Is hematogenous in character, as in the majority of cases it is due to the presence, in the circulation, of a poisonous substance formed by distilled liquors. Early in the disease the organ may be somewhat enlarged, but in the typical stage the liver is small, contracted, the surface irregular, the color varying greatly, is very hard, dense, and cuts with great difficulty. The nodules that project are composed of liver-cells, while the depressed areas are formed by bands of connective tissue that have contracted. These bands are grayish in color, the elevated portions yellowish or brownish, the color depending upon the fatty degeneration or the presence of bile. As a rule such a liver will weigh more than usual on account of the increase in the density of the tissue.

Microscopically the process begins as a localized infiltration of round cells about the interlobular branches of the portal vein. This is followed by a proliferation of the connective tissue with the formation of new fibers. These increase in number, and undergoing contraction interfere with the portal circulation. The blood-vessels will show endarteritis or thrombosis. This gives rise to certain associated symptoms, as ascites 4 to 15 liters of clear fluid may be present, gastro-intestinal catarrh, hemorrhoids, and distention of the superficial abdominal veins (the caput medusae). Jaundice is seldom present. Hemorrhage, with hematemesis, due to rupture of various veins of the esophagus or of the cardiac end of the stomach may occur. There may also be an oozing from the gastric mucosa. The entire lobule eventually becomes surrounded, and as the contraction continues the hepatic cells undergo atrophy till at last there may be an island composed of a few epithelial elements. The connective tissue does not tend to become intralobular.

Associated with the above changes is more or less marked fatty degeneration. An important feature in this disease is the proliferation of bile-ducts in the interlobular connective tissue. There is usually a decided increase in their number derived from pre-existing ducts or from a reversion of the liver cells to the less specialized type.

Fig. 158. - Chronic Indurating Cirrhosis of the Liver (McFarland).

a, Liver lobule, most of whose cells are in a fatty infiltrated condition; b, greatly hypertrophied periportal connective tissue; c, proliferated bile-ducts.

Sometimes the liver-cells may contain large amounts of pigment granules, varying in shade from yellow to dark green; may be hemosiderin or bile-pigment.