to the number of 

 forty or fifty, scattered throughout the liver. They occur in 

 the course of pyaemia and septic inflammations of parts tribu- 

 tary to the portal vein. 



Microscopically : In the early stage of their formation there 

 is noted an area of necrosis, the centre of which may have 

 become simply a granular detritus arising from the disinte- 

 gration of the liver-cells. Surrounding the necrotic area is a 

 zone of more or less marked inflammatory infiltration. 



Chronic interstitial inflammation or cirrhosis of the liver is 

 also known as " gin-drinkers' " liver, for at least two-thirds 

 of the cases are due to chronic alcoholism. Certain acute in- 

 fectious diseases, chiefly cholera, typhoid, and intermittent 

 fever, are supposed by some to be important etiological fac- 

 tors. Among chronic infectious diseases, syphilis is an un- 

 doubted cause of cirrhosis. Gout and rheumatism seem to be 

 responsible for some cases. Experimentally, the condition has 

 been produced in lower animals by chronic poisoning with 

 phosphorus and cantharides. Though in most instances 

 hematogenous in its origin, in some it is biliary, due to an 

 obstruction of the bile-ducts. 



In the early stages the liver may be considerably hyper- 

 trophied ; finally, however, in the great majority of cases it is 

 reduced in size even to one-third the normal. The longer the 

 duration of the disease the greater the atrophy, and the tougher 

 and more leathery the consistence of the organ. Its surface 

 is rendered irregular by numerous nodular projections vary- 

 ing in size from a millet-seed to that of a hazclnut. The 

 yellow color of these granulations suggested to Lacnnec the 

 term cirrhosis (from xifipoz, yellow). On section a grating 

 sound is emitted, and the almost cartilaginous consistence of 



