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though  never  extremely  so.  In  the  majority  of  cases,  old  adhesions 
due  to  perihepatitis  exist  between  the  convexity  of  the  liver  and 
the  diaphragm,  such  adhesion  being  sometimes  complete  and 
universal.  The  characters  of  the  liver  generally  fulfil  the  picture  of 
a  multilobular  cirrhosis,  the  nodular  projections  on  the  surface  being 
always  small,  firm,  and  closely  set.  In  section,  the  colour  is  generally 
yellow  or  yellowish  brown,  but,  as  in  other  varieties  of  cin-hosis,  many 
variations  in  tint  are  often  seen  in  the  various  groups  of  isolated 
lobules. 
Examined  microscopically,  persistent  islands  of  hepatic  tissue  of 
irregular  size,  mostly  rounded  in  shape,  are  separated  from  one 
anothei  by  extensive  bands  of  cbnnective  tissue  of  somewhat  varying 
character.  The  tracts  of  hepatic  tissue  contain  large,  universally 
granular  liver  cells  ;  these  have  lost  the  more  or  less  regular  ramifying 
arrangement  in  relation  to  lobules — indeed  no  definite  lobules  are 
visible  even  in  the  largest  persistent  tracts. 
The  liver  cells  vary  considerably  in  size,  the  larger  frequently 
containing  two  nuclei,  as  if  compensatory  hepatic  regeneration  is  in 
progress.  The  liver  cells  are  frequently  vacuolated  or  show  other 
signs  of  degeneration  than  the  granular  character  already  mentioned. 
They  sometimes  exhibit  a  very  marked  ‘  vesicular  ’  degeneration.  In 
such  areas,  the  hepatic  cell  nuclei  are  reduced  in  number,  and  those 
which  persist,  stain  more  faintly  than  is  the  rule  elsewhere,  The 
cells  referred  to  have  not  a  definitely  fatty  appearance,  but  suggest 
that  degeneration  products  of  the  protoplasm  have  been  dissolved  out 
in  great  part,  leaving  only  a  hazy,  reticulated  residuum.  The  tracts 
of  connective  tissue  separating  the  hepatic  islands  are  densely 
cellular.  Between  the  connective  tissue  fibrillae  are  multitudes  of 
small  lymphocytes.  Polymorphonuclear  cells,  some  of  which  are 
eosinophiloLis,  occur  fairly  frequently  amongst  them.  In  these  tracts, 
hepatic  cells,  single  or  m  small  groups,  are  found,  showing  pressure 
and  other  changes.  Considerable  numbers  of  small  capillary  vessels, 
with  thin  walls,  are  also  found  in  these  tracts.  Where  the  lymphocytic 
infiltration  is  less  dense,  one  sees  that  spindle-shaped  fibroblastic 
elements  largely  compose  the  tissue.  There  is  a  comparative  absence 
the  increased  duct  formation  common  in  other  varieties  of  hepatic 
cirrhosis. 
