=Chronic Atrophy, Cirrhosis or Hob-nail Liver.= The form of atrophy of the liver which we now have to consider, is slow in its progress, and is usually associated with abdominal dropsy. The appearance and density of the gland varies to a considerable extent in different cases of chronic atrophy, yet the usual appearance is that seen in what is known as cirrhosis,[23] or “hob-nail liver,” also sometimes called “gin-drinker’s liver.” Here the liver has become reduced in size, from a slow destruction of the secreting tissue, while, at the same time, the fibrous tissue of Glisson’s capsule has become thickened and hardened, from a chronic inflammatory action, often due to the use of spirituous liquors. The outer surface presents a granular or nodulated character, which has given rise to the term “hob-nail,” as applied to this disease; while, upon section, the interior presents firm fibrous bands, surrounding yellow patches of secreting tissue. While, in the majority of cases, this disease is plainly owing to an abuse of spirituous liquors, in others, it is found associated with disease of the heart, or with constitutional syphilis, where the patient has been strictly temperate. The increased density, in connection with the diminution of size, and granulated character of the surface, renders the disease readily recognizable in a post-mortem examination. The early stage of this disease appears to be accompanied with a degree of enlargement of the gland, resulting from the congestion attending the inflammation of the fibrous structure. As this structure increases in density, by pressure it causes a gradual absorption of the secreting lobules, and thus results in a reduction in the size and weight of the organ. The secreting cells of the lobules of the liver, may undergo fatty change, or they may become entirely destroyed. Thrombi may be found in the portal vein. The hepatic artery and its branches become increased in size, while the interlobular hepatic veins become quite destroyed. The obstruction to the circulation through the liver, resulting from these changes, gives rise to the dropsical effusions usually found in this disease. Prominent among the symptoms attending this disease, during life, may be mentioned:—1st. Diminished area of hepatic dulness. 2d. Ascites, particularly in advanced stages of the disease, although patients may die before dropsy sets in. 3d. Enlargement of the spleen—this being present at least in about one-half the cases. 4th. Enlargements of the superficial veins of the abdomen, from obstructed flow of the portal blood, or from pressure upon the vena cava, from abdominal distension. 5th. Hæmorrhoids, epistaxis, hæmatemesis, etc. 6th. The rare occurrence of decided jaundice. 7th. In all cases, the advance of the disease is marked by progressive emaciation and debility, the patient usually dying of exhaustion, although in some cases death is due to an attack of pneumonia, œdema of the lungs, or acute peritonitis.