Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 3: Ins-Pla
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit29464/202/
194 
ABNORMAL ANATOMY OF THE LIVER. 
Sometimes these tumours present a certain de¬ 
gree of consistence, but as they increase in 
size they become more and more softened and 
pulpy. Baillie describes a large tumour in 
the liver which he considers scrofulous from 
being softened in the centre, and containing a 
fluid resembling pus; this is most probably 
a tumour of the kind I am now describing. 
Another tumour, of which he expresses himself 
at a loss to understand the nature, soft, of a 
brownish colour, and of about the size of a 
nut, appears to be also referable to the same 
species. 
The second and third varieties of the tubera 
diffusaof Farre present characters resembling this 
disease. V. 2. “ Tubera, elevated at the surfaces 
of the affected organ, encysted, or having dis¬ 
tinct cells, formed by the growth of a fungus, 
which separates in flakes, and is composed of 
a fine reticular texture, containing an opaque 
white fluid.” V. 3. “ Tumours rising with a 
regular swell from the surfaces of the affected 
parts and yielding to the touch, composed of a 
very delicate reticular texture, pulpy in its 
consistence, varying in its colour even in the 
same subject, charged with an opaque fluid, 
and growing from cysts or cells.” 
Cruveilhier considers the venous capillary 
system as the seat of origin of carcinoma, par¬ 
ticularly of the form which I am now consi¬ 
dering ; hence he observes, “ Ayant exprimé 
d’une coupe faite à un foie cancéreux une ma¬ 
tière d’un blanc-rougeâtre, encéphaloïde qui 
se moulait à la manière du vermicelle, et qui 
pouvait acquérir en se tordant une grande lon¬ 
gueur, j’aperçus sur cette coupe un orifice plus 
considérable que les autres ; j’incisai cet orifice 
et je parvins dans un vaisseau très volumineux 
qui me parut être une des ramifications de la 
veine porte. Alors je disséquai avec beaucoup 
d’attention cette veine, et je ne fus pas peu 
étonné de voir que cette veine, depuis les plus 
grandes jusq’aux plus petites divisions, était 
remplie par cette matière encéphaloïde, adhé¬ 
rente aux parois et tout-à-fait semblable à celle 
qu’on exprimait par les coupes faites au foie. 
Il me fut facile de suivre les ramifications ex¬ 
trêmement dilatées de la veine jusque dans 
l’areoles des coupes. L’altération était bornée 
à la veine porte, les veines hépatiques et leurs 
ramifications étaient parfaitement saines.”* 
1. Fungus hæmatodes is the term applied to 
all carcinomatous tumours which have a ten¬ 
dency to the unnatural development of new 
vessels and to effusions of blood into their tissue. 
In the same organ, hard and cartilaginous 
scirrhous tumours may exist with those of a 
softer texture, and of a medullary form, and 
both of these may be mingled together in the 
soft, elastic, and bleeding mass which consti¬ 
tutes fungus hæmatodes. The tumours of 
fungus hæmatodes are often of very large size, 
and by their frequent hémorrhagies give rise to 
extreme symptoms and the speedy death of the 
patient. Farre arranges this form of carcinoma 
among his tubera diffusa, of which it forms the 
fourth variety, which he thus defines r “ Tu¬ 
mours elevated at the surfaces of the liver and 
inclining to a round figure ; pulpy in their con¬ 
sistence, being charged with a thick and opaque 
fluid, variegated in their colour, chiefly white 
mingled with red, the former prevailing in their 
incipient, the latter in their advanced stages, 
composed of a very vascular and reticular tex¬ 
ture, attached either to distinct pouches or to 
the substance of the liver, and so unlimited 
and rapid in its growth as to burst or destroy 
the peritoneal tunic of this organ and to pro¬ 
trude in the form of a bleeding fungus.” 
m. Melanosis.—Melanosis exists in the diver, 
as in other structures of the body, 1st, as a 
melanic secretion infiltrating the cellular struc¬ 
ture of the organ, and giving a diffused general 
blackness to the substance of the lobules; 2d, 
as a morbid tissue composed of an areolar cel¬ 
lular network, in which the black carbonaceous 
matter is deposited ; or 3dly, as a melanic 
pigment accompanying carcinoma or tubercle, 
and imbuing the abnormal tissue with its pe¬ 
culiar colour. The colour of melanosis in the 
liver varies from a deep chocolate-brown to a 
rich black. Sometimes it is diffused in patches 
through the substance of the organ, at other 
times it exists in the form of rounded circum¬ 
scribed tubercles of variable size and number. 
Laennec considers melanosis as an accidental 
tissue without analogue among the animal tis¬ 
sues ; he classes it with cancerous degenera¬ 
tions, and describes it as existing in his two 
favourite conditions of crudity and softening. 
But the researches of Cruveilhier have shewn 
that in many instances melanosis is to be re¬ 
ceived as a mere pigment, resembling the pig- 
mentum nigrum of the choroid, which impresses 
its peculiar colour upon natural and morbid 
tissues, and he has also proved, in opposition 
to the view entertained by Laennec, that the 
softened state or state of infiltration very fre¬ 
quently precedes the more dense and encysted 
form. Melanosis rarely exists in the liver with¬ 
out being at the same time found in various 
other structures of the body, as in the brain, 
eye, lungs, heart, spleen, kidney, mucous mem¬ 
brane, muscles, skin, &c. 
6. Disorders of function.—The principal 
function of the liver being the secretion of bile, 
we shall have to consider under this head the 
changes which may occur in the secretion of 
this fluid and in the fluid itself, in consequence 
of derangement of function in the organ. These 
disorders may be divided into three kinds : — 
a. Suppression of the bile. 
b. Alterations in the physical properties of 
the bile. 
c. Alterations in the chemical qualities of 
the bile. 
a. Suppression of secretion of the bile, like 
suppression of urine, occasionally occurs in 
the liver. This disease appears to have been 
known to Darwin,* who calls it “ paralysis of 
the secretory vessels” of the liver; the patients, 
he says, “ lose their appetite, then their flesh 
and strength diminish in consequence, there 
appears no bile in their stools nor in their urine, 
Anatomie Pathologique, liv. 12. 
* Zoonomia, vol. ii, p. 5.
        

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