Inflammations of the liver, and their sequelae : atrophy, cirrhosis, ascites, haemorrhages, apoplexy, and hepatic abscesses.

  • Harley, George, 1829-1896.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: Inflammations of the liver, and their sequelae : atrophy, cirrhosis, ascites, haemorrhages, apoplexy, and hepatic abscesses. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    trophied) connective tissue, shrinking not only more rapidly, but more completely, than the secreting hepatic cells, small lobuli are thereby formed in consequence of the puckering in, as it were, of their surrounding con- nective tissue, producing the nodulated appearance, not at all unlike a door studded with globular-headed nails. That the morbid anatomical appearances which I call lobulated, nodulated, or hobnailed atrophy, according to the dimensions of the projections, should come about after a preceding inflammatory enlargement of the organ is easy enough to understand, when it is remembered that during the inflammatory stage the connective tissue becomes greatly hypertrophied, and, by the pressure it exerts on the secreting cells, interferes not only with its own, but at the same time with their proper nourish- ment, and thereby induces degeneration of tissue. So that, ultimately, not only the normal smooth appearance of the organ may be entirely lost, but it may shrink to even one quarter of its original size. In some cases so small is the hver that no dull sound is said to have been ehcitable from it. I have never met with a case where I could not succeed in getting a dull note; but I have certainly met with more than one where the duE, per- pendicular area did not exceed more than an inch in extent. As it requires considerable experience to detect an imperfect dull hver-sound, I may as well call atten- tion to the fact that there are several reasons why the hepatic percussion note may be obscured and lead to an erroneous diagnosis, when there is in reahty but a moderate atrophy of the organ. These are :— 1. Along with a chronically atrophied Hver there is usually ascites, and when fluid is present in the abdomen it so interferes with the hepatic tone as to render it, if feeble, almost imperceptible. \