HEPATITIS OF DIFFERENT PARTS OF THE LIVER. 123 



bear a strong resemblance to pleurisy and pneumonia. 

 There is cough, oppression, dyspnoea, pain in course of 

 the diaphragm, much increased on inspiration; the pulse 

 is quick and hard; the tongue is dry; and there is thirst, 

 heat and dryness of the skin. The stools are disordered* 

 at first scanty, dry, and infrequent, at other times relaxed 

 and more or less tinged with bile, and the urine is 

 scanty, high-coloured and charged with lithates. 



B. When the concave and posterior surface of the 

 liver is inflamed there are marked functional derange- 

 ments of stomach, nausea and vomiting, particularly 

 after food; thirst, great anxiety with urgent pain in the 

 epigastrium and back, which often extends to the right 

 shoulder and neck. The pulse varies from an irritable, 

 quick, small, contracted, to a hard one. There is often 

 a sense of fluttering with heavy dragging pains in the 

 pit of the stomach ; great anxiety, frequent sighing, and, 

 in the advanced stage, hiccup. The usual posture of 

 the patient is on thu back or right side. 



c. The leading symptoms of inflammation of the 

 substance of the liver are marked early by chills, rigors, 

 irregular diarrhcea, uneasiness, weight, and oppression 

 in the right hypochondrium and pit of the stomach, 

 i- x it-nding to the ensiform cartilage and diaphragm to 

 the back and shoulder-blades, increased on pressure 

 made beneath the ribs and over the stomach, or a deep 

 inspiration. The pulse at this stage is hardly affected, 

 but as the inflammatory action progresses it becomes 

 quick, particularly towards night ; the pulse, however, 

 varies, as we sometimes find it slow, oppressed, irregular, 

 and even intermittent ; the countenance is pale, sallow, 

 and anxious ; the spirits depressed ; the tongue is white 



