_Active congestion_ of the liver may result from blows or injuries over the region of the gland, from suppression of hæmorrhoid discharges, or suppression of the menses in the female. It will then be found presenting a deep red color, may be greatly increased in size, is more firm, and before opening the body, may be frequently felt below the margin of the ribs on the right side. One of the most frequent causes of _passive congestion_ of the liver, is organic disease of the heart, accompanied with obstruction in the circulation through the lungs, giving rise thus to difficulty in emptying of the right side of the heart, and of the venous system generally. A chronic form of congestion of the liver may result from emphysema of the lungs, large pleuritic effusions, or tumors within the chest, and is frequently found in persons of sedentary habits who have been “high livers,” or in those who have used large quantities of alcoholic or fermented liquors, or in the residents of hot climates or malarial districts. Temporary congestion of the liver, although very extreme, does not result in structural change; but when arising from a permanent cause, as disease of the heart, etc., it produces the following effects:—“The distended capillaries of the portal-hepatic plexus press on the intervening cells; these become in part atrophied or stunted; in extreme cases almost destroyed; in part they are gorged with yellow matter to such a degree that they appear as opaque masses. The quantity of yellow matter thus formed is far greater than any that exists in a healthy state of the organ, and as some of it is doubtless absorbed and carried into the blood, we find in this circumstance some explanation of the icteric hue which is so often observed in such patients. Whether long-continued congestion produces still further changes is not yet made out clearly.”[22] Extreme congestion of the liver may sometimes result in =Hæmorrhagic Effusion=, the blood being either poured out near the surface, and dissecting up the capsule, or more deeply in the substance of the gland; or, rupturing the capsule, it may escape into the peritoneal cavity. Such effusions may be found in new-born children after protracted and difficult labors, or as a result of external violence, and sometimes attend malignant fevers, scurvy, and purpura. =Perihepatitis.= The peritoneal covering of the liver, very frequently in post-mortem examinations, presents appearances of having been attacked by inflammation, in the presence of bands of adhesion connecting different portions of the surface of the gland to adjoining organs. The whole of the upper surface will sometimes be found closely united in this manner, to the diaphragm. Such appearances are sure indications of the existence at one time, of an attack of peritoneal inflammation. In a cirrhosed condition of the gland, and over the seat of abscesses of the liver, such adhesions almost universally form.