Andral f sees, in the cirrhosis, atrophy of the red substance and hypertrophy of the yellow substance. Of all modern authors, Cruveilhier approaches nearest to the true condition of the organ, but from his misapprehension of the exact nature of the lobules, even his opinion cannot be accepted without limitation. Cirrho sis, says this authora is " atrophie du plus grand nombre des grains glanduleux, et hyper trophie avec coloration jaune des grains gland u leux restans." Now cirrhosis is undoubtedly a partial atrophy of the liver with hypertrophy of the cellular structure; complete atrophy of some of the lobules, partial atrophy of others, and biliary congestion without atrophy or hy pertrophy of the rest. Those small yellow grains varying in size from a millet-seed to a t pea or to a hazel-nut, are not distinct lobules in a variable state of hypertrophy, but small ; uncongested patches composed of parts of several adjoining lobules, and having a single or several interlobular spaces for a centre.
• Hence it is, as we have before shown, that Cru veilhier§ has observed the " partie centrale de chaque granulation repond au radicule biliare, ? et consequemment est sonvent teinte en jaune et que la partie excentrique repond a l'element vasculaire et consequemment est plus rouge que la partie centrale." • Softening of the liver may accompany any s of the changes resulting from acute inflamma tion. The degree of softening is very variable, e the organ having at one time a simple abnormal degree of friability when pressed by the hand,and • at others constituting a pulpy mass scarcely re • tamed in its form by the cellular framework of its n vessels and Glisson's capsule. Softening may be n unaccompanied by any marked change in the d bulk of the organ, but is always associated with a it variable intensity of venous congestion. Biliary congestion is also frequently present, and tinges the substance of the organ with a variable hue of yellow, green, &c. Portal observes that the liver of patients who have died of scurvy is often so much softened that it appears in a state of decomposition, has a reddish brown colour, and resembles the lees of red wine. Baillie remarks that softening of the liver is not uncommon in old persons, that it ap proaches in consistence to the texture of the spleen, and is of a brownish red colour.
e. Induration of the liver is occasionally attendant upon hypertrophy or atrophy of the organ, but it may also exist with a normal size of the liver without other apparent change than the brownish red tint which it receives from venous congestion, or the various shades of yellow, green, or brown induced by biliary congestion. The density and hardness acquired by the liver in a state of atrophy are sometimes truly astonishing. In a case detailed by Mor gagni the organ resisted the knife, and several such instances are to be met with among the writings of the older pathologists.
f Fatty degeneration of the liver.—Upon referring to the section upon the chemical analysis of the liver, it will be observed that a certain proportion of oily matter is one of its natural constituents. Under the influence of diseased action this quantity is greatly aug mented, and increases to such an extent as completely to take the place of the normal structures. Vauquelin has published an analy
sis of a fatty liver, from which the quantity of oily matter present may be fairly estimated thus; in 100 parts he found, Oil 45 Parenchyma 19 Water 36 • 100 The fatty matter is usually distributed equally through the organ, being apparently infiltrated into the cellular texture of the parenchyma. At other times it is deposited in a mass or forms se veral collections in different parts of theliver. The fatty liver is greasy upon the surface, and when cut into has the appearance of a section of yellow soap. The vessels seem pressed upon and are scarcely perceptible, while the greasy deposition is divided into angular masses by a coarse and compressed cellular tissue.
Fatty liver is generally consistent and solid in its texture, but sometimes the fat exists almost in a fluid state. Portal has observed the liver quite white and softened almost to the fluidity of melted fat, where no hepatic sym ptoms existed during life; and he particularly records the case of a woman suffering under a severe form of syphilis in which this condition of the liver existed.
From the name which has been given to this disease by pathologists, fatty degeneration, we might be led to infer that the texture of the organ was actually converted into this oily sub stance. This, however, is quite inconsistent with our knowledge of pathological phenomena. The fatty deposition is obviously an undue secretion of a normal constituent, but whether resulting from irritation from whatever cause, or from absence of vital energy, is a question upon which I am unwilling, without further investigation, to hazard an opinion. With regard to the causes of fatty liver Andral observes, " Les causes sous ['influence des quelles le foie devient le siege dune secretion de ma•re grasse sont encore inconnues. On tl'a emis qu'une hypothese lorsq'on a dit que la degeneration graisseuse du foie etait le produit d'une irritation de cet organe. Car on pourrait tout aussi bien soutenir que cette degeneration graisseuse, loin d'avoir ete precedee par un (tat d'irritation du foie, est survenue parceque la nutrition de cet organe est devenuc moans active; et cette derniere hypothese serait d'au tant plus soutenable, qu'elle se deduirait d'une grande loi de Feconomie en vertu de laquelle, toutes les fois qu'un organe tend a s'atrophier, une mature grasse vient a se secreter autour de cet organe ou a la place mame de ses mole cules."* Fatty liver is most frequently observed in Persons who have died from scrofulous tubercles in the lungs; in those, says Andral, in whom the blood has not been efficiently arterialised, and in whom the pulmonary exhalation is greatly diminished. Can it be, he inquires, from the absence of the due separation of hydrogen from the lungs that this compound of hydrogen, fat, becomes deposited in the paren chyma of the liver? This question is well deserving the attention of pathologists, and its solution might lead to important information. The disease has also been observed in some cancerous disorders and in dartrous diseases of of the skin.