ABNORMAL ANATOMY OF THB LIVER. 
year. The patient died with jaundice and 
ascites. The liver, a portion of which I pos- 
sess, presented a fine specimen of granulated 
cirrhosis; it “ was diminished to one-half its 
natural size, and Mr. Kiernan on injecting it, 
discovered that a collateral venous circulation 
had been established by way of the diaphragm.” 
In another case in a woman who had been 
tapped ninety times, Kiernan upon injecting 
the liver found that the same kind of collateral 
circulation had been formed. The circulation 
through the liver had been impeded by the 
developement of condensed cellular tissue, and 
the greater part of the blood of the portal vein 
had made its way through dilated vessels upon 
the surface of the organ to the diaphragm, and 
from thence into the general venous circulation. 
Tn this case there were numerous bands of ad- 
hesion between the liver and diaphragm, and 
between the intestines and the walls of the 
abdomen, and these also were traversed by 
large veins conveying blood from the portal 
vein into the genera! venous current. 
With regard to the pathological nature of 
the disease many opinions have been enter- 
tained by different writers. Laennec, dazzled 
by an ingenious theory deduced from his ob- 
Servations upon the nature and progress of 
scrofulous tubercle, saw in the mottled and 
granular section of cirrhosis only a “ morbid 
deposit,” a special accidental tissue existing in 
the two states of crudity and softening. But 
I quote the words of this author as detailed by 
Ferrus,* for while he errs in his speculations 
with regard to the nature of the disease, he 
draws an excellent picture of its general cha- 
racters and appearance. “ Les cirrhons ex- 
istent dans l’état de crudité et de ramollisse- 
ment. Dans le premier de ces états elles 
présentent un tissu d’une couleur fauve plus 
au moins foncée, qui quelquefois tire un peu 
sur le verdatre; on ne peut s’en faire une 
meilleure idée qu’en la comparant a celle 
u’offrent les capsules surrénales chez l’adulte. 
e tissu, quoique fort consistant, a une sorte de 
flaccidité que je ne puis mieux comparer qu’ a 
celle de certains fongus, ou d’un cuir mou. 
Le tissu des cyrrhoses est d’ailleurs compact, 
assez humide et trés-délié. On n’y distingue 
aucune trace de fibres, quoiqu’il presente en 
certains cas des divisions en forme de squames. 
Les cyrrhoses prennent en se ramollissant une 
couleur plus brunatre.” 
«M. Laennec admet trois sortes de cyrrhoses: 
1°. cyrrhoses en masses; 2°. en plaques; 
3°. en kystes. Lorsqu’il existe, dit-il, des 
cyrrhoses dans le foie, elles forment ordinaire- 
ment de petites masses dont le volume ne 
Surpasse jamais celui d’un noyau de cerise, et 
quelquefois égale 4 peine celui d’un gros grain 
de millet. Ces masses sont toujours extréme- 
ment nombreuses, et tout le tissu du foie en 
est par-emé. Leur petitesse fait que lorsqu’on 
incise un foie dans lequel il en existe un grand 
nombre, son tissu parait au premier coup d’eil 
homogeéne et d’une couleur jaune fauve. Mais 
si on examine plus attentivement le tissu hepa- 
tique, on s’apercoit facilement qu’il est rempli 
* Dictionnaire de Médecine, Art. Foie. 
189 
d’une innombrable quantité de corpuscules 
assez semblables, pour l’aspect 4 ces lobules 
de graisse durcie et rousse&tre que l’on trouve 
communément dans le tissu cellulaire sous- 
cutané de la cuisse et de la jambe des sujets 
attaqués d’anasarque. Ces petites masses sont 
que!quefois unies trés-intimement au tissu du 
foie ; mais assex souvent elles en sont separées 
par une couche mince de tissu cellulaire qui 
leur forme une enveloppe tenue, et alors ils se 
détachent assez facilement. La surface exté- 
rieure du foie devient flétrie, rugueuse, et ratatinée 
a-peu-pres de la méme maniére qu’umé pomme 
flétrie.” 
Bouillaud* considers this condition of the 
liver a dissociation of the two natural elements 
of the organ: “ les masses jaunes fauves con- 
stituant le tissu accidentel, appelé cirrhose, ne 
sont autres chose que les granulations secre- 
toires se desorganisant graduellement par l’effet 
de l’obliteration du lacis vasculaire, et de 
Vobstacle a la circulation hepatique qui en 
resulte.” We have already combatted the ex- 
istence of two substances, and further remark 
upon this subject must be quite unnecessary. 
Andral + sees, in the cirrhosis, atrophy of the 
red substance and hypertrophy of the yellow 
substance. Of all modern authors, Cruveilhier 
approaches nearest to the true condition of the 
organ, but from his misapprehension of the 
exact nature of the lobules, even his opinion 
cannot be accepted without limitation. Chetia: 
sis, says this author,} is “atrophie du plus 
grand nombre des grains glanduleux, et hyper- 
trophie avec coloration jaune des grains glandu- 
leux restans.” Now cirrhosis is undoubtedly 
a partial atrophy of the liver with hypertrophy 
of the cellular structure; complete atrophy of 
some of the lobules, partial atrophy of others, 
and biliary congestion without atrophy or hy- 
pertrophy of the rest. Those small yellow 
grains varying in size from a millet-seed to a 
pea or to a hazel-nut, are not distinct lobules 
in a variable state of hypertrophy, but small 
uncongested patches eomipoaedl of parts of 
several adjoining lobules, and having a single 
or several interlobular spaces for a centre. 
Hence it is, as we have before shown, that Cru- 
veilhier§ has observed the “ partie centrale de 
chaque granulation repond au radicule biliare, 
et consequemment est souvent teinte en jaune 
et que la partie excentrique repond & l’element 
vasculaire et consequemment est plus rouge 
que la partie centrale.” 
d. Softening of the liver may accompany any 
of the changes resulting from acute inflamma- 
tion. The degree of softening is very variable, 
the organ having at one timea simple abnormal 
degree of friability when pressed by the hand, and 
at others constituting a pulpy mass scarcely re- 
tained in its form by the cellular framework of its 
vessels and Glisson’s capsule. Softening may be 
unaccompanied by any marked change in the 
bulk of the organ, but is always associated with a 
variable intensity of venous congestion. Biliary 
* Mémoire de la Societé Médicale d’Emulation, 
+ Anatomie Pathologique, vol. ii. p. 
${ Anatomie Descriptive, vol. ii, p. 568. 
§ Anatomie Pathologique, livraison 12. 
