HEPATIC CANCER. 



187 



discoloration of the skin, which in the advanced stage 

 becomes of a citron-yellow, or olive-green, and dry 

 like parchment. The respiration becomes more or less 

 impeded, dependent on a participation of the dia- 

 phragm in the cancerous degeneration distention of 

 the abdomen, or pleurisy of the right side. 



There may be jaundice, but this is not a constant 

 symptom, unless the position of the tumours are such 

 as to implicate the large bile-ducts. If the jaundice 

 attains a considerable degree of intensity, we may 

 fairly infer that a cancerous tumour has become 

 developed in the fissure of the liver between this and 

 the duodenum in such a way as to obstruct the flow 

 of bile. There is one peculiarity in the jaundice 

 dependent upon hepatic cancer which is worthy of 

 note whether slight or severe it never disappears, 

 but continues to the close of the scene. 



ASCITES. Cancer of the liver may give rise to 

 effusion of water into the peritoneal cavity in 

 various ways ; when slight in amount the accumula- 

 tion of fluid appears to result from chronic peritonitis ; 

 \\-}u'ii abundant, from pressure of the large venous 

 trunks. The water sometimes accumulates to such an 

 extent as to demand tapping in order to relieve the 

 distressing breathing it incurs. As regards the 

 frequency of ascites, in the thirty-one cases recorded 

 by Frerichs, he found the peritoneum contained a large 

 quantity of water in 18 : five times it consisted of pure 

 serum ei-lit limes serum and fibrinous flakes four 

 times bloody fluid, and once pure blood. Of sixty 

 cases recorded by others, dropsy was present in 

 thirty, absent in nineteen, and no record of the 



