G ALEN and his associates beIieved the Iiver to be the seat of a11 evi1. AbnormaI conditions of the Iiver were considered as the principa1 cause of changes in the constitution of the bIood. PIethora, anemia, cachexia and dropsy were attributed to certain changes in the activity of the gIand. A further cause of genera1 disease was found in the products of the Iiver secretions, the yehow and bIack biIe, which, under a humora pathology, were considered to be important eIementary constituents of the organism. The yehow biIe was beheved to induce acute diseases, Iike erysipeIas, that run a rapid course and are accompanied by high temperature; whiIe bIack biIe was beheved to give rise to chronic diseases, such as mentaI derangements, apopIexy, convuIsions, etc. YeIIow tinging of the skin, and of severa of the secretions, by biIe pigments engaged the attention of the earIy physicians. Later the chemica1 and physica properties of biIe were examined more carefuIIy and in a11 cases and forms of jaundice, a search was made for causes which were IiabIe to obstruct the bihary flow. It was reserved for the experimenta physioIogists to further enhghten us regarding the Iiver and its functions. For many years it has been recognized by surgeons that the deepIy jaundiced patient is a poor surgica1 risk, chieffy because such patients show a tendency to hemorrhage. It has been found, however, that the degree and duration of jaundice is not aIways an indication of whether a patient wiII breed or not. Determination of the coaguIation time of the bIood preoperativeIy is of no practica1 vaIue as an indicator of a hemorrhagic tendency in such cases (Lewisohn,l Linton2). Linton studied the sedimentation rate in reIation to postoperative hemorrhage in jaundiced patients. He found this a more accurate indicator of a hemorrhagic tendency than the coagulation time. If the sedimentation rate was rapid, there was usuahy postoperative hemorrhage; if the rate was normaI, it indicated that there was IittIe risk of hemorrhage. At the New York HospitaI, the “cIotting factors ” are determined and expressed as an index, which is obtained by muItipIying prothrombin by fibrinogen and dividing by antithrombin vaIues. An index beIow 0.7 indicates a tendency to hemorrhage (Lewisohn). The Iiver may be damaged and its function more or Iess deficient in cases where there is no jaundice. This is especiaIIy true in gaII-bIadder disease. Recent investigations have shown that there is practicahy aIways some pathoIogica1 change in the Iiver in cases of gaII-bIadder disease even if there is no chemicahy evident bihary stasis or jaundice. A number of cases of “Iiver death ” have been described in apparentIy good operative risks. Death occurred after operation fohowing a characteristic cIinica1 syndrome with rapid rise of temperature, increased puIse rate and termina1 signs of renaI faiIure and uremia (Deaver,3 Eiss,I Graham,5 Heyd, 6 HeIwig and Schutz7). The Iiver has many functions besides the secretion and excretion of biIe. It