x 
_ its physical properties. 
ts prop 
ABNORMAL ANATOMY OF THE LIVER. 
nor is any hardness or swelling perceptible in 
the region of the liver.” Kiernan, who has 
observed several cases of this disease, informs 
me that the symptoms are sudden jaundice, 
depression of the powers of the system, and 
speedy dissolution ; upon dissection he found 
complete absence of bile in the biliary ducts, 
the mucous membrane of which appeared 
bleached. 
b. Alterations in the physical properties of 
the bile-——The changes to which the bile is 
liable are in no wise referable to any particular 
alteration in the liver. In cases where this 
organ has been considerably diseased, the se- 
cretion of the bile has been found natural and 
healthy; and in other cases, where a slight de- 
gree of congestion was all the apparent patho- 
logical derangement, the secretion has assumed 
_ a morbid epEerance, or has been deficient or 
Superabundant in quantity. Gall-stones are 
sometimes found in the gall-bladder without 
any admonitory symptoms during life, and 
icterus may be a frequent and even a fatal 
malady without any obstruction appearing in 
the course of the biliary tubes after death, or 
without any satisfactory indications of diseased 
action in the liver. “I have been sometimes 
astonished,” says Andral, “ on seeing the 
enormous quantity of bile which distended the 
alimentary canal in cases where the slightest 
degree of congestion existed in its coats, and 
when the liver appeared in no wise altered.” 
Nay, it has been proved both by observation 
and experiment that the bile is materially 
changed in appearance, quantity, and consist- 
ence by the mere alteration of diet. Experi- 
ments made upon living animals have long 
since shewn that bile taken from different indi- 
viduals is capable of producing very different 
effects upon the animals into whose bodies it 
has been introduced; thus some will give rise 
to a trifling irritation, while others will occasion 
more or less serious symptoms and even rapid 
death. Some bile may be touched and even 
tasted without inconvenience, while other bile, 
precisely similar in appearance, will produce 
pustular eruptions and ulcerations upon the 
tongue and upon the lips. “ Here then,” says 
Andral, “ are serious changes in the bile which 
are wholly imperceptible to the investigation 
of anatomy.” 
The colour of the bile differs very consi- 
derably, being sometimes hardly distinguish- 
able from serum, and at other times presenting 
a variable tint of amber, orange, green, brown, 
olive, and even black. In consistence it is 
equally various, being one while limpid and 
diffluent, and another while black, viscous, and 
grumous. 
b. Alterations in the chemical properties of 
the bile —In chemical composition, the altera- 
tions in the bile are not less numerous than in 
In fatty liver the bile 
been found composed almost wholly of 
albumen and water. Under other circum- 
stances the natural constituents are greatly 
altered in their relative proportion. 
The formation of biliary calculi may be re- 
ferred to disproportionate secretion of the na- 
195 
tural elements of the bile, the increased quantity 
of certain of its constituents giving rise to the 
deposition and accretion of these substances in 
a form corresponding with the cavities in which 
they are produced. Gall-stones have been 
found in the smaller biliary ducts in the sub- 
stance of the liver, in the excretory ducts both 
within and external to the organ, and in the 
gall-bladder. They have also been me rith 
inclosed in a cyst, formed most probably by 
the obliteration of one of the hepatic ducts, 
and adherent to the organ or suspended from it 
by a pedicle. Malpighi found gall-stones in 
the small biliary ducts and considered them as 
petrified lobules. The size of biliary concre- 
tions is very various, being sometimes exceed- 
ingly small, and at other times of considerable 
bulk. When small they are generally numerous ; 
I have counted upwards of a hundred, and in- 
stances are recorded where more than a thousand 
were found in the gall-bladder. When they 
are large they are few in number, and frequently 
single. I have seen the gall-bladder filled with 
three, two, and even one large calculus. A 
large oval gall-stone now before me equal in 
size to a pigeon’s egg I removed from the 
ductus choledochus. Their form is equally 
various with their size and other physical cha- 
racters. I have now before me gall-stones with 
a flattened shape, triangular, and tuberculated 
on the angles and on the surface; others have 
three equal facettes with sharp or flattened or 
rounded angles; others again are irregular in 
their outline and would seem to be moulded 
to the canals and cavities from which they have 
been withdrawn. Being stained by the colour- 
ing matter of the bile, their colour varies with 
the predominant tint of the secretion in which 
they have been formed, hence some are reddish 
brown or black; others are yellow, and others 
again white; some are mottled yellow and 
black, or white and black with various shades 
of green. 
In chemical composition there are, according 
to Andral, five principal varieties of biliary 
concretions ; they are, 1. of yellow colouring 
matter; 2. of resin; 3. of cholesterine; 4. of 
picromel; 5. of phosphate of lime. The first 
kind appears very ill founded, for yellow is a 
prevailing tint among gall-stones, and is the 
mere pigment by which cholesterine and the 
other substances are coloured. By far the 
largest proportion of gall-stones are formed of 
cholesterine, either pure, when it presents a 
white semitransparent mass beautifully cystal- 
lized in its interior, or variously tinted with 
brown, yellow, or orange, and radiating from 
the centre towards the circumference or from 
a small central nucleus. The smaller calculi 
also exhibit upon fracture the same radiated 
appearance. The gall-stones of resin and 
picromel may be classed together and consi- 
dered as biliary concretions formed of inspis- 
sated bile probably accreted through the agency 
of cholesterine. The calculi of salts of lime 
are less frequent ; they are found in the gall- 
bladder or in the ductus communis choledochus. 
I have observed them to present two varieties, 
firstly, incrustations of phosphate of lime upon 
02 
