MICROSCOPICAL STUDIES ON ABSCESS OF 
THE LIVER 
BY 
J. C. DAVIS, M.D. 
[reprinted from “archives of medicine,” AUGUST, 1879.] 
NEW YORK 
G. P. PUTNAM’S SONS 
182 FIFTH AVENUE 
1879 Fif. / 
Tzy. Z - 
Fiy. 3. MICROSCOPICAL STUDIES ON ABSCESS OF THE 
LIVER. 
By J. C. DAVIS, M.D. 
IN vol. xxvii of the New York Med. Journ., I published 
some clinical observations on abscess of the liver, and 
took the ground that, in all probability, abscess of the liver 
was due in most, if not in all cases, to an inflammatory pro- 
cess in some of the organs of the abdominal cavity, from 
which the radicles of the portal system take their rise, ex- 
cepting, of course, those cases which are due to a parasitic 
origin (Echinococcus). Abscess of the liver seems to follow 
only embolism in the portal vein. These embolisms are due 
to transported particles of pus or shreds from the wall of 
some pus cavity, which being carried into the portal system, 
produce either suppurative phlebitis in the porta hepatis, the 
so-called pyle-phlebitis, or suppurative process in any part of 
the liver in which an embolus may have lodged. The ques- 
tion why pus or tissue in suppuration, if transmitted into a 
healthy tissue, should again produce suppuration, cannot be 
satisfactorily answered. We know that pyaemia, which is 
invariably due to a primary suppurative process on the outer 
surface of the body, or in an internal organ, is very com- 
monly accompanied by multiple abscess in the liver. The 
conclusion that such abscesses are mainly produced by em- 2 
ABSCESS OF THE LIVER. 
bolism of pus, gains ground, if we consider the fact that 
pyaemia will never ensue unless suppurative phlebitis be 
present in the neighborhood of the primary suppuration. 
My microscopical studies of abscess of the liver have 
been made on sections from a case of multiple abscess pro- 
duced by pyaemia, the liver being crowded with inflammatory 
foci, some of which are broken down into abscesses. Sec- 
tions from this liver, if viewed with a power of one to two 
hundred diameters, exhibit innumerable foci of inflamma- 
tion. Some are yet in the earliest stage, and others in 
full suppuration. In so far as conclusions may be allowed 
from neighboring analogous formations, the history of sup- 
purative inflammation of the liver is, I think, plain. 
It is, in my opinion, beyond question that all inflamma- 
tory foci have their seat in the interstitial tissue, built up 
by the relatively small amount of connective tissue, which 
heretofore has been called “ Glisson’s capsule,” and which 
accompanies all the branches of the portal vein, the hepatic 
artery and the bile ducts. It is well known that this con 
nective tissue does not in the human liver enclose the single 
lobules, but is present only in a limited portion of the cir 
cumference of the lobules. 
The inflammatory foci vary greatly in extent. Some con- 
sist merely in a slight infiltration of the interstitial connec- 
tive tissue; others occupy the whole amount of interstitial 
tissue between several lobules, while others are produced by 
both involution of the interstitial tissue and the lobules 
themselves. Lastly there are inflammatory foci, in which 
no distinction between interstitial connective tissue and 
epithelial tissue of the lobule is possible, but all look granu- 
lar with a low power, which means, that there have already 
formed, or are forming, small abscesses. 
The origin of abscess of the liver is evidently the same 
as that of plastic interstitial hepatitis and miliary tubercu- y. C. DAVIS. 
3 
losis of the liver ; although the termination is entirely differ- 
ent in the three kinds of inflammatory process. In the 
process termed plastic interstitial hepatitis, the termination 
consists in a new production of dense fibrous connective 
tissue, the result being that which we call cirrhosis of the 
liver. In tuberculosis the inflammation leads to a complete 
loss of blood-vessels in certain territories, with the result of 
shrinkage of the inflammatory elements, originating from all 
the tissues in a circumscribed territory. They become 
separated and isolated, thus producing that which we call a 
tubercle or a dry abscess. 
As to the origin of the inflammatory elements in cirrhosis, 
Heinrich Muller* has made accurate studies. He has de- 
monstrated that not only the interstitial connective tissue 
and the capillary blood-vessels are transformed into inflam- 
matory elements, but that the liver epithelia also share in 
the formation of such elements, through the increase of the 
living matter in their bodies. The result of this is a recur- 
rence of the formation of indifferent or medullary corpuscles. 
All these corpuscles remain uninterruptedly connected with 
each other, become spindle-shaped and are partly trans- 
formed into basis substance, so as to produce a considerable 
amount of fibrous or homogeneous dense connective tissue. 
Thus the participation of the liver epithelia in the inflam- 
matory process fully explains why in cirrhosis many of the 
lobules are so considerably reduced in size, while the newly 
formed connective tissue, which very soon retracts, is so 
notably and greatly augmented. 
The objections which might be raised against Muller’s 
conclusions, are based merely upon hypothetical grounds, 
viz., that epithelia would never produce connective tissue 
and that on the contrary connective tissue never would pro- 
duce epithelia. This objection falls to the ground in con- 
* Sitzungsber. der K. K. Akad. der Wissenschaft., in Wien., 1876. 4 
ABSCESS OF THE LIVER. 
sideration of the fact that in the earliest stages of embryonal 
development, there are present indifferent or medullary ele- 
ments only, from which all future tissues must necessarily 
arise. 
As to the origin of the inflammatory elements in tuber- 
culosis of the liver, direct observations are wanting. It is 
reasonable to conclude, however, that in tuberculosis just as 
well as in cirrhosis, the liver epithelia themselves furnish a 
large amount of medullary tissue, which, owing to the absence 
of blood-vessels, shrivel, become disintegrated and exhibit 
the crumbly material termed yellow tubercle. I have met 
with a case of tuberculosis in the liver of a duck, in which 
some of the lobules were partly, others entirely transformed 
into yellow tubercles, evidently through the participation of 
the epithelia in the production of indifferent elements. 
As to suppuration of the liver, my studies have led me to 
the conviction that, although the inflammatory process 
commences in the interstitial or connective tissue, soon 
thereafter the epithelia also become involved, taking their 
part in the formation of indifferent or medullary elements. 
In order to illustrate, what I wish to say on the morbid 
changes within the protoplasm of the epithelia of the liver, 
I must briefly recapitulate C. Heitzmann’s discovery of 
the structure of protoplasm in general. These observations 
were first published in 1873, in the transactions of the Im- 
perial Academy of Sciences in Vienna. It would be but 
presumption on my part to attempt a defence of the correct- 
ness of Heitzmann’s views, when so many of the ablest 
microscopists of the old world have already accepted them. 
Actual observation has satisfied me of the existence of this 
reticulum ; my deductions respecting it may be erroneous, 
but the microscope certainly cannot make visible that, which 
does not exist. 
According to this author’s views each protoplasmic body, J. C. DA VIS. 
5 
the formerly so-called cell, is built up by a delicate reticulum, 
the points of intersection of which are the formerly so-called 
granules of the protoplasm. The nucleus, eventually the 
nucleolus, is but a larger granule, inasmuch as the reticu- 
lum is in close connection with both the nucleus and the 
nucleolus. This reticulum is living matter and flat layers 
of the same matter also build up the shell of the nucleus 
and the bounding layers of the protoplasmic lump. In con- 
nective tissue of any description the protoplasmic bodies 
(formerly so-called cells), exhibiting the reticular structure, 
send delicate offshoots into the basis substance, which being 
formations of the living matter, produce a reticulum within 
the basis substance, somewhat wider than that of the proto- 
plasmic bodies themselves. In the meshes of the protoplasm 
there is present a lifeless fluid, while in the basis substance 
of the connective tissue the meshes of the reticulum con- 
tain a solid mass, which has evidently arisen from the former 
protoplasmic fluid. 
Through the reticulum of living matter which pierces 
the basis substance everywhere, all protroplasmic bodies are 
brought into uninterrupted connection. The old cell doc- 
trine, which has suggested that the animal body is built up 
like a dwelling with innumerable individual bricks, put to- 
gether by the cement of the inter-cellular substance, has 
fallen to the ground. The new doctrine suggests that in 
the body the living matter is in uninterrupted connection 
and that the whole body as such represents the individual, 
which is traversed by closed spaces (blood and lymph 
vessels) containing isolated protoplasmic bodies (blood and 
lymph corpuscles). The plan of organization is the same 
as in an individual amoeba, in which there may appear 
temporarily at least, closed spaces, so-called vacuoles, in 
the fluid of which there may float about, isolated particles 
of living matter. 6 
ABSCESS OF THE LIVEE. 
In epithelial and endothelial layers the single elements 
are protoplasmic bodies, flattening each other and separated 
from each other by the cloak of the horny cement-sub- 
stance. This cloak, however, does not isolate the proto- 
plasmic bodies, as the cements-ubstance is everywhere trav- 
ersed by delicate conical threads, the so-called thorns, which 
are the bridges of living matter uninterruptedly uniting all 
neighboring epithelia and endothelia. These, therefore, 
form continuous layers of living matter, which by means of 
delicate offshoots of the same matter, are also in direct 
union with the subjacent formations of connective tissue. 
If this doctrine be correct, we shall see in the inflam- 
matory process that the living matter, owing to the in- 
creased afflux of nourishing mateiial, must be augmented 
and from it must arise all elements heretofore termed inflam- 
matory corpuscles. In inflammation, however, the newly- 
formed elements may remain in uninterrupted connection, 
thus representing a tissue. If, on the contrary, the inflam- 
matory elements be separated from each other by being torn 
apart, the result will be pus from the broken down tissue, 
and the sum total of the pus corpuscles together with a cer- 
tain amount of serous fluid, will go to make up that which 
we call abscess. 
In the earliest stages of interstitial hepatitis, marked only 
by slight changes of the connective • tissue, we see with 
higher powers of the microscope (1000-1200 diameters) 
that the protoplasmic bodies,—the connective tissue cells— 
are coarsely glanular ; the nucleus is hidden by the coarse 
granules, or it is visible in the shape of a shining homoge- 
neous globule of living matter. Such globules, of varying 
size, are also scattered throughout the fibrous basis sub- 
stance and have evidently originated from particles of living 
matter, which in the normal condition produce the living 
reticulum in the basis substance. Such formations appear J. C. DAVIS. 
7 
in the largest number around the blood-vessels, both arteries 
and branches of the vena portae. Next we see that the 
fibrous basis substance has completely disappeared and is 
replaced by a large number of partly shining homogeneous, 
partly nucleated protoplasmic lumps, which are connected 
with each other by means of delicate threads. (See Fig. i). 
The transformation of normal into inflamed connective 
tissue has evidently taken place by liquefaction or dissolu- 
tion of the basis substance and increase of the living matter 
held therein with the result of a new-formation of inflam- 
matory elements. In this stage the blood-vessels in the in- 
flamed tissue are as yet recognizable, although their endo- 
thelial walls are considerably thickened, the endothelia 
themselves being engaged in a lively new production of 
living matter ; while the central lumen is* first narrowed, 
afterwards completely lost and filled up with inflammatory 
elements. It is the same process of proliferation, which 
breaks down the portal veins, the hepatic arteries and the 
bile ducts ; the same process, which leads to the consolida- 
tion of the capillaries within the lobules and their trans- 
formation into inflammatory elements. , All these elements 
are originally united with each other, thus representing what 
we call an indifferent, or inflammatory, or medullary, or gran- 
ulation tissue. In foci of inflammation, where the process 
has advanced up to the formation of pus, the connection of 
the single protoplasmic bodies is lost. Here isolated pus 
corpuscles are suspended in the albuminous serum, which 
latter in chromic acid specimens, such as I have exclusively 
used for examination, looks finely granular. The epithelia 
within the lobules of the liver at the same time share in the 
inflammatory process in a very marked way. Firstly they 
undergo changes, as first described by Heinrich Muller in 
the above quoted publication. They swell up ; the cement 
substance becomes invisible between a number of proto- 8 
ABSCESS OF THE LIVER. 
plasmic bodies, which now look like large irregular clusters. 
Necessarily, with the loss of the cement-substance goes also 
the loss of a number of bile capillaries. The epithelia and 
the protoplasmic bodies arising therefrom, become coarsely 
granular with their living matter augmented to such an 
extent that the nuclei are mostly concealed ; they have in 
part also become increased in size, shining and homogene- 
ous. Many of the granules assume the shape of nuclei and 
throughout the whole cluster new lines of demarkation 
appear, which lead to the formation of relatively small lumps 
of protoplasmic bodies, viz., inflammatory elements. All 
these elements are first directly connected with each other 
by delicate threads and in this condition represent an in- 
different tissue, closely resembling that formed from the 
connective tissue. Lastly, however, these medullary ele- 
ments are completely separated from each other and now 
represent pus corpuscles. (See Fig. 2.) 
The transformation into pus may be localized in the inter- 
stitial connective tissue alone; or it may involve the inter- 
stitial connective tissue and a portion of the neighboring 
lobules; or, lastly, a large territory of the liver-tissue being 
engaged in the inflammatory process, breaks down into pus. 
The result under all circumstances will be an abscess, vary- 
ing only in size. As to the emigration of colorless blood 
corpuscles, which was thought to be the only source of pus 
(J. Cohnheim), I have nothing to say. The origin of pus in 
my specimens at least, could be satisfactorily traced from the 
breaking down of the tissue itself, so much so, that in my 
opinion the emigrated colorless blood-corpuscles, if they 
were present at all, could have been by no means the main 
source of the pus corpuscles. 
Abscess sometimes forms in the liver, which is never made 
manifest by noticeable symptoms; the patient going on 
perhaps for years, and finally dying from some other disease, J. C. DAVIS. 
9 
or from some traumatic cause. This never happens in mul- 
tiple abscess of the liver in pyaemia, as the disease is gener- 
ally rapid in its course, and death its result. In a case 
of formation of abscess of the liver of long standing, 
the abscess becomes encysted. The changes leading to 
the formation of a sac around the abscess have been 
studied by myself in a specimen, in which a liver abscess of 
the size of a man’s fist was formed on the convex surface 
close to the peritoneum, which was found transformed into- 
a tough pseudo-membrane of at least 4 mm. in thickness, 
and closely adherent to the diaphragm. 
Microscopic sections made through the pseudo-membrane- 
and the adjacent portions of the liver, again illustrate the 
way in which the pseudo-membrane, or mcmbrana pyogena, 
had been formed. It was very plain to be seen, with high 
powers of the microscope, that the interstitial connective 
tissue of the liver and the connective tissue of the peri- 
toneum in many cases were broken down into indifferent or 
medullary elements, all these being in uninterrupted con- 
nection by means of delicate thorns of living matter. The- 
epithelia of the liver were transformed into medullary tissue, 
in exactly the same way which I have described above, when' 
speaking of the formation of an abscess. The difference 
was, that in the latter instance the medullary elements were 
left in uninterrupted continuity. In some places the medul- 
lary elements became spindle shaped, and were partly trans- 
formed into a basis substance, that led to the formation of 
a delicately striated cicatricial connective tissue. The main 
mass of the medullary elements, however, had been simply 
transformed into a homogeneous or slightly granular basis 
substance, with rather scanty protoplasmic bodies. With 
high powers the reticular structure of the basis substance 
was plainly visible, due evidently to the presence of the 
iving matter throughout the whole newly-formed mass of 10 
ABSCESS OF THE LIVER. 
•connective tissue. Enclosed in this mass I met with scanty- 
capillary blood-vessels, and a large number of islands of un- 
changed liver epithelia, which latter had escaped the trans- 
formation into medullary elements, and became involved in 
the newly formed connective tissue. (See Fig. 3.) 
In looking over the literature on this subject, I have 
found the following, which may be worthy of quotation : 
“ The young cells, which in local irritations fill the con- 
nective tissue interstices, ought and must, for the greater 
part, be regarded as having ‘ migrated in.’ But these still 
remain provisionally connective tissue cells, and their place 
of formation were the surrounding connective tissue cells. 
Even to-day yet we must not look upon the connective 
tissue as quite unfruitful, because an experiment of v. 
Recklinghausen proves that even excised pieces of the cor- 
nea, under proper conditions, are capable of a moderate cell 
production.” (Rindfleisch, p. 455, Phila. ed., 1872.) 
“ The pus corpuscles which usually accumulate so as to 
form abscesses, are almost entirely emigrants, although re- 
cent investigations render it highly probable that they may 
also originate by the endogenous process of the liver cells” 
•(Green’s Pathol, and Morbid Anat., Phila., 1878). 
Remak, Buhl, L. Oser and S. Strieker maintain “ that 
pus corpuscles arise in various epithelia, partly by division, 
partly by endogenous formation, also from connective tissue 
• corpuscles, from muscular cells, etc.” 
The conclusions I have arrived at through my microscop- 
ical studies on formation of abscess in the liver, are as fol- 
lows : 
1. The inflammation invariably starts in the interstitial 
connective tissue of the liver, and secondarily involves a 
varying amount and number of the lobules of the liver. 
2. Both the connective tissue with its blood-vessels and 
the epithelia of the lobules, through an increase of the liv- y. C. DAVIS. 
11 
ing matter, become transformed into embryonal or medullary 
elements, thus constituting what is termed the inflammatory 
infiltration. 
3. The medullary elements originally connected with 
each other by means of delicate thorns, in turn become iso- 
lated by rupture of these thorns, and now being suspended 
in a serous fluid, represent pus corpuscles, the sum total of 
which is called an abscess. 
4. The pus corpuscles, therefore, are a direct offspring of 
the liver tissue, both connective and epithelial, and no indi- 
cation could be seen of an emigration of colorless blood 
corpuscles, which latter may be assumed, but by no means 
could be directly proved. 
5. On the boundary of the abscess the inflammatory tis- 
sue is transformed into a homogeneous or striated connec- 
tive tissue, building a wall around the abscess. In the for- 
mation of this, also the peritoneum shares, if the abscess had 
formed near it. 
6. Through my studies the doctrine of C. Heitzmann of 
plastic and suppurative inflammation has been satisfactorily 
corroborated. As long as the indifferent elements remain 
united with each other, they represent a tissue, and are 
ready at any time to produce a basis substance, viz., new 
connective tissue. On the contrary, if the indifferent ele' 
ments are broken apart, they become pus corpuscles, arisen 
from all constituent elements of the inflamed tissue itself. 
EXPLANATION OF THE PLATE. 
Fig. 1. Formation of pus in interstitial connective tissue (Glis- 
son’s capsule) of the liver ; a a, fibrous basis substance in normal 
condition, with protoplasmic bodies b b ; c, portal vein ; d, bile- 
duct ; e e, increased living matter in shape of shining homogeneous 
lumps ; f, inflammatory elements arisen from epithelia of bile- 
duct ; gg, zone in which the whole connective tissue is transform- 
ed into medullary elements, all being connected by means of ABSCESS OF THE LIVER. 
12 
delicate threads of living matter ; hh, zone in which the medul- 
lary of elements are torn apart and represent pus-corpuscles. 
Magnified 1000 diam. 
Fig. 2. Formation of pus from the epithelia of a lobule of the 
liver ; a a, normal epithelia, separated from each other by the 
cement-substance, united by delicate thorns ; b b, capillaries of the 
lobules ; c c, zone in which the epithelia are coarsely granular, 
transformed into multinuclear lumps ; d d, narrowed capillaries, 
with swelled endothelia ; e e, zone of medullary elements, arisen 
from both epithelia of the liver and endothelia of the capillaries, 
all connected with each other; ff, medullary elements torn 
asunde rand no wrepresenting pus-corpuscles. Magnified 1000 
diam. 
Fig. 3. Formation (d) of the connective tissue capsule around 
the abscess of the liver ; a a, indifferent or medullary elements, 
produced by inflammation of both the interstitial connective tissue 
and the epithelia of the lobules ; b b, zone in which the medul- 
lary elements became spindle shaped, and partly transformed into 
basis-substance; cc, newly formed fibrous basis-substance with 
scanty protoplasmic bodies ; d, island of unchanged liver-epithelia. 
Magnified 1000 diam. AECHIYES OF MEDICIITIC 
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