Medical Chronicle - v. 3 Author:Unknown Author Purchase of this book includes free trial access to www.million-books.com where you can read more than a million books for free. This is an OCR edition with typos. Excerpt from book: direct result of portal obstruction, for if so the fluid should be in greatest quantity early in the stage of the disease, when haemorrhages from the stomach and... more » bowels were most in evidence. As Packard and Lecomte point out in a most excellent paper, it does not follow that the portal pressure need be highest at this hsemorrhagic stage. The' vessels which give way are anastomotic channels which have, in all probability, less resistance to pressure than normal ones. The objectors to the mechanical theory attribute the ascites to a general toxaemia resulting from the inability of the diseased liver to absorb and destroy alimentary toxins. They therefore insist that the enlargement of the anastomotic circulation, so far from doing good, will actually do harm by increasing the facilities for the direct passage of these poisons into the general circulation. Against this view it may be very reasonably urged that if the ascites be due to a general toxaemia, we should observe the implication of other serous membranes, the pleura or the pericardium, with the peritoneum, a rare association unless in the last stages of the disease with a failing heart. Even if the ascites be of toxic origin, we may yet imagine the operation being of benefit by relieving the portal circulation, and so allowing the liver to deal more efficiently with the blood circulating through it. Possibly, too, the increased vascular supply to the surface of the liver will improve the nutrition of the cells there, and even originate the growth of new cells. Microscopical examination seems to give some support to this latter suggestion. The whole question has been very carefully studied experimentally. In 1874, Eck ligatured the portal vein in dogs, formed a fistula between the vena porta and the vena cava, and obser...« less