9 
ON IliEMORRIIAGE FROM THE LIVER. 
649 
On opening* the abdomen we observe the intestines deluged 
with dark venous blood, in a fluid state, the quantity sometimes 
exceeding ten gallons; the peritoneum and intestines of a faint 
yellow colour, or quite blanched. The liver presents a tumid 
appearance; its concavities are filled up or rendered convex; 
some portions of the peritoneal coat appear opaque, and four 
or five times the natural thickness; elsewhere one or more rents 
in the part of the peritoneal coat, which is of the usual tenuity, 
are observed, through which the extravasated blood has escaped 
from the ramifications of the vena portarum*; beneath the peri¬ 
toneal membrane on each side of the fissures there is generally 
some dark coagulated blood. The colour of the liver is various, 
being either fawn, light yellow, or brown; its substance is exceed¬ 
ingly brittle, can easily be torn by the finger, and is in some 
places so broken down, that small portions of solid float in the 
semifluid or grumous mass into which other parts are converted: 
circumscribed coagula of blood are also frequently found by 
cutting into parts of the liver which are not so much disorganized, 
and occasionally extravasations of blood are formed beneath the 
peritoneum over and around the kidneys, extending even to the 
pelvis: the weight of the liver and extravasated coagula, in some 
cases, exceeds sixty pounds. The hepatic duct always contains 
bile. 
This increased size of the liver is occasioned by the extravasa¬ 
tion of blood into the substance, and under the peritoneal coat, 
not by an increase of the natural substance of the organ. If the 
haemorrhage be not very profuse, the symptoms are less marked, 
and occasionally doubtful; but, in most instances, one or more 
of the characteristics of the complaint are present, or the ob¬ 
scurity that first existed is gradually dissipated by the aggrava¬ 
tion of the symptoms, which generally assume the severe form in 
a few days. 
Diminished appetite, swelling of the hind leg’s, faintness in 
work, apparent fulness of abdomen, slight uneasiness, some¬ 
times looking back or lying down but without rolling’, have 
been the deviations from health first noticed. At this period the 
pulse may be scarcely altered, but soon becomes frequent and 
feeble; the buccal and Schneiderian membranes appear at first 
of their natural colour, afterwards paler or pale yellow, lastly 
blanched. There is occasional sighing; the size of the abdomen 
increases; the tongue becomes furred and disagreeable; the ears 
are clammy; the bulk of the body reduces, owing’ to the absorp- 
* If warm water be injected into the vena portariim after having tied 
the vena cava posterior in the thorax, the water will escape from innu¬ 
merable orifices oil the abraded parts of the liver. 
VOL. III. 4 S 
