CAUSES. 71 



Let us briefly examine these in the order as set down. 

 1. Inflammation of the capsule of the liver, and of 

 Glisson's capsule. The Peri-hepatitis vel Peritonitis 

 Hepatica of some writers. 



CAUSES. Inflammation of the covering of the liver 

 may arise from many causes. We sometimes meet with 

 it as a part of general peritonitis ; at other times the 

 result of external violence directed against the hepatic 

 region, as once occured in my own practice, from the 

 kick of a horse. The result was fatal, while a post- 

 mortem examination revealed not only inflammation of 

 the capsule, but rupture of the liver as well. In other 

 cases the inflammatory process is found to spread from 

 neighbouring structures, and morbid deposits ; such as, in 

 pleurisy of the right side, the serous coverings of the 

 diaphragm, ulceration, and cancer of the stomach. But 

 diseases of the liver itself, such as abscess and chronic 

 induration (cirrhosis), are the most prolific causes ; as 

 in such cases Necropsy invariably reveals the capsule 

 thickened, and united by numerous bands of cellular 

 tissue, which extend to the neighbouring peritoneum, the 

 surface of the ribs, or to the adjacent portion of intestines. 

 Peri-hepatitis in its more ordinary forms is not as a 

 rule a very serious disease, but may become so when 

 implicated with thickening of ' Glisson's capsule/ the 

 il vein, artery, or vena cava. Hence the im- 

 portance of paying strict attention to all the symptoms 

 which indicate its presence. 



ii'iuMvroLOGY. The leading characteristics which 

 attend Peri-hepatitis are, a certain amount of tenderness 

 of the region of the liver, which is increased upon 

 pressure, motion, and upon deeply inspiring ; there is 



