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“ABNORMAL ANATOMY OF THE LIVER. 
-union between the peritoneum proprium and 
the peritoneum reflexum. In this state, adhe- 
sions are not uncommonly met with upon the 
convex surface of the liver, but not so fre- 
quently upon its concave side. The inflam- 
matory action is confined to the peritoneum of 
the organ itself, and that of the parietes of the 
abdomen immediately in contact with it, and 
seldom extends to the serous membrane of 
neighbouring viscera. This is the membranous 
hepatitis of pathological writers, and is accom- 
panied by considerable local uneasiness, and 
by sympathetic pains in various parts of the 
body, dependent upon the communication of 
its proper nerves with the nerves of other re- 
gions, as with the phrenic nerve, giving rise to 
pain in the right shoulder and chest, with 
cough; with the pneumogastric nerve, producing 
uneasiness at the cardia, pain along the cesopha- 
gus, dysphagia and nausea ; and with the solar 
plexus and lesser splanchnic nerve, causing 
pain in the right kidney, &c. This disease is 
usually associated with chronic congestion of 
the substance of the liver, but exists, some- 
times, quite independently of any internal 
morbid action. 
As a consequence of chronic inflammation, 
the serous membrane is sometimes thickened 
and opaque and dense in its consistence ; at 
other times it is less resisting than natural and 
easily broken. 
Depositions are occasionally found in the 
‘subserous tissue of the liver as a result of 
chronic inflammation of the serous membrane. 
They consist most frequently of an athero- 
matous substance, and orcasionally of thin 
plates, having a cartilaginous density and appear- 
ance. The gall-bladder is not unfrequently 
thickened in its coats by the deposition of fat, 
of tuberculous, or of calcareous substance. 
The latter has been described as ossified gall- 
bladder. 
2. Diseases of the mucous membrane.—In- 
flammation of the mucous membrane of the 
liver is acute or chronic, and is more frequent 
than that occurring in the serous membrane. 
Being continuous with the mucous membrane 
of the duodenum, the lining of the biliary 
ducts and gall-bladder is constantly subject to 
sources of irritation from disorders of diges- 
tion, improper aliment, and stimulating sub- 
stances taken into the alimentary canal, or from 
any cause giving rise to undue action in the 
intestinal mucous surface. Almost all the 
chronic diseases of the liver are to be referred 
to this prolific source, and it is also hy means 
of this direct continuity that many of the thera- 
utic remedies exert their alterative influence. 
e effects of inflammation on the mucous 
membrane, are 
5 a. Thickening. 
b. Softening. 
c. Hemorrhage. 
d. Suppuration. 
e. Deposition. 
a. Thickening of the submucous tissue is 
the most frequent consequence of irritation of 
the mucous membrane ; the calibre of the ducts 
is in this way diminished ; actual stricture and 
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obliteration of the tubes occurs, and the bile, 
at first but partially impeded, becomes alto- 
gether obstructed. The gall-bladder is some- 
times enormously thickened, particularly where 
the irritation is kept up by the presence of se- 
veral or a single large gall-stone. The coats 
are usually very much condensed and con- 
tracted, and their structure appears lost ; occa- 
sionally they are dilated. In a case which 
occurred to Amussat,* wherein the ductus com- 
munis choledochus was obliterated, and the 
gall-bladder and ducts were very much distend- 
ed, the middle coat presented atthe characters 
of muscular fibres. 
b. Softening of the mucous membrane may 
occur in the biliary ducts, but more particularly 
in the gall-bladder, and from the same causes 
which produce it in other mucous surfaces. 
I have seen two instances in the gall- 
bladder in which patches of the surface were 
converted into a softened pulp, which gave 
way upon the distension of the sac with air. 
c. Hemorrhage.—The gall-bladder has been 
observed filled with blood, having its source in 
the capillaries of the mucous membrane. In 
these cases intestinal hemorrhage had occurred 
before death, and upon examination, no conges- 
tion or lesion could be found in the mucous 
membrane other than that which was seen in 
the gall-bladder. 
d. Pus has likewise been found in the gall- 
bladder, and in the larger hepatic ducts, some- 
time pure, but generally mingled with the bile. 
e. Abnormal deposits in the submucous cel- 
lular tissue are occasionally seen. They are 
most frequent in the gall-bladder, and consist 
generally of calcareous accretions. 
3. Disorders of the venous circulation 
Under this head I have to describe the various 
forms of congestion of the liver. It has been 
customary hitherto to consider hepatic con- 
gestion as a pathological condition, and in 
compliance with that custom I have given it a 
place under the above title, although I shall 
have occasion to shew that it is not in itself a 
disease, but the mere result of diseased actions 
occurring in other parts, and wholly dependent 
upon the peculiar anatomical structure of the 
organ. Andral, in his excellent work on pa- 
thological anatomy, observes, “ L’hyperémie du 
foie est un des états morbides que présente le 
plus fréquemment cet organe. Tantdt cette 
hyperémie est générale, alors le foie est partout 
d’un rouge uniforme; son volume est aug- 
menté et sa consistance peu changée, lorsque 
V’hyperémie est simple. Cette hyperémie est 
souvent partielle; alors, en un certain nombre 
de points, on trouve comme des taches rouges 
variables en forme et en grandeur, qu’entoure 
un parenchyme plus pale. _ 
“Trois espéces d’hyperémie du foie doivent 
étre admises, relativement aux conditions de 
l’économie dans lesquelles elles surviennent. 
“ Une premiere espece d’hyperémie est celle 
* Dictionnaire de Médecine, article Foie. Mr. 
Kiernan was the pupil of Amussat at this period, 
and saw this interesting case. He informs me 
that the appearance was distinctly muscular, 
