The enlarged cirrhotic liver / by Arthur Foxwell.

  • Foxwell, William Arthur.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: The enlarged cirrhotic liver / by Arthur Foxwell. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    than natural, and sometimes it is very greatly reduced in weight. The post mortem records of Guy's Hospital record several instances in which the organ has weighed as little as 32 or 34 ounces, and cases have been recorded in which it has been still smaller. But not uncommonly a cirrhosed liver is found after death to be of the natural size, or even above it. Whenever considerable enlargement is present, I believe that the organ is almost always also loaded with fat. But this view is not confined to the statements of text books. Dr. Saundby in a valuable paper read before the Association in 1890 on the Varieties of Hepatic Cirrhosis gives the size of the liver in the alcoholic variety as usually small; in the cardiac, usually large; in the gummatous, irregular; in the scarlatinal, normal; and in the other six large. He thus makes a broad clinical distinction between the alcoholic and other forms of cirrhosis. Such a distinction as this is not, I believe, in accord with the facts of the case. It seems to me we have come to a stage when the student can quite justifiably be taught a simple, clear and unified doctrine on this condition. I will venture to put my meaning into words. Prolonged excess in any variety of alcohol produces a chronic form of inflammation which, as is usual in such inflammations, selects for special attack the supporting structure rather than the parenchyma of the organ. As the alcohol is brought to the liver by the portal vein it is only natural that the portal spaces should bear the brunt of the attack and suffer most, but the intralobular connective tissue is also affected and the parenchyma itself not seldom undergoes injury. After any special indulgence the inflammation is of a more acute nature and is accompanied by acute hypersemia, which latter greatly and suddenly increases the size of the liver, its edge descending as much as two or three inches in the course of twenty-four hours, giving to the finger the sense of great rigidity and hardness. But, with abstinence from alcohol, this sudden swelling soon subsides and the edge retires to nearly the position it held before the attack. As the case progresses the liver either permanently enlarges or grows
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