ABNORMAL ANATOMY OF THE LIVER. 
state of the organ they are more obscure, as 
may easily be inferred when we perceive such 
distinguished authorities as Miller and Cru- 
veilhier, from want of making the liver the 
_ subject of especial investigation, deceived by 
_ such appearances. That Cruveilhier has actu- 
ally mistaken the uncongested patches seen on 
_ the surface of a congested liver for the lobules, 
_ isclearly proved by a succeeding paragraph :— 
_ “Du reste, le volume des grains glanduleux 
_ présente beaucoup de variétés suivant les indi- 
_ vidus, et ce volume est tout-a-fait indépendant 
' du volume du foie lui-méme. Les médecins 
| quis’occupent d’anatomie pathologique ont sou- 
| vent noté ce dévelopment, sous le titre d’hepar 
_ acinosum. II est une maladie caractérisée par 
_ la coincidence de l’atrophie du foie, qui est 
 réduit 4 la moietié, au tiers de son volume, et 
_ du dévelopment considérable des grains glan- 
_ duleux.” Now the hepar acinosum is without 
question a liver in the second stage of hepatic 
_ venous congestion, and presents several varie- 
ties in the precise form of the uncongested 
_ patches. 
_. Starting with erroneous data such as these, 
_ what can be expected as the result of an expe- 
_ rimental injection of the liver made by Cru- 
_ veilhier, those who are thoroughly informed 
_ upon the exact anatomy of this organ will have 
no difficulty in anticipating; but to those who 
_ areonly imperfectly acquainted with it, his con- 
clusions must appear startling :—“ Le foie ainsi 
_injecté soumis a divers agens chimiques a pré- 
senté les resultats suivans: 1, l’injection bleue, 
c’est-a-dire celle de la veine cave, avait péné- 
tré dans la partie centrale des grains yglandu- 
leux, partie qu’on appelle substance jaune du 
foie. Au milieu de la partie centrale était 
Yinjection jaune, c’est-a-dire l’injection du 
canal biliare. Autour de l’injection bleue, 
etait Vinjection rouge, c’est-a-dire, linjection 
de la veine porte, et de l’artére hépatique, 
ui occupait toute la substance dite rouge 
Za foie. ll suit de la que chaque grain 
glanduleux présente un appareil vasculaire 
ainsi disposé: 1, au centre, un canal biliare ; 
2, sur un plan plus excentrique, un cercle vas- 
culaire formé par les ramifications de la veine 
hepatique; 3, un cercle vasculaire concen- 
trique au précédent, formé par les ramifications 
de la veine porte et de |’artere hepatique.” 
Thus in the centre of his lobule, Cruveilhier* 
found the yellow colour of the ducts, most 
probably effused and colouring the whole of the 
yellow portion of his lobule. Next came a 
circle of blue, and then a circle of red, formed 
conjointly by the portal vein and hepatic ar- 
Now we have shewn that the centre of 
Cruveilhier’s lobule is an uncongested patch 
formed by the contiguous margins of several 
adjoining hepatic lobules, and having an inter- 
_ lobular space for a centre ;—where, therefore, 
* These injections were not made by Cruveilhier 
himself, but by his assistant M. Bonami, as we are 
informed b M. Dujardin, in his paper ‘‘sur le 
foie, &c.”” The material used for the purpose was 
Spirit varnish, and the results were not alway’ suc- 
cessful, 
187 
could we expect to find the yellow but in the 
interlobular space, and diffused immediately 
around it, so that the colouring matter would 
obscure the red injection of the portal vein and 
artery of that immediate point. Around the 
uncongested patch and in the congested sub- 
stance we should find the intralobular veins of 
three or four or five surrounding hepatic lo- 
bules, (hence the vatiable size of Cruveilhier’s 
lobules,) embracing by a kind of zone the 
yellow centre ; and externally to the vein, the 
surrounding iuterlobular fissures would display 
the red injection of the portal vein and hepatic 
artery. 
4. Disorders of biliary excretion— Bil- 
iary congestion may be produced by various 
causes; the most frequent is temporary thick- 
ening of the mucous lining of the ducts from 
inflammation or capillary congestion ; this will 
simply diminish the calibre of the ducts or 
produce a complete stricture. The obstruction 
may endure for a shorter or longer period ; 
the swelling of the membrane may subside 
and the tube be restored to its original dimen- 
sions, or it may become chronic and be a per- 
manent impediment to the free current of the 
bile. Another cause of congestion of the bile- 
ducts is hepatic venous congestion, which acts 
by producing pressure upon the lobular biliary 
plexus and interlobular ducts. This is usually 
a chronic cause. Congestion of the bile-ducts 
may likewise depend upon the impaction of a 
gall-stone in the larger biliary ducts or ductus 
choledochus, obliteration of one of the ducts 
by the pressure of a tumour, disease of the 
pancreas, or thickening of the mucous mem- 
brane of the duodenum. In each of these 
cases the ducts are loaded with bile, which 
gives a yellowish or greenish hue to the whole 
substance of the liver. Biliary congestion in a 
chronic form is usually accompanied with more 
or less of hepatic venous congestion. 
When one of the bile-ducts is obliterated or 
obstructed by a biliary concretion, the ducts 
become dilated above the constriction, and 
considerable reservoirs are formed in the sub- 
stance of the organ. If the impediment exist 
in the ductus choledochus, the gall-bladder 
becomes greatly distended as well as the biliary 
ducts. The irritation caused by the pressure 
of the bile has given rise to inflammation and 
ulceration of the coats of the gall-bladder or 
of the ducts, and the bile has been effused into 
the peritoneal cavity and produced death. 
When the cause of the obstruction is a biliary 
calculus of moderate size, the pressure of the 
column of the bile will sometimes force it on- 
wards into the duodenum, and thus remove 
the impediment. In other cases, when the 
obstruction occurs in the cystic duct, the bile 
ceases to enter the gall-bladder, the sac be- 
comes thickened and diminished in size, and 
filled with a colourless viscid mucus. 
5. Diseases of the parenchyma. — The 
diseases of the substance or parenchyma of the 
liver may be referred to the following heads :— 
a, inflammation ; 6, hypertrophy ; c, atrophy ; 
d, softening; e, induration; f, fatty degene- 
