ZZ 
ABNORMAL ANATOMY OF THE LIVER. 
__ The irritation of abscess causes the effusion 
_ of lymph and adhesion to the abdominal pa- 
rietes or to the adjoining viscera ; ulceration fol- 
_ lows, and the contents of the cyst are discharged 
_ through the artificial opening. The situations in 
which the matter escapes from the cavity of the 
abscess are various. 1. It may burst externally, 
_ making its way either between the ribs or up- 
wards towards the axilla. In a case observed 
by Dr. Macnaught the abscess pointed at the 
epigastrium and was opened by the surgeon in 
attendance. 2. It may become adherent to the 
diaphragm and burst into the pleura. 3. It may 
cause adhesion between the serous membrane 
_ of the liver and of the diaphragm, and between 
_ the latter and the pleura pulmonalis, and the 
matter may escape into the lung and be 
coughed up, as in the case already detailed, 
which occurred to Dr. Munro. 4. In rare cases 
_ the pus has been effused into the cavity of the 
_ peritoneum. 5. The abscess may become adhe- 
rent to the stomach, duodenum, or colon, and 
the matter be discharged into the alimentary 
canal. A well-marked case of abscess dis- 
charging its contents into the stomach occurred 
to myself in the case of a woman who has 
Since perfectly recovered. About two pints of 
matter were vomited by the patient. In a simi- 
lar case observed by Dr. Macnaught the patient 
recovered. In two other cases, where the 
matter was poured into the intestines, the 
patients died. 6. Abscess has been seen to 
Open into the gall-bladder, and the pus to be 
conveyed thence through the ductus communis 
choledochus into the duodenum. 7. In one 
case the matter was discharged into the vena 
cava; and in another, 8, described by Dr. 
Smith, into the pericardium; and in a case 
detailed by Dr. Graves,* the abscess opened 
both into the stomach and pericardium. 
Besides the preceding form of abscess, which 
is idiopathic in its origin, abscess may occur in 
the liver from external injury, as from a blow. 
The inflammation attending upon this injury is 
much slighter than that which gives rise to 
idiopathic abscess; the collection of matter is 
generally smaller, and terminates either by dis- 
charging its contents or by absorption. 
The second variety of abscess in the liver, 
that in which numerous purulent collections 
exist, depends for its cause upon the occurrence 
of wounds or, of surgical operations. The suc- 
cession of abscesses in the liver from wounds, 
particularly of the head, has long since been 
admitted as a well-established fact, for the 
explanation of which numerous theories have 
been invented. Theory, however, has now 
5 yielded before facts,—facts, too, of the most 
interesting and satisfactory kind, for which 
= 
4 
? 
pathology is indebted to the genius and indus- 
try of Cruveilhier. The experimental re- 
searches + of this excellent author, published 
in 1826, enabled him to establish a law of the 
utmost importance in the consideration of the 
phenomena of disease, viz. that “ tout corps 
* Dublin Medical Journal, January 1839. 
+ Recherches sur la siege immed, de ]’inflamma- 
tion. Nouv, Bibl. Med. vol. iy. 
191 
etranger introduit en nature dans le systeme 
veineux determine lorsque son elimination par 
les emonctoires est impossible des abscés viscé- 
raux entitrement semblables 4 ceux qui suc- 
cédent aux plaies et aux opérations chirurgicales, 
et ces abscés sont le resultat d’une phlebite 
capillaire de ces mémes visceres.”* These 
experiments consisted in the introduction of 
metallic mercury into the veins of an animal, 
say of the lower extremity. In the course of 
twelve, eighteen, or twenty-four hours the animal 
experienced much difficulty of breathipg, and 
soon expired. Upon inspection globules of the 
mercury were found in the lungs. Ifa smaller 
quantity of mercury were introduced the animal 
would live for several days or weeks, and upon 
examining the lungs at different periods the 
globules were at first seen to be surrounded by 
a red induration and afterwards by pus. This 
experiment was varied by pouring the mercury 
into the medullary cavity of a bone with pre- 
cisely the same results; in one instance he 
placed a single globule in the medullary cavity 
and found it again at the end of a month in 
the lungs, divided into several minute globules, 
each of which formed the centre of a small 
tuberculous abscess. Cruveilhier then injected 
a small quantity of mercury into one of the 
omental veins of a dog—the subject of umbili- 
cal hernia; the dog was killed in the third 
month after the operation, being reduced toa 
state of marasmus. Upon inspection the liver 
was found filled with small abscesses, each 
surrounding a small globule of mercury. Having 
by means of these experiments satisfied himself 
that the lungs were the barrier to all foreign 
matters introduced into the general circulation, 
as was the liver of those admitted into the 
abdominal circulation, he proceeded to another 
series of experiments. Opening a vein in the 
hinder extremity of a dog he introduced into it 
a long piece of stick, which gave rise to 
phlebitis aud the secretion of pus. The pus 
thus produced being carried into the circulation 
excited, in the first instance, abscesses in the 
lungs, and, secondly, in the liver. Upon 
these facts and upon a multitude of excellent 
observations Cruveilhier founds his opinion that 
abscess in the liver from wounds and surgical 
operations is always preceded or accompanied 
by purulent collections in the lungs, and 
always results from the same cause, viz. from 
capillary phlebitis, consecutive upon phlebitis 
in the neighbourhood of the wound, and im- 
mediately produced by the irritative action of 
globules of pus brought from the diseased veins 
to the capillaries of the structures in which the 
secondary suppuration is developed. 
In every case of secondary abscess in the 
liver, following wounds of the head, or after 
amputation or operations upon bones, Cruveil- 
hier has found phlebitis of the vessels situated 
in the structure of the bones. Hence he esta- 
blishes an important general proposition, that 
“ le phlébite des os est une des causes les 
plus fréquentes des abscés viscéraux suite des 
plaies et des opérations chirurgicales dans 
* Anatomie Pathologique, liv. xi. 
