ABNORMAL ANATOMY OF THE LIVER. 
- compound mass, which assumes the form of 
_ the particular part of the organ in which it is 
placed, and is divided into compartments, 
marking its original multiple form by septa of 
condensed Glisson’s capsule supporting dilated 
vessels. It would appear to be this form of 
tumour which has been described by Farre as 
the first variety of his tubera diffusa; he gives 
them the following character. ‘‘ Tubera, ele- 
vated at the surface of the organ, but not uni- 
form in their figure, some rising with a regular 
Swell into a round form, others acquiring a 
margin by being gradually depressed towards 
the centre, forming tumours without cysts, 
almost pulpy in their consistence, cellular in 
their structure, and containing an opaque white 
fluid.” 
_ Another form of the albuminous carcinoma- 
tous tumour is the “ large white tubercle” of 
_ Baillie, the tubera circumscripta of Farre, by 
whom they are thus admirably described : 
Their colour inclines to a yellowish white, 
and their projecting surfaces, slightly variegated 
with red vessels, deviate from a regular swell 
by a peculiar indentation at or near their cen- 
tres, which are perfectly white and opaque. 
They vary much in size, which depends on the 
duration of each tuber, for at its first appear- 
ance it is very minute, but during its growth it 
assumes the character above described, and at 
its maturity exceeds an inch in its diameter. 
They adhere intimately to the liver, and their 
figure is well defined. They commonly remain 
distinct at the surface of the liver, but inter- 
nally they ultimately coalesce and form im- 
mense morbid masses which pervade its sub- 
stance. They possess so close a cellular struc- 
ture that the section of them at first view 
appears solid and inorganic; but on the edge 
of the knife, by which they have been disse- 
vered, an opaque white fluid of the consistence 
_ of cream is left, and a fresh portion of this 
fluid is gathered on it at each time that it is 
repassed over the surface of the section. Their 
cellular structure becomes more apparent after 
long maceration.” 
The depression in the centre of carcinoma- 
tous tumours, although generally met with, is 
not a necessary character of cancer. Its mode 
of formation has been ably pointed out by Dr. 
Carswell, in his beautiful work on pathological 
anatomy: “ The depression is not observed 
_ unless when the tumour is divided or is situ- 
ated on the surface of an organ, as the liver, 
_ where tumours of this kind are generally met 
with. In the former case the depression arises 
_ from the softer substance, after the division of 
the tumour raising itself by its elasticity above 
the unyielding nucleus; in the latter it is pro- 
duced hy the peritoneum adhering to the sur- 
face of the tumour when small, and preventing 
its development in that direction. If the tu- 
mour does not come in contact with the peri- 
_ toneum until it has acquired a considerable size, 
it presents no such depression, or only a very 
small one. Hence the reason why, in carci- 
noma of the liver, we meet with some tumours 
having a smooth globular surface, and others with 
a central depression of greater or less extent.” 
VOL. IIT. ; 
193 
Another variety of carcinomatous tumour is 
named the gelatiniform cancer, from the exis- 
tence of a firm and jelly-like deposit which oc- 
cupies the cells of the tumour in place of the 
albuminous secretion common to the preceding 
forms. I have before me an interesting speci- 
men of gelatiniform tubercle. The liver con- 
tains a considerable number of these tumours 
of variable size, and dispersed through every 
part of its structure. The smallest resemble 
the small patches described above as the inci- 
pient stage of carcinomatous tumour generally ; 
the largest are equal in size to a walnut. They 
are distinctly circumscribed, and the lobules 
immediately surrounding them are flattened 
and compressed. In the smaller tubercles the 
form of the lobules is quite distinct, but in the 
larger the lobules have yielded to the peculiar 
characters of the disease. On the surface the 
centre of the tubercle presents an oval or cir- 
cularly indented ring, around which the tumour 
swells suddenly and then subsides to the cir- 
cumference. On making a section of one of 
these tumours, 1 found a central area of about 
two lines in diameter, transparent, dense, and 
apparently gelatinous, and distinctly bounded 
by a white marginal line; the marginal portion 
of the section forming the bulk of the tumour 
was elastic, and rose above the central area to 
subside gradually in the marginal line of the 
circumference. The whole section bore a stri- 
king resemblance to the conjunctiva affected 
with chemosis, only that it was paler in its 
colour, or to a beautiful flower with a single 
large and expanded circle of petals. On exa- 
mining a thin section with a lens of low power 
a number of minute parallel injected capillaries 
were seen traversing the marginal portion of 
the tubercle towards the boundary line of the 
area, but no vessels could be traced beyond 
that line into the central portion. The resem- 
blance to the petals of a flower was produced 
by white lines which radiated from the boun- 
dary line of the area to the circumference, and 
divided the marginal portion of the tumour 
into six or eight compartments. From careful 
examination it appeared to me that the central 
area was a single lobule expanded by the gela- 
tinous deposition with which its tissue was in- 
filtrated, and the marginal compartments pre- 
sented a similar character. 
k. Medullary sarcoma.—Another form of tu- 
bercle, associated with the cancerous diathesis 
and belonging to the carcinomatous family, is 
medullary sarcoma, or encephalosis. The tu- 
mours produced by this disease are larger than 
scrofulous tubercles, and more regular in form 
and fewer in number than scirrhous tumours, 
Developed originally in the same way with 
scirrhus, by infiltration into the tissue of the 
lobules, or into the vessels themselves, of the 
peculiar greyish white and opaque substance of 
which they are composed, they increase in size 
and obstruct the circulation in the surrounding 
lobules. Their internal structure is a loose 
cellular base, filled with a soft and brain-like 
matter, frequently coloured with blood, or 
containing coagula in various stages of soften- 
ing, resulting from hemorrhagic extravasation, 
cs) 
