GLANDS. 421 



presence, in the venous hepatic vessels, of a considerable 

 quantity of blood, the portal vessels being at the same time 

 almost destitute of this fluid ; it has been called by Mr. 

 Kiernan the first stage of hepatic venous congestion, and is 

 said to be clue to the continuance of capillary action in the 

 vessels after the general circulation has ceased. 



In the second stage of hepatic venous congestion, not 

 merely the centres of the lobules are red, but also the portal 

 plexus in parts ; the parts of the lobules which are most free 

 from congestion are those surrounding the interlobular spaces; 

 so that the non-congested portions appear in the form of isolated 

 and irregular patches, in the midst of which are situated the 

 interlobular fissures and spaces. The second stage of hepatic 

 venous congestion commonly attends disease of the heart and 

 other disorders in which there is an impediment to the venous 

 circulation, and it also gives rise, in combination with accumu- 

 lation of bile in the secreting cells, to those various appearances 

 which characterise the nutmeg or dram-drinker's liver. 



A third form of venous congestion is that which affects 

 the portal veins alone ; in this the margins of the lobules are 

 red, while their centres are pale ; it is the very reverse con- 

 dition to hepatic venous congestion in its first stage, arid has 

 been distinguished by Mr. Kiernan, by the name of portal 

 venous congestion. This form of congestion is rare, and has 

 hitherto been noticed to occur in children only. 



The fluid of the liver, the bile, has already been described 

 in this work ; in addition to the epithelial scales derived from 

 the mucous membrane lining the gall-bladder, the bile fre- 

 quently contains, when inspissated, concrete masses of biliary 

 matter, which have been mistaken for true cells, also crystals 

 of cholesterine, gall-stones, and the parasite called the fluke 

 with its ova. 



Hydatids are frequently developed in the substance of the 

 liver ; these often attain a very large size.*' 



* On one occasion I noticed the liver to be thickly studded throughout 

 with numerous cysts, the largest of about the twelfth or eighth of an 

 inch in diameter. These cysts contained a gaseous fluid only ; the se- 

 creting cells included a greater quantity of oil than natural. 



L L 4 



