ACUTE, OR YELLOW ATROPHY OF THE LIVER. 75 



symptoms are usually ushered in with vomiting, by 

 means of which there is first thrown up the ordinary 

 contents of the stomach, then is followed grey mucus, 

 and lastly blood, in the form of a dirty brown or black 

 coffee-ground substance. There is severe pain in the 

 head, which soon lapses into delirium. In the gene- 

 rality of cases this delirium is noisy ; the sufferers scream 

 out, beat themselves, endeavour to leave their beds, and 

 are with difficulty restrained. In other cases they are 

 quieter, lay in a comatose condition, and are only roused 

 by loud shouting. The delirium is sometimes succeeded 

 by convulsions, which extend over most of the voluntary 

 muscles, or are confined to certain localities, such as the 

 muscles of the face and neck ; occasionally they appear 

 in the form of trismus or lock-jaw; and in other cases 

 one half of the body is implicated to a greater extent 

 than the other. After a time the patient becomes by 

 degrees more and more tranquil, the state of excitement 

 L r ra<lually passing into a stupor, and finally into a deep 

 coma ; there is a vacant stare, the pupils become large, 

 react but slowly to the light, and the respiration becomes 

 sighing, intermittent, and stertorous. The pulse, which 

 at first is slow, continues so as long as the Jaundice 

 remains simple ; but as the nervous system becomes 

 more exalted, it increases in frequency, and gradually 

 rises to 110 or 1 _>, and even more ; at the same time 

 it presents variations in frequency and volume which 

 are very remarkable, as sometimes, when the patients 

 are roused, the pulse rises from 70 or 80 to 120 or 130, 

 which soon lapses again into its normal standard, or 

 even below it. These variations in the frequency of the 

 pulse cease when the disease draws towards a close 



