184 
gui résulte d’un travail d'irritation dont le foie 
est devenu le siége. Cette irritation est tantét 
idiopathique, et tantdt elle est la suite d’une 
Irritation primitivement fixée sur le tube di- 
“ Une seconde espéce d’hyperémie, dont le 
foie me parait susceptible, est celle dans la- 
quelle le sang s'accumule d’une manitre toute 
passive au sein du parenchyme hépatique, 
comme il s’accumule dans les gencives des 
scorbutiques. : 
“ Enfin le troisitme espéce d’hyperémie du 
foie est purement mécanique; elle s’observe 
dans les cas od un obstacle quelconque s’oppose 
a la libre entrée du sang dans les cavités droites 
du ceeur; le sang stagne alors dans les veines 
sus-hépatiques, et engorge le foie.” 
Now the researches of Kiernan have proved 
that “ in consequence of its double circulation, 
the liver is naturally in a state of sanguineous 
congestion” afier death, and that author has 
also pointed out the various forms of conges- 
tion which are observed in the organ. “ San- 
guineous congestion of the liver,” he observes, 
‘is either general or partial.”’ 
a. General congestion affects the whole of the 
substance of the liver, which presents a gene- 
rally diffused red colour; the central portions 
of the lobules having usually a deeper hue than 
the marginal portions. 
Partial congestion is of two kinds, 
Hepatic venous congestion. 
Portal venous congestion. 
b. Hepatic venous congestion may exist in 
two stages. “In the first and most common 
stage (fig. 42) the hepatic veins, their intra- 
lobular branches, and the central portions of the 
lobular venous plexuses are congested. The 
congested substance is in small isolated patches 
of a red colour, and occupying the centres of 
the lobules is medullary; the non-congested 
substance is of a yellowish white, yellow, or 
greenish colour, according to the quantity and 
quality of the bile it contains; it is conti- 
nuous throughout the liver, and forming the 
marginal portions of the lobules is cortical.” 
Fig. 42. 
Rounded lobules in the first stage of ic venous con- 
gestion, as seen upon the surface of the liver. After 
Kiernan, 
“This is the usual and natural state of the 
organ afier death,” and arises from arrest in the 
eirculation of the hepatic veins, while the cur- 
ABNORMAL ANATOMY OF THE LIVER. 
rent of blood in the minute branches 
portal vein is still in motion. 
“Tn the second stage (fig. 43) the con 
extends through the lobular venous plexuses t 
those branches of the portal vein situated it 
the interlobular fissures, but not to those in tl 
spaces, which being larger there and giv 
origin to those in the fissures, are the last t 
congested ; when these vessels contain bl 
the congestion is general, and the > liv 
red. In this second stage the non-cc ges 
substance appears in isolated circular and 
mous patches, in the centres of which the spa 
and fissures are seen. This form of congest 
“very commonly attends disease of the h 
and acute:disease of the lungs or pleura; 
liver is larger than usual in consequence of” 
quantity of blood it contains, and is frequet 
at the same time in a state of biliary cong 
tion, which probably arises from the 
neous congestion. Although in the first s 
the central portions of the plexuses, aud in| 
second the greater portion of each plexus, a 
those branches of the portal vein occupying t 
fissures are congested, and although the ple 
are formed by the portal vein, yet as this 
of congestion commences in the hepatic 
and extends towards the portal vein, and 
is necessary to distinguish this form fre 
commencing:in the portal vein, the term of hi 
patic-venous congestion will not probably | 
deemed inapplicable to it.” The second sta 
of hepatic venous congestion, generally © 
bined with biliary congestion, gives rise to thos 
various appearances which are called drat 
drinkers’ or nutmeg liver. 
c. “ Portal venous congestion is of very rare 
occurrence ; I have seen it in children only 
In this form, the congested substance never as- 
sumes the deep red colour which characteri eS 
hepatic-venous congestion ; the interlobular fis- 
sures and spaces and the marginal ions of 
the lobules are of a deeper colour usual 5 
the congested substance is continuous and cor- 
tical, the non-congested substance being me-— 
re 
