APPEARANCE OF CANCER OF THE LIVER. 189 



of lithic acid and lithates which are almost always 

 pinkish. When general cachexia has fully set in, and 

 the patient is exhausted by insufficent nourishment and 

 repeated loss of blood, the urine acquires the anccmic 

 character as described by M. Becquerel; and it has 

 been shown by the same observer that all serious organic 

 affections of the liver are attended by febrile urine ; 

 cancer of this organ only obeys the general law, whilst 

 the change does not become established till an advanced 

 period of the disease. 



THE LIVER. The last and most important group of 

 symptoms which I shall now have to refer to, are the 

 peculiar characters presented by the liver when invaded 

 by cancer. I have already said that the early symptoms 

 are obscure, and refer chiefly to signs which may easily 

 be confounded with indigestion, or a mild form of 

 hypochondriasis. After these ailments, however, have 

 lasted for some time, the medical attendant, or perhaps 

 the patient himself discovers that the region of the liver 

 is larger or fuller than usual, and that there is more 

 or less pain and tenderness on pressure. 



The surface and margins of this fulness, or swelling, 

 are in exceptional cases smooth, but in by far the 

 majority of cases are covered with large or small 

 hard nodules. With these symptoms are not unfre- 

 quently associated jaundice, ascites, and a puffiness of 

 the lower liniKs, particularly round the ankles. These 

 symptoms from time to time undergo aggravation ; the 

 pains become more acute, and shoot up between the 

 shoulders; the abdominal walls become tense. The 

 breathing is distressed, the skin is hot and dry, and the 

 pulse is quick. These symptoms, and a repetition of such, 



