188 
ration ; g, pus ; h,tubercle ; i, scirrhus ; k, medul- 
lary sarcoma ; /, fungus hematodes; m, melanosis. 
a. Inflammation.—The tissue of the liver is 
liable to inflammation,—hepatitis, or the lobular 
hepatitis of some writers. The symptoms, like 
those detailed in the consideration of inflam- 
mation of the serous membrane, are severe and 
prominent, and clearly indicative of the nature 
of the disease. The pathologic appearances 
are deep redness, softness, general congestion, 
and enlargement of the organ from distension 
with blood. This condition is but rarely ob- 
served, from the circumstance of inflamma- 
tion of the liver having no direct tendency to 
cause death, but being rather the precursor of 
the various other forms of disease which affect 
the organ. All the changes which occur in 
the liver are preceded or accompanied by in- 
flammation acute or chronic, but more fre- 
quently by the latter, and in most instances by de- 
rangement of the venous circulation, and, occa- 
sionally, of the biliary excretion, giving rise to a 
complication of venous and biliary congestion. 
b. Hypertrophy of the liver is increase of 
bulk of the organ, not depending, as in con- 
gestion, upon the quantity of blood circulating 
through it, but upon actual augmentation of 
the tissues of which it is composed. This 
state of enlargement of the liver may be gene- 
ral, or it may be confined to a part, as to a 
single lobe. Its predisposing cause is proba- 
bly irritation of the mucous membrane of the 
ducts which gives rise in the first instance to 
retarded circulation and venous congestion, or 
it may be impediment either in the circulation 
through the heart, or through the rest of the 
venous system ; or, again, it may depend upon 
diminution of the general powers of the system, 
as in a scrofulous constitution. The lobules 
are always in a state of partial congestion, re- 
sembling the second stage of hepatic venous 
congestion ; the congested portion presents a 
deep red tint, and the uncongested part is 
ramose or convoluted in appearance, of a dirty 
white, greyish, yellowish, or greenish hue, in 
proportion to the condition of the biliary ap- 
paratus and to the quantity of bile contained 
within the liver. Sometimes the organ is pale, 
and appears deficient in its supply of blood ; 
at other times it has a generally diffused red- 
ness, or the congestion may be greater in some 
situations than in others. The consistence of 
the liver in hypertrophy is equally variable 
with its colour: sometimes it is softer than 
natural, at other times it is dense and appa- 
rently granulated, the uncongested part pro- 
jecting from the surface, and the congested 
portion sinking beneath its level. Hyper- 
trophy of the liver is generally associated with 
chronic disease of the lungs, scrofula, and 
rickets, and often exists as a cause in ascites. It 
has been observed fifteen, eighteen, thirty-five, 
and even forty pounds in weight, and to have 
produced the displacement of the other abdo- 
minal viscera by its enormous size. 
c. Atrophy of the liver is a condition of the 
nutritive functions of the organ which may 
succeed chronic inflammation or even hyper- 
ABNORMAL ANATOMY OF HE LIVER. 
trophy ; it occurs more rarely than hypertre 
to which its comparative frequency has bee 
estimated by Portal as 5to95. The substa 
of the liver diminishes in bulk, the 
become indistinct and variously congest 
they appear intermingled we 
by the cellular structure with which th 
surrounded. Sometimes the proper 
of the liver is entirely removed and 
by a loose or condensed cellular ti 
other times the entire substance of th 
is to have been absorbed by an er 
abscess, which has evacuated its cont 
the intestinal canal, and the parietes 
terwards contracted and degenerated i 
atrophied mass. Lieutaud gives an 
of a liver that was shrivelled into a on 
larger than his fist. Portal found the liver | 
a case of ascites not bigger than an apple. 
ordinary size. Partial atrophy of the li 
conjoined with hepatic venous ion is n 
an te consequence of the practice 
lacing. I have before mea very interesting spe 
men of this affection. The surface of the live 
marked by deep fissures into irregular pe 
gonal divisions resembling very strikingly 
lobulated appearance of the foetal kidney. — 
One situation the stages of this change are’ 
tinctly apparent ; a certain portion of the or 
about half an inch in breadth, has beco: 
partially atrophied from the pressure of 
adjoining and protuberant portions of the 1 
and in the lobulated portion the ie su 
stance of this atrophied mass has col 
pletely removed by absorption, leaving a 
of condensed cellular cicatrix extending like 
septum for some distance into the organ, 
is in this way that many of the grooves at 
fissures upon the convex surface of the liv 
are raat 
But the most interesting form of atro 
the liver is that which was named by 
cirrhosis. In cirrhosis, the liver is diminish 
in volume to the extent of one-half or on 
third of its natural bulk, the relative si 
the right and left lobes is destroyed, ar 
surface is rendered shapeless by the projec 
of a number of ridges or granular points. — 
entire organ appears wrinkled and shri 
and ofa yellow or greenish colour, varying i 
tint from a bright chrome to a yellowish 
greenish brown. Upon dividing it with 
knife it is observed to be more dense the 
usual, and the surface of the section present 
number of patches of variable size and of 
roundish form, which resemble granules; hen 
this condition of the organ is named by 
French authors “ foie granuleux.” In an a 
vanced stage it is accompanied with jaune 
and ascites, and is frequently preceded by som 
disease, either of the lungs or heart. 
Kiernan is, I believe, the first pathologi 
who distinguished the true nature of cirrhosis, 
which he called atrophy of the liver. A very 
interesting case of this disease occurred in St. 
Bartholomew’s Hospital, under the care | 
Dr. Latham, in 1832, an account of which ws 
published in the Lancet in November of thi 
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