LIVER. 



near each other, and are of a rounded diape. They frive 

 an appearance every where of irivgularity to its fiirface. 

 When cut into, they are found to conlill of a brownifh 

 or ycllowidi-whitc folid matter, lliey are fometimcs of a 

 very fmall fize, fo as not to be larger than the heads of 

 large pins ; but moll frequently they are as large as fmall 

 hazel nuts, and many of them are fometimcs larger. When 

 the liver is tinis tuberculatcd, it feels much harder to the 

 touch than natural, and not uncommonly its lower edge is 

 bent a little forwards. Its fize, however, is generally not 

 larger tlian in a healthy Hate, and I tliink it is often fmaller. 

 If a feftion of the lis-er be made in this ftafe, its veflels 

 fetm to have a fmaller diameter tlian they have naturally. 

 It very frequently happens that in this ftate the liver is of 

 a yellow colour, arifing from the bile accumulated in its 

 fubftance ; and there is alfo water in the cavity of the ab- 

 domen, which is yellow, from the mixture of bile. The 

 gall-bladder is generally much contracted, and of a white 

 colour, from its being empty. The bile, from the prcffure 

 of the hard liver upon tlie pari biliarii, docs not reach the 

 tiuclut hepat'ictis, and therefore cannot pafs into the gall- 

 bladder. The colour of the fl<in in fuch cafes is jaun- 

 diced, and it remains permanently fo, as it depends on a 

 ftate of liver not liable to change. This is the common 

 appearance of what is generally called a fchirroi^s liver : 

 but it bears only a remote refemblance to fchirnis, as it 

 fhe\Ts itfeif in other parts of the body. I (hould therefore 

 be difpofed to confidcr it as a peculiar difeafe afiefting this 

 'vifciis." Morbid Anat. chap. ix. 



This account of the ftate of the indurated and tubercu- 

 latcd liver renders it unneceffary to explain, at any length, 

 th( origin of the dropfy, jaundice, &c. which accompany 

 thefe difeafes, when inveterate. It muft be obvious to thofe 

 who underlland the ttrufture of the parts, that if fome 

 bile is fecreted in the liver, but, from the compreffed ftate 

 of the dufts, it cannot pafs into the inteftines, it will be 

 abforbed into the circulating blood, and produce jaundice. 

 (See jAtiyniCE. ) And dropfy will enfiie, in confequence 

 of the impermeability of many of (lie blood-veffels of the 

 liver, which arc comprefled by the fnrrounding tubercles ; 

 whence, as in all cafes of fuch ohllruftion to the circu- 

 lation, the thinner parts of the blood will exude from the 

 exhalant extremities of the over-dilteiided vefTels behind. 

 (See a R0vs\, eaufis of.) From the fame obftruClion, and 

 ■the over-dillention of the venous fyllem, thefe velfels are 

 liable to give way; whence hemorrhagies, or difcharges of 

 dark blood, are liable to occur, under fuch morbid tlates of 

 the liver, from the ilomach, inteftines, nole, and other in- 

 ternal paflages; but efpecially from the two former, fince 

 the blood which circulates through them, as we 1 as through 

 the fpker., pancreas, and omentum, muft pafs through the 

 liver to reach the heart ; the circulation, tl>erefore, muft be 

 particularly impeded in the organs juft mentioned, when that 

 of the liver is ob!lru£led ; and the blood will force its way 

 through other palTages, if the veftels are not ftrong enough 

 to refift any extraordinary difteiiding force. 



The liver is liable to be aifeftcd with other varieties of 

 tubercle, of a larger fize than thole above defcribed : Dr. 

 Baillie has ir.entioned three varieties of thefe, which he 

 calls the large white tubercle, foft brown tubercle, and 

 fcrofulous tubercle. The tiril of thefe, which is by no 

 means fo frequently met with as the common tubercle, re- 

 /embles more nearly the ordinary appearance of fchirrus 

 in. other parts of the body. Thefe tubercles are hard 

 whitilh maffes, of a jjlobular form, and firm opaque fub- 

 iftance, often as large as a chefmit, and fometimcs much 

 ilarger, or on the other hand, eonfiderably fmaller. ".They 



are to be found near the furface of the liver," Dr. Baillie 

 obferves, " in greater number, than near the' middle of ita 

 fubftance : two or three frequently lie contiguous to each 

 other, with a confidcrable portion of the liver, in a healthy 

 ftate, interpofed between them and a cluftcr of fimilar tu- 

 bercles. The liver in this difeale is frequently a good deal 

 enlarged beyond ita natural fize." Dr. Baillie adds, that 

 " thefe tubercles appear to be tlrft formed round the blood- 

 veflels of the liver, as is feen in making fedions of a liver 

 in this ftate. While the liver is under fuch circumllances 

 of difeafe, there is fometimcs water in the cavity of the ab- 

 domen, and fometimcs none ; the liver is fometimcs tinged 

 ill its colour, from the accumulation of bile, and fometiines 

 the colour of its fubftance, between the tubercles, is per- 

 fettly natural.'' (Loc. cit.) The two other fpecies of tu- 

 bercle are very rare ; the one conlifts of a fmootli, loft, 

 brownilh matter, the nature of which is not thoroughly 

 known ; the other bears a itrong refcrablance to the tubercle 

 of the lungs. See Cox.sumi'tion. 



There arc no peculiar fymptoms, by which the exiftence 

 of thefe diiierent tubercles can be difcriminated in the living 

 body. When the parietes of the abdomen are thin, and 

 there is little dropfy, and efpecially when the liver is en- 

 larged, the tubercles can fomttimes be diftincitly felt by the 

 fingers, upon an attentive examination, along the lower 

 edge of the vifcus. Dr. Baillie corrocUy ftatcs, th,it the 

 large white tubercle is not fo often attended with jaundice 

 and afcites as the common tubercle. We witneffed the ex- 

 emphfication of thefe obfervations, in a ftriking inftance, 

 fome years ago ; in which a' woman, addidled to Ipirit- 

 drinking, had been afFetted with the large tubercle of tlje 

 liver for feveral years, but had complained only of lo(s of 

 appetite, and occalional ficknels ani^i pains in the fide, had 

 been pregnant and brought forth twins, and never had any 

 appearance of dropfy to the lall, nor of a jaundiced com- 

 plexion, until within eight days of her death. Yet in this 

 perfon, the liver was not only found about three times its 

 natural bulk, (filling half the cavity of the belly, and being 

 diftinftly felt, before death, extending down the uml/ilicus, 

 and thence to the fpine of the pelvis,) but appeared, on 

 making^ a fection, to confift. of a mere mafs of tubercles, 

 with fome loofe intcrfticial matter, but without any fem- 

 blance of the natural fubllance of the vifcus. The firftion 

 prefented an appearance not unlike the pudding-ftone of 

 mineralogifts. It would feem that, from the laxity of the 

 intervening fubftance between the tubercles, the circulation 

 through the branches of the -vena porU was not materially 

 impeded ; and hence no dropfical eifufion took place from 

 the vcO'lIs of the peritoneal vifcera. The patient was con- 

 fined to bed only eight days, and was apparently cut off^ by 

 an inccflant agonifing pain in the dileafed organ, which firlt 

 induced delirium, and afterwards wore out the powers of 

 life. 



The liver is not unufually found fofter and much more 

 flaccid in its fiibftance than natural, without any other ap- 

 pearance of difeafe. It feels, in fuch inftances, nearly as 

 foft as the fpleen, and is commonly of a leaden colour. 

 This ftate of liver is feldom, if ever, found in young per- 

 fons ; moft commonly in perfons advanced in life. Some 

 other rare morbid changes have alfo been feen in the liver ; 

 fuch as the convcrfiun ot part of its coats into cartilage, and 

 the formation of cartilaginous cyfts in its fubftance, con- 

 taining an earthy matter of a foft fmooth quality, and 

 browniih-whiie colour. 



It. is not unufual, or. diffcftion, to fee adbefions formed 



between the liver and the contiguous parts, wiiich are the 



coafecfuence of a previous inflammatiou in. the membrane 



4 covering 



