Hepato-lienal fibrosis without cirrhosis: non-cirrhotic intrahepafic portal hypertension

In 1933, John McMichael was awarded a gold medal by the University of Edinburgh for his M.D. thesis. This was entitled 'The pathology of hepatolienal fibrosis' and was published in an abridged form in 1934 in the Journal of Pathology and Bacteriology. It was a masterly account of the pathological changes associated with portal hypertension. Pathological changes in spleen and portal vasculature were identical whether or not cirrhosis was present. McMichael was particularly interested in the non-cirrhotic cases. In all of them a mild 'hepatitis' usually portal zone lesions, could be demonstrated. He speculated that it might be due to vasodilatation of the hepatic arteries or to spasm of the portal venules in the liver. These observations were at least 30 years ahead of their time. The newer techniques of intrasplenic and wedged hepatitic venous pressure measurement, hepatic blood flow and splenic venography have only served to confirm McMichael's original observations (Fig. 1).