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.