lib. vi.) to have resembled the crooked staff borne by the Augurs. The
lituus consisted of a cylindrical tube 4 or 5 ft. long, having a narrow
bore, and terminating in a conical bell joint turned up in such a manner
as to give the instrument the outline of the letter "J." Unlike the
buccina, cornu and tuba, the other military service instruments of the
Romans, the lituus has not been traced during the middle ages, the
medieval instrument most nearly resembling it being the cromorne or
tournebout, which, however, had lateral holes and was played by means of
a reed mouthpiece. A lituus found in a Roman warrior's tomb at Cervetri
(Etruria) in 1827 is preserved in the Vatican. Victor Mahillon gives its
length as 1 m. 60, and its scale as in unison with that of the trumpet
in G (_Catalogue descriptif_, 1896, pp. 29-30). (K. S.)
LIUDPRAND (LIUTPRAND, LUITPRAND) (c. 922-972), Italian historian and
author, bishop of Cremona, was born towards the beginning of the 10th
century, of a good Lombard family. In 931 he entered the service of King
Hugo of Italy as page; he afterwards rose to a high position at the
court of Hugo's successor Berengar, having become chancellor, and having
been sent (949) on an embassy to the Byzantine court. Falling into
disgrace with Berengar on his return, he attached himself to the emperor
Otto I., whom in 961 he accompanied into Italy, and by whom in 962 he
was made bishop of Cremona. He was frequently employed in missions to
the pope, and in 968 to Constantinople to demand for the younger Otto
(afterwards Otto II.) the hand of Theophano, daughter of the emperor
Nicephorus Phocas. His account of this embassy in the _Relatio de
Legatione Constantinopolitana_ is perhaps the most graphic and lively
piece of writing which has come down to us from the 10th century. The
detailed description of Constantinople and the Byzantine court is a
document of rare value--though highly coloured by his ill reception and
offended dignity. Whether he returned in 971 with the embassy to bring
Theophano or not is uncertain. Liudprand died in 972.
He wrote (1) _Antapodoseos, seu rerum per Europam gestarum, Libri VI_,
an historical narrative, relating to the events from 887 to 949,
compiled with the object of avenging himself upon Berengar and Willa
his queen; (2) _Historia Ottonis_, a work of greater impartiality and
merit, unfortunately covering only the years from 960 to 964; and (3)
the _Relatio de Legatione Constantinopolitana_ (968-969). All are to
be found in the _Monum. Germ. Hist_. of Pertz, and in the _Rer. Ital.
Script_. of Muratori; there is an edition by E. Dümmler (1877), and a
partial translation into German, with an introduction by W.
Wattenbach, is given in the second volume of the _Geschichtsschreiber
der deutschen Vorzeit_ (1853). Compare Wattenbach, _Deutschlands
Geschichtsquellen im Mittelalter_. Three other works, entitled
_Adversaria, Chronicon, 606-960_, and _Opusculum de vitis Romanorum
pontificum_, are usually, but wrongly, assigned to Liudprand. An
English translation of the embassy to Constantinople is in Ernest
Henderson's _Select Documents of the Middle Ages_ (Bohn series, 1896).
A complete bibliography is in A. Potthast's _Bibl. Hist. Medii Aevi_
(Berlin, 1896).
LIVE OAK, a city and the county-seat of Suwannee county, Florida,
U.S.A., 81 m. by rail W. of Jacksonville. Pop. (1890) 687; (1900) 1659;
(1905) 7200; (1910) 3450. Live Oak is served by the Atlantic Coast Line,
the Seaboard Air Line, the Live Oak, Perry & Gulf and the Florida
railways. There are extensive areas of pine lands in the vicinity, and
large quantities of sea-island cotton are produced in the county. Lumber
and naval stores are also important products. The first settlement on
the site of the city was made in 1865 by John Parshley, of
Massachusetts, who erected a large saw-mill here. Live Oak was first
incorporated as a town in 1874, and in 1903 was chartered as a city.
LIVER (O. Eng. _lifer_; cf. cognate forms, Dutch _lever_, Ger. _Leber_,
Swed. _lefver_, &c.; the O. H. Ger. forms are _libara, lipora_, &c.; the
Teut. word has been connected with Gr. [Greek: hêpar] and Lat. _jecur_),
in anatomy, a large reddish-brown digestive gland situated in the upper
and right part of the abdominal cavity. When hardened _in situ_ its
shape is that of a right-angled, triangular prism showing five
surfaces--superior, anterior, inferior, posterior and right lateral
which represents the base of the prism. It weighs about three pounds or
one-fortieth of the body Weight.
Although the liver is a fairly solid organ, it is plastic, and moulds
itself to even hollow neighbouring viscera rather than they to it. The
superior surface is in contact with the diaphragm, but has peritoneum
between (see COELOM AND SEROUS MEMBRANES). At its posterior margin the
peritoneum of the great sac is reflected on to the diaphragm to form the
anterior layer of the _coronary ligament_. Near the mid line of the
body, and at right angles to the last, another reflection, the
_falciform ligament_, runs forward, and the line of attachment of this
indicates the junction of the _right_ and _left lobes_ of the liver. The
anterior surface is in contact with the diaphragm and the anterior
abdominal wall. The attachment of the falciform ligament is continued
down it. The posterior surface is more complicated (see fig. 1);
starting from the right and working toward the left, a large triangular
area, uncovered by peritoneum and in direct contact with the diaphragm,
is seen. This is bounded on the left by the inferior vena cava, which is
sunk into a deep groove in the liver, and into the upper part of this
the _hepatic veins_ open. Just to the right of this and at the lower
part of the bare area is a triangular depression for the right
suprarenal body. To the left of the vena cava is the _Spigelian lobe_,
which lies in front of the bodies of the tenth and eleventh thoracic
vertebrae, the lesser sac of peritoneum, diaphragm and thoracic aorta
intervening. To the left of this is the fissure for the _ductus
venosus_, and to the left of this again, the left lobe, in which a broad
shallow groove for the oesophagus may usually be seen. Sometimes the
left lobe stretches as far as the left abdominal wall, but more often it
ends below the apex of the heart, which is 3½ in. to the left of the mid
line of the body. The relations of the lower surface can only be
understood if it is realized that it looks backward and to the left as
well as downward (see fig. 1). Again starting from the right side, two
impressions are seen; the anterior one is for the hepatic flexure of the
colon, and the posterior for the upper part of the right kidney. To the
left of the colic impression is a smaller one for the second part of the
duodenum. Next comes the _gall bladder_, a pear-shaped bag, the fundus
of which is in front and below, the neck behind and above. From the neck
passes the _cystic duct_, which is often twisted into the form of an S.
To the left of the gall bladder is the _quadrate lobe_, which is in
contact with the pylorus of the stomach. To the left of this is the
_left lobe_ of the liver, separated from the quadrate lobe by the
umbilical fissure in which lies the _round ligament_ of the liver, the
remains of the umbilical vein of the foetus. Sometimes this fissure is
partly turned into a tunnel by a bridge of liver substance known as the
_pons hepatis_. The under surface of the left lobe is concave for the
interior surface of the stomach (see ALIMENTARY CANAL: _Stomach
Chamber_), while a convexity, known as the _tuber omentale_, fits into
the lesser curvature of that organ. The posterior boundary of the
quadrate lobe is the _transverse fissure_, which is little more than an
inch long and more than half an inch wide. This fissure represents the
hilum of the liver, and contains the right and left hepatic ducts and
the right and left branches of the hepatic artery and portal vein,
together with nerves and lymphatics, the whole being enclosed in some
condensed subperitoneal tissue known as _Glisson's capsule_. Behind the
transverse fissure the lower end of the Spigelian lobe is seen as a knob
called the _tuber papillare_, and from the right of this a narrow bridge
runs forward and to the right to join the Spigelian lobe to the right
lobe and to shut off the transverse fissure from that for the vena cava.
This is the _caudate lobe_. The right surface of the liver is covered
with peritoneum and is in contact with the diaphragm, outside which are
the pleura and lower ribs. From its lower margin the _right lateral
ligament_ is reflected on to the diaphragm. A similar fold passes from
the tip of the left lobe as the _left lateral ligament_, and both these
are the lateral margins of the coronary ligament. Sometimes, especially
in women, a tongue-shaped projection downward of the right lobe is
found, known as _Riedel's lobe_; it is of clinical interest as it may be
mistaken for a tumour or floating kidney (see C. H. Leaf, _Proc. Anat.
Soc_., February 1899; _Journ. Anat. and Phys_. vol. 33, p. ix.). The
right and left _hepatic ducts_, while still in the transverse fissure,
unite into a single duct which joins the cystic duct from the gall
bladder at an acute angle. When these have united the duct is known as
the _common bile duct_, and runs down to the second part of the duodenum
(see ALIMENTARY CANAL).
[Illustration: From A. Birmingham Cunningham's _Text-book of Anatomy_.
FIG. 1.--The Liver from below and behind, showing the whole of the
visceral surface and the posterior area of the parietal surface. The
portal fissure has been slightly opened up to show the vessels passing
through it; the other fissures are represented in their natural
condition--closed. In this liver, which was hardened _in situ_, the
impressions of the sacculations of the colon are distinctly visible at
the colic impression. The round ligament and the remains of the ductus
venosus are hidden in the depths of their fissures.]
[Illustration: FIG. 2.--Transverse section through the hepatic lobules.
i, i, i, Interlobular veins ending in the intralobular capillaries.
c, c, Central veins joined by the intralobular capillaries. At a, a
the capillaries of one lobule communicate with those adjacent to it.]
_Minute Structure of the Liver._--The liver is made up of an enormous
number of _lobules_ of a conical form (see fig. 3). If the portal vein
is followed from the transverse fissure, it will be seen to branch and
rebranch until minute twigs called _interlobular veins_ (fig. 2, i)
ramify around the lobules. From these _intralobular capillaries_ run
toward the centre of the lobule, forming a network among the polygonal
hepatic cells. On reaching the core of the conical lobule they are
collected into a central or _intralobular vein_ (fig. 2, c) which
unites with other similar ones to form a _sublobular vein_ (fig. 3,
s). These eventually reach the hepatic radicles, and so the blood is
conducted into the vena cava. In man the lobules are not distinctly
separated one from the other, but in some animals, e.g. the pig,
each one has a fibrous sheath derived from Glisson's capsule (fig. 3,
ct.).
_Embryology._--The liver first appears as an entodermal hollow
longitudinal outgrowth from the duodenum into the ventral mesentery.
The upper part of this forms the future liver, and grows up into the
_septum transversum_ from which the central part of the diaphragm is
formed (see DIAPHRAGM). From the cephalic part of this primary
diverticulum solid rods of cells called the _hepatic cylinders_ grow
out, and these branch again and again until a cellular network is
formed surrounding and breaking up the umbilical and vitelline veins.
The liver cells, therefore, are entodermal, but the supporting
connective tissue mesodermal from the septum transversum. The lower
(caudal) part of the furrow-like outgrowth remains hollow and forms
the gall bladder. At first the liver is embedded in the septum
transversum, but later the diaphragm and it are constricted off one
from the other, and soon the liver becomes very large and fills the
greater part of the abdomen. At birth it is proportionately much
larger than in the adult, and forms one-eighteenth instead of
one-fortieth of the body weight, the right and left lobes being nearly
equal in size.
[Illustration: FIG. 3.--Vertical section through two hepatic lobules
of a pig.
c, c, Central veins receiving the intralobular capillaries.
s, Sublobular vein.
ct, Interlobular connective tissue forming the capsules of the
lobules.
i, i, Interlobular veins.]
_Comparative Anatomy._--In the Acrania (Amphioxus) the liver is
probably represented by a single ventral diverticulum from the
anterior end of the intestine, which has a hepatic portal circulation
and secretes digestive fluid. In all the Craniata a solid liver is
developed. In the adult lamprey among the Cyclostomata the liver
undergoes retrogression, and the bile ducts and gall bladder
disappear, though they are present in the larval form (Ammocoetes). In
fishes and amphibians the organ consists of right and left lobes, and
a gall-bladder is present. The same description applies to the
reptiles, but a curious network of cystic ducts is found in snakes and
to a less extent in crocodiles. In the Varanidae (Monitors) the
hepatic duct is also retiform (see F. E. Beddard, _Proc. Zool. Soc_.,
1888, p. 105). In birds two lobes are also present, but in some of
them, _e.g_. the pigeon, there is no gall-bladder.
[Illustration: FIG. 4.--Diagrammatic Plan of the Inferior Surface of a
Multi-lobed Liver of a Mammal. The posterior or attached border is
uppermost.
u, Umbilical vein of the foetus, represented by the round ligament
in the adult, lying in the umbilical fissure.
dv, The ductus venosus.
vc, The inferior vena cava.
p, The vena portae entering the transverse fissure.
llf, The left lateral fissure.
rlf, The right lateral fissure.
cf, The cystic fissure.
ll, The left lateral lobe.
lc, The left central lobe.
rc, The right central lobe.
rl, The right lateral lobe.
s, The Spigelian lobe.
c, The caudate lobe.
g, The gall bladder.]
[Illustration: FIG. 5.--Human Liver showing a reversion to the
generalised mammalian type.]
In mammals Sir William Flower pointed out that a generalized type of
liver exists, from which that of any mammal may be derived by
suppression or fusion of lobes. The accompanying diagram of Flower
(fig. 4) represents an ideal mammalian liver. It will be seen that the
umbilical fissure (u) divides the organ into right and left halves, as
in the lower vertebrates, but that the ventral part of each half is
divided into a central and lateral lobe. Passing from right to left
there are therefore: right lateral (rl), right central (rc), left
central (lc), and left lateral (ll) lobes. The gall-bladder (g), when
it is present, is always situated on the caudal surface or in the
substance of the right central lobe. The Spigelian (s) and caudate
lobes (c) belong to the right half of the liver, the latter being
usually a leaf-shaped lobe attached by its stalk to the Spigelian, and
having its blade flattened between the right lateral lobe and the
right kidney. The vena cava (vc) is always found to the right of the
Spigelian lobe and dorsal to the stalk of the caudate. In tracing the
lobulation of man's liver back to this generalized type, it is evident
at once that his quadrate lobe does not correspond to any one
generalized lobe, but is merely that part of the right central which
lies between the gall bladder and the umbilical fissure. From a
careful study of human variations (see A. Thomson, _Journ. Anat. and
Phys_. vol. 33, p. 546) compared with an Anthropoid liver, such as
that of the gorilla, depicted by W. H. L. Duckworth (_Morphology and
Anthropology_, Cambridge, 1904, p. 98), it is fairly clear that the
human liver is formed, not by a suppression of any of the lobes of the
generalized type, but by a fusion of those lobes and obliteration of
certain fissures. This fusion is, probably correctly, attributed by
Keith to the effect of pressure following the assumption of the erect
position (Keith, _Proc. Anat. Soc. of Gt. Britain, Journ. Anat. and
Phys_. vol. 33, p. xii.). The accompanying diagram (fig. 5) shows an
abnormal human liver in the Anatomical Department of St Thomas's
Hospital which reproduces the generalized type. In its lobulation it
is singularly like, in many details, that of the baboon (_Papio
maimon_) figured by G. Ruge (_Morph. Jahrb_., Bd. 35, p. 197); see F.
G. Parsons, _Proc. Anat. Soc_., Feb. 1904, _Journ. Anat. and Phys_.
vol. 33, p. xxiii. Georg Ruge "Die äusseren Formverhältnisse der Leber
bei den Primaten," (_Morph. Jahrb_., Bd. 29 and 35) gives a critical
study of the primate liver, and among other things suggests the
recognition of the Spigelian and caudate lobes as parts of a single
lobe, for which he proposes the name of lobus venae cavae. This
doubtless would be an advantage morphologically, though for human
descriptive a natomy the present nomenclature is not likely to be
altered.
The gall-bladder is usually present in mammals, but is wanting in the
odd-toed ungulates (Perissodactyla) and Procavia (Hyrax). In the
giraffe it may be absent or present. The cetacea and a few rodents are
also without it. In the otter the same curious network of bile ducts
already recorded in the reptiles is seen (see P. H. Burne, _Proc.
Anat. Soc., Journ. Anat. and Phys_. vol. 33, p. xi.). (F. G. P.)
SURGERY OF LIVER AND GALL-BLADDER.--Exposed as it is in the upper part
of the abdomen, and being somewhat friable, the human liver is often
torn or ruptured by blows or kicks, and, the large blood-vessels being
thus laid open, fatal haemorrhage into the belly-cavity may take place.
The individual becomes faint, and the faintness keeps on increasing; and
there are pain and tenderness in the liver-region. The right thing to do
is to open the belly in the middle line, search for a wound in the liver
and treat it by deep sutures, or by plugging it with gauze.
_Cirrhosis of the Liver._--As the result of chronic irritation of the
liver increased supplies of blood pass to it, and if the irritation is
unduly prolonged inflammation is the result. The commonest causes of
this chronic hepatitis are alcoholism and syphilis. The new fibrous
tissue which is developed throughout the liver, as the result of the
chronic inflammation, causes general enlargement of the liver with,
perhaps, nausea, vomiting and jaundice. Later the new fibrous tissue
undergoes contraction and the liver becomes smaller than natural. Blood
then finds difficulty in passing through it, and, as a result, dropsy
occurs in the belly (ascites). This may be relieved by tapping the
cavity with a small hollow needle (Southey's trocar), or by passing into
it a large sharp-pointed tube. This relieves the dropsy, but it does not
cure the condition on which the dropsy depends. A surgical operation is
sometimes undertaken with success for enabling the engorged veins to
empty themselves into the blood-stream in a manner so as to avoid the
liver-route.
_Inflammation of the Liver_ (hepatitis) may also be caused by an attack
of micro-organisms which have reached it through the veins coming from
the large intestine, or through the main arteries. There are, of course,
as the result, pain and tenderness, and there is often jaundice. The
case should be treated by rest in bed, fomentations, calomel and saline
aperients. But when the hepatitis is of septic origin, suppuration is
likely to occur, the result being an hepatic abscess.
_Hepatic Abscess_ is especially common in persons from the East who have
recently undergone an attack of dysentery. In addition to the local
pain and tenderness, there is a high temperature accompanied with
shiverings or occasional rigors, the patient becoming daily more thin
and miserable. Sometimes the abscess declares itself by a bulging at the
surface, but if not an incision should be made through the belly-wall
over the most tender spot, and a direct examination of the surface of
the liver made. A bulging having been found, that part of the liver
which apparently overlies the abscess should be stitched up to the sides
of the opening made in belly-wall, and should then be explored by a
hollow needle. Pus being found, the abscess should be freely opened and
drained. It is inadvisable to explore for a suspected abscess with a
hollow needle without first opening the abdomen, as septic fluid might
thus be enabled to leak out, and infect the general peritoneal cavity.
If an hepatic abscess is injudiciously left to itself it may eventually
discharge into the chest, lungs or belly, or it may establish a
communication with a piece of intestine. The only safe way for an
abscess to evacuate itself is on to the surface of the body.
_Hydatic Cysts_ are often met with in the liver. They are due to a
peculiar development of the eggs of the tape-worm of the dog, which have
been received into the alimentary canal with infected water or uncooked
vegetables, such as watercress. The embryo of the taenia echinococcus
finds its way from the stomach or intestine into a vein passing to the
liver, and, settling itself in the liver, causes so much disturbance
there that a capsule of inflammatory material forms around it. Inside
this wall is the special covering of the embryo which shortly becomes
distended with clear hydatid fluid. The cyst should be treated like a
liver-abscess, by incision through the abdominal or thoracic wall, by
circumferential suturing and by exploration and drainage.
_Tumours of the Liver_ may be innocent or malignant. The most important
of the former is the _gumma_ of tertiary syphilis; this may steadily and
completely disappear under the influence of iodide of potassium. The
commonest form of malignant tumour is the result of the growth of
cancerous elements which have been brought to the liver by the veins
coming up from a primary focus of the large intestine. Active surgical
treatment of such a tumour is out of the question. Fortunately it is, as
a rule, painless.
_The Gall-bladder_ may be ruptured by external violence, and if bile
escapes from the rent in considerable quantities peritonitis will be set
up, whether the bile contains septic germs or not. If, on opening the
abdomen to find out what serious effects some severe injury has caused,
the gall-bladder be found torn, the rent may be sewn up, or, if thought
better, the gall-bladder may be removed. The peritoneal surfaces in the
region of the liver should then be wiped clean, and the abdominal wound
closed, except for the passage through it of a gauze drain.
Biliary concretions, known as _gall stones_, are apt to form in the
gall-bladder. They are composed of crystals of bile-fat, cholesterine.
Sometimes in the course of a _post-mortem_ examination a gall-bladder is
found packed full of gall-stones which during life had caused no
inconvenience and had given rise to no suspicion of their presence. In
other cases gall-stones set up irritation in the gall-bladder which runs
on to inflammation, and the gall-bladder being infected by septic germs
from the intestine (_bacilli coli_) an abscess forms.
_Abscess of the Gall-bladder_ gives rise to a painful, tender swelling
near the cartilage of the ninth rib of the right side. If the abscess is
allowed to take its course, adhesions may form around it and it may
burst into the intestine or on to the surface of the abdomen, a _biliary
fistula_ remaining. Abscess in the gall-bladder being suspected, an
incision should be made down to it, and, its covering having been
stitched to the abdominal wall, the gall-bladder should be opened and
drained. The presence of concretions in the gall-bladder may not only
lead to the formation of abscess but also to invasion of the
gall-bladder by cancer.