84 DISEASES OF THE SOLID ORGANS OF THE ABDOMEN. 



an appearance of discomfort, very marked in a proportion of cases, from 

 which it might be inferred he was suffering from pain. His position 

 assumed on lying down is somewhat characteristic, it being on his chest 

 and belly. He shows a disinclination to exertion and on getting up his 

 movements appear stiff and painful. Thirst is usually excessive ; vomiting 

 attends a certain proportion of cases and the odor of the breath becomes 

 markedly offensive. The condition of the bowels is not indicative ; loose- 

 ness occurs in some, and in other cases the bowels are constipated ; the 

 two may alternate. 



Unless the attack be associated with pulmonary disease, the respiration 

 is at first unaffected. Fever is a constant symptom ; the pulse becomes 

 full, bounding, and rapid. Tenderness on pressure over the liver is char- 

 acteristic. 



Jaundice appears quite early in the disease, generally within four days 

 after the first symptoms are manifested. The skin becomes yellow, the 

 eyes of the same tint, or dull and lustreless ; the mucous membrane of 

 the mouth paler, the urine darker in color leaving an indelible stain, and 

 the discharges are "clay colored." The pulse previously rapid now falls, 

 sometimes below the normal. The enlargement of the liver or a swelling 

 in some part of it now very likely appears, but its increase in size may 

 not in all cases be sufficient to be appreciated. 



The course of the disease is usually rapid, and may terminate in abscess, 

 recovery without abscess, or resolve into the chronic form. When death 

 occurs from abscess, a swelling over the region of the liver can usually be 

 determined. Emaciation is rapid and associated with the usual signs of 

 failure and exhaustion. The breathing changes, becoming quick and hur- 

 ried; the pulse weak and feeble. The bowels assume the appearance of 

 pregnancy. 



"Diagnosis. —Early in the disease the diagnosis is exceedingly difficult 

 in many cases ; in none will it be easy. The manner of the attack, the loss 

 of appetite, the high fever, the local tenderness and evident pain, and the 

 occurrence of jaundice, render the existence of acute hepatitis highly 

 probable. If in addition to these symptoms the liver is found to be en- 

 larged, the diagnosis may be made with reasonable certainty. 



Prognosis.— Acute hepatitis is a disease attended with great danger, 

 and will in nearly all cases prove fatal if an abscess forms. When asso- 

 ciated with other diseases the danger is intensified. Even if recovery 

 takes place convalescence is apt to be slow and tedious. 



Treatment. —The purposes of treatment are to arrest inflammation, 

 thereby preventing the formation of abscess. 



The amount of pain and constitutional disturbance will indicate the use 

 of opium, which should be given in the form of Dover's powder; dose five 



