164 
an exabdominal tumour, and be uncovered ex- 
cepting by the membranes of the ovum. But 
the most interesting and unexplained form of 
‘altered position is that in which the whole of 
the viscera of the body are trans , and the 
liver becomes placed on the left instead of the 
right side. These cases are generally perfect, 
and the peculiarity does not seem to interfere 
with the life or functions of the subject. The 
liver presents its natural form and size, and 
with the simple exception of left for right, pre- 
cisely the same relations. The aorta, of course, 
occupies the right side, and the vene cave the 
left, while the stomach is transferred to the 
right. Sir Astley Cooper has preserved the 
viscera of an adult who was the subject of 
this transposition. And a few years since I 
had the opportunity of examining a similar 
case in the body of Smithers, a man who 
was executed for committing arson accom- 
panied with loss of life in Oxford-street. The 
viscera of this man were eghen: healthy, the 
liver finely formed, and the general fabric ro- 
bust. 
The gall-bladder (fig. 33, 12,) (cystis 
fellea) is a membranous sac of a pyriform 
shape, situated in the shallow fossa upon the 
under surface of the right lobe, and lying pa- 
rallel with the longitudinal fissure. For con- 
venience of description it has been customary 
to divide it into a body, fundus, and neck 
(cervix), although no precise mark of division 
subsists between these parts. The body is the 
middle portion ; the fundus the expanded ex- 
tremity, which approaches the notch in the free 
border of the liver, and frequently extends be- 
ond it; and the neck the narrow and taper- 
ing portion of the sac which enters the right 
extremity of the transverse fissure and forms 
the cystic duct. 
The sac is in relation by its upper surface 
with the substance of the liver, and by the 
under part with the pylorus and ascending 
duodenum. The fundus corresponds with the 
right border of the rectus muscle, and may be 
felt in that situation when filled with gall- 
stones. 
The coats of the gall-bladder are three :—1. 
an external or serous covering derived from the 
peritoneum, which covers all that portion of 
the sac which is not in contact with the sub- 
stance of the liver. The gall-bladder is some- 
times completely surrounded by the peritoneum, 
and hangs loosely connected with the liver by a 
duplicature of that membrane. 2. A fibrous 
layer* (nervous) composed of cellulo-fibrous 
tissue intermingled with tendinous fibres; and, 
3..a mucous coat which lines the interior of the 
sac, and is continuous through the cystic and 
hepatic ducts with the mucous lining of the 
biliary structure of the liver, and through the 
ductus communis choledochus with the mu- 
cous membrane of the duodenum and ali- 
mentary canal. The internal surface of the 
mucous layer is raised into innumerable small 
ridges and folds (ruge) by the ramifications of 
the cystic artery and its capillaries, which give 
* In the ox, according to Monro, this coat is 
distinctly muscular. 
NORMAL ANATOMY OF THE LIVER. 
to it a peculiarly reticulated appearance, an 
the fl rece of the ruge are jepresiet il 
numerous small muciparous follicles. In th 
neck of the sac the mucous membrane is 
duced into from six to twelve small f{ 
forming a kind of spiral valve b Pans 
which the bile is regulated in its descent i 
the duodenum, and assisted in its entrance j 
the gall-bladder. The existence of this pe 
liar valvular apparatus gives to the neck ¢ 
gall-bladder a sacculated appearance. - 
cous membrane is but loosely connected 
the fibrous coat, and the cystic artery wi 
branches ramify hetween them. ‘ 
The excretory duct of the gall-bladd 
cystic, (fig. 33, 11); it is about 
and a half in length, and in diame 
equal to the cylinder of a crow’s quill. 
generally somewhat tortuous in its coursi 
appears sacculated from the continuatiot 
it of the spiral valve. Upon enterit 
transverse fissure it unites with the 
duct of the liver, the hepatic duct, 
junction of the two constitutes the d 
communis choledochus. The ductus ec 
choledochus, about three inches in h 
cends through the right border of the 
err lying in front of the portal ve 
to the right of the hepatic > a 
into the duodenum by TE ing or n 
tance obliquely between its coats. Itis 
to the other vessels in its course by the ¢e 
tissue of Glisson’s capsule, and near 
mination is considerably constricted. 
The excretory ducts of the liver and 
bladder have three coats, an external or 
coat, a reo or fibrous, and an intern 
cous. A question exists among physi 
as to the probable muscularity ¢ he 
coat in man; it is undoubtedly contractil 
in some few instances of obstruction ha 
sented an appearance very closely resem 
muscular fibres. Cruveilhier thinks the 
ture analogous to the dartos. In some 
as in the horse and dog, this coat is ¢ 
muscular, 
Varieties in the gall-bladder.— 
sometimes enormously dilated without a 
parent obstruction in its ducts. Occ 
in acephalous and anencephalous feetuse 
altogether absent. In a preparation now! 
me of the liver of a foetus at the full p 
which lived for several hours after b 
which presented, in anatomical s 
peculiarities dependent upon 2 
velopment, the most careful di 
failed to discover the slightest ind) 
gall-bladder. Among the lower mai 
in cats, a double or accesso 
by no means uncommon. Kierna' 
served several instances of this variety. — 
self have seen two, and have one 
before me. In the kinkaju an ac 
bladder is the normal character, 
liver of a small animal 
in the Museum of the College of & 
there are three gall-bladders. 
Structure of the liver.—The liver ; 
posed of lobules, of a connecting 
ture, | 
Ie 
; 
