104 SYMPTOMS OF SECOND STAGE OF CIRRHOSIS. 



structures, which are separated from each other by 

 narrow strips of grey, or more or less vascular " areolar 

 tissues ;" in some cases the colour is dark from the pres- 

 ence of bile-pigment ; in other cases pale, from the deposit 

 of fatty matter. 



In the second stage, symptomatologically speaking, the 

 patients still complain of feeble digestion, which is 

 easily disordered by articles of diet that formerly could 

 be taken with impunity. The appetite falls off. There 

 is distention and tenderness of the epigastrium along 

 with flatulence and obstinate constipation ; after a time 

 these symptoms abate, but return from time to time from 

 any slight and trivial cruise. 1 \y degrees such patients lose 

 flesh and strength ; the colour of the skin becomes either 

 pale, earth-coloured, or a dirty yellow, whilst the skin 

 itself is dry, scaly, and rough. The abdomen now 

 becomes distended, and fluctuates, the prominent out- 

 lines of the liver are no longer felt by either percussion 

 or palpation, but a close examination reveals atrophy 

 of this organ, and considerable enlargement of the 

 spleen. 



Onward now is the course of destruction of cirrhosis, 

 a general condition of emaciation and debility sets in. 

 The watery portion of the blood is effused into the abdo- 

 men (ascites), producing distention of that cavity, and, as 

 a consequence, urgent and distressing dyspnoea. Haemor- 

 rhages take place from the stonuu-li and intustines, the 

 nose and mouth; the urine, at first tolerably abundant, 

 now becomes more and more scanty as the flood of 

 dropsy advances, and, at the same time, puts on a deep- 

 red hue, often turbid, and deposits a brick-red sedin 

 The dyspnoea becomes more urgent day by day, and in 



