354 SURGICAL APPLIED ANATOMY. [Chap. xvn. 



abdominal cavity. From the relation of the liver to 

 the right lower ribs, it follows that this viscus may be 

 damaged when the ribs are fractured, and in some 

 cases the broken ends of the bones have been driven 

 through the diaphragm into the liver substance. Stabs 

 through the sixth or seventh right intercostal space, 

 over the liver region, would wound both the lung and 

 the liver, would involve the diaphragm, and open up 

 both the pleural and }>eritoneal cavities. The intimate 

 relation of the liver to the transverse colon is illus- 

 trated by a case where a toothpick, four inches in 

 length, was found in the substance of the liver. It 

 had worked its way there, from the colon, along an 

 abscess cavity that connected the two viscera. The 

 relation of the liver to the heart may be illustrated by 

 a case still more remarkable. In this instance a loose 

 piece of liver, weighing one drachm, was found in the 

 pulmonary artery. The patient had been crushed 

 between two waggons, the liver was ruptured, and the 

 diaphragm torn. A piece of the liver had been 

 squeezed along the vena cava into the right auricle, 

 whence it had passed into the right ventricle, and so 

 into the pulmonary artery. The heart itself was quite 

 uninjured. Portions of the liver may protrude through 

 abdominal wounds, and are usually easy to reduce. In 

 one instance of such protrusion the surgeon did not 

 find the reduction easy, so he placed a ligature round 

 the projecting part of the viscus, and then cut this 

 obstinate portion of the liver off. The patient re- 

 covered. 



From a reference to the relations of the liver, it 

 will be readily understood that an hepatic abscess may 

 open into the pleura, and in some cases, indeed, the 

 pus from the liver has been discharged by the bronchi. 

 Thus, it has been possible for a patient to cough up 

 some portion of his liver, although, of course, in a very 

 disintegrated and minute form. Hepatic abscess may 



