ABNORMAL ANATOMY OF THE LIVER. 
Fig. 44. 
Lobules in a state of portal venous congestion, as seen 
on the surface of the liver. The congested part oc- 
' cupies the margins of the lobules, the uncongested 
portion their centres. After Kiernan. 
dullary and occupying the centres of the lo- 
bules.” 
The causes of congestion are all such as tend 
to interfere with the circulation in the liver 
or with the general circulation; for in- 
stance, impediment to the circulation of the 
blood through the capillaries of the lungs, 
diseases of the valves of the heart, aneurism, 
&e. A slighter degree of obstacle produces 
congestion of the hepatic veinsonly, the venous 
turgescence being limited by the lobular ve- 
nous plexus. If the obstruction be greater, the 
lobular venous plexus itself is congested ; if 
the cause continue, the congestion extends 
through the interlobular fissures into the neigh- 
bouring lobules, and in a more advanced de- 
gree the congestion spreads itself throughout 
the whole of the lobules, and becomes general. 
From the liver the congestion extends to the 
alimentary canal, and gives rise to intestinal 
hemorrhages, hemorrhoids, ascites, &c. : 
The variety of appearance in the vascularity 
of the lobules in congestion, and the constancy 
i i 
of its occurrence, have deceived those patholo- 
gists who maintain the existence of two sub- 
stances, and the difference of position and form 
of the congested and uncongested portions has 
given cause for the diversity of opinion with 
regard to its situation. For a perfect elucida- 
tion of these difficulties, physiology is indebted 
to the genius and perseverance of Kiernan. 
The mode in which the attention of this author 
was drawn to the subject forms part of the his- 
tory of hepatic congestion, and deserves to be 
detailed in his own words. “ My attention,” 
he observes, “ was first directed to the anatomy 
of the liver by the study of the admirable works 
of M. Andral. In the first organs I examined 
I found the small branches of the hepatic veins 
ramifying exclusively in the red,j and those of 
the portal vein in the yellow substance. I 
concluded that the liver was composed of two 
venous trees, a portal and an hepatic tree, the 
former having a cortex of yellow, the latter of 
red substance ; and with M. Bouillaud, I thought 
it probable that the red substance was the organ 
185 
of the function imagined by Bichat. I next 
ascertained the lobular structure, and concluded 
with Ferrein, that the red substance was me- 
dullary and the yellow cortical. Subsequent 
dissections, in which I found branches of both 
the portal and hepatic veins ramifying in the 
red substance, tended to unsettle the opinions I 
had formed respecting the anatomy and physio- 
logy of the two substances, and these opinions 
were finally overturned by the examination of 
a liver in which I found the branches of the 
portal vein alone ramifying in the red, and 
those of the hepatic veins in the yellow sub- 
stance. The only conclusion ttt could be 
drawn was, that the red colour resulted from 
congestion ; that it was medullary, occupying 
the centre of each lobule, when the hepatic, 
and cortical forming the circumference, when 
the portal vein was congested.” 
Miiller, in the eleventh figure of plate 11 of 
his admirable work on the glands, has made a 
singular error with regard to the structure of 
the liver, and the arrangement of the ultimate 
biliary ducts. In the description of this figure 
he says, “Segmentum hepatis Sciuri junioris, 
microscopio simplici visum. Observantur fines 
ductuum biliferorum elongati, seu cylindri- 
Fig. 45. 
A part of Miiller’s \\th figure of plate 11, which he 
considers to represent the distribution and arrange- 
ment of the ultimate biliary ducts. The liver in 
this section isin a state of hepatic venous conges- 
tion in the second stage. The congested portion 
corre: generally with the central or hepatic part 
of the lobules, and the uncongested portion with the 
interlobular fissures, in which are situated the 
branches of the portal vein. 
a, A small branch of the portal vein giving off 
twigs to the various interlobular spaces. If these 
twigs be continued so as to unite with each other, 
the form of the lobules will be apparent; as at b, b. 
The angles formed by the giving off of the twigs 
from the portal vein are the interlobular spaces. 
ce, Irregularly oval patches of uncongested lobules ; 
the dark spot in the centre is an interlobular space, 
from which the portal vein radiates in various di- 
rections, so as to surround the various lobules by 
whose conjunction the space is formed. d,d, Lo- 
bules entirely congested. Inthe centre of the lo- 
bules of this section I have marked the situation of 
the intralobular vein, although it may not be appa- 
rent, or but slightly so, in the congested liver. The 
small spaces, e, e, generally mistaken for intralo- 
bular veins in this form of congested liver, are in- 
terlobular spaces. 
