192 
lesquelles ces os ont été intéressés.” The re- 
moval of hemorrhoids and operations upon the 
uterus are sometimes followed by abscess of 
the liver, a circumstance which is easily expli- 
cable upon the principles so clearly demon- 
strated by this author. 
An excellent instance of secondary abscess 
of larger size than usual has been kindly fur- 
nished to me by my frend and colleague Mr, 
Rutherford Alcock, who, from his official posi- 
tion in Spain and Portugal during the recent 
struggles, has had much experience in injuries 
to the head. A man received a bayonet wound 
in the scalp, and died upon the fourteenth day 
after his admission into the hospital. Upon 
inspection there was observed thickening of the 
dura mater and a small quantity of matter 
upon the pia mater. No pus was discovered 
in the lungs, but a large abscess was found 
occupying the greater part of the right lobe. 
A statistical report from a work upon gun-shot 
wounds by the same author is also interesting. 
“ Of scalp wounds, with and without abrasion, 
there were sixty-one; two only died, and one 
only presented disease of the liver; the other 
died from an attack of erysipelas.”’ 
The pathological changes which take place 
in the liver in these cases are, in the first 
instance, effusion of blood and lymph and 
induration around the inflamed vein ; secondly, 
a.secretion of a yellow concrete pus into the 
ninute veins and among the lobules, giving to 
the liver, as Cruveilhier remarks, a granite-like 
appearance. In the next place the pus collects 
into small abscesses lodged in irregular cells, 
which increase in size by continued secretion 
and by communication with other cells. All 
these collections of matter are surrounded by a 
congested circle, which gives them a peculiar 
and characteristic appearance. After having 
existed for some time Cruveilhier has observed 
that the pus becomes converted into a concrete 
mass, very closely resembling the matter of 
scrofulous tubercle. 
h. Tubercle in the liver is a disease of rare 
occurrence, and has seldom been observed 
independently of the existence of similar depo- 
sitions in the lungs and other organs of the 
body, and of general indications of a scrofulous 
diathesis. When present, it exists in the form 
of small rounded tubercles, generally numerous, 
and varying in size from that of a millet-seed to 
a hazel-nut. They are composed of the soft 
cheesy or curdy deposit which is characteristic 
of this disease, and have a tendency to a 
brownish colour. The tuberculous matter is 
deposited in the tissue of the lobules by infil- 
tration, and the lobules immediately surround- 
ing the tumours are compressed nt § congested. 
The obstruction to the circulation in the organ 
being general on account of the number of the 
tubercles, the entire liver is more or less con- 
i. Scirrhus.—Carcinoma affects the liver 
under a variety of forms, but appears most 
frequently as tubercles of different size and 
consistence. These tubercles are more fre- 
quent than those of scrofulous origin, and are 
generally accompanied by symptoms denoting 
ABNORMAL ANATOMY OF THE LIVER. 
a cancerous diathesis, and by the existenes 
the same time of similar tumours in other par 
of the body. In their earliest development 
the liver nearly all carcinomatous tumours pr 
— - same chara! resembling sma 
whitish, semi-opaque es,,occupying t 
tissue of one 6 pe mito g of the loblead 
they increase in size they put on certain peculij 
ap ces, which have gained for t 
subdivision into species and varieties. 
not intend in this place to enter into the 
rangements proposed by authors, but will bri 
describe the most striking varieties that hi 
fallen beneath my own examination. The s 
plest of these tumours has been termed 8 
rhous tubercle, a name which appears parti 
larly applicable from its resemblance in ¢h 
racters and structure to the same form of t 
mour occurring in other parts of the bo 
Commencing like the carcinomatous tume 
generally in a semi-opaque patch, the outl 
the lobules is for some time distinctly perce 
tible through its area, but at a later perid 
centre of the patch becomes quite opaque, 
presents a cartilaginous hardness .nd creakit 
sound when divided with the knife. Thee 
cumference is gradually diffused in the su 
rounding textures, and the progressive inerea 
of the tumour seems to take place by the 
cretion of a milky albuminous fluid into 
meshes of the lobular venous plexuses. 1 
circulation in these plexuses is at first uni 
peded, but by the increase and induration 
the secretion it is gradually arrested, and 
vessels obliterated. The obliterated 
give rise to the appearance of small cells, i 
which the carcinomatous matter is deposi 
and the larger are are produced by the tissu 
of the capsules of the lobules variously dis 
torted from their original form by the inere 
deposition. As the tumours become more an 
more large, white lines, formed by compresse 
cellular tissue, are observed radiating from tl 
centre towards the circumference. When 
upon the surface of the liver, the scirr 
tubercle appears flat, or very slightly depresse 
towards the centre. In a preparation of thi 
form of tubercle now before me, the 
tumour is slightly raised above the surface 
presents no central depression, is cartilaginou 
in appearance, and has an irregular outlit 
Its section is dense and hard like cartilagi 
with no appearance of vessels, and of th 
tly and semitransparent whiteness whi 
is generally observed, in scirrhous tube 
particularly in the variety which this prepa 
tion illustrates. Sometimes these tubera a 
small and very numerous, of a yelloy 
brownish colour, and have a great activity: 
increase ; the cells in which they are cont: 
are thick and of larger size, and the albun 
nous secretion less firm than in the precedin 
variety. Occasionally they are reddened in th 
centre by the effusion of blood, from the con- 
gestion of unobliterated vessels, and some- 
times by the continuation, through the tumour 
of dilated vessels, which supply them 
nutrition. In their enlarged state 
quently coalesce and give rise to an i 
mort) Ls 
