126 PRACTICE OF MEDICINE. 



of preventing their recurrence. Small doses of ferri sulph. with 

 pil. rhei. c, may be useful, if taken regularly. 



ACUTE HEPATITIS. 



Causes, — External violence ; hepatic calculi ; suppressed secre- 

 tions ; influences of climate ; duodenitis, &c. 



Symptoms. — General febrile excitement ; lancinating or dull pain 

 of the right side, increased on full inspiration ; a sympathetic pain 

 is also sometimes felt in the right (very rarely in the left) shoulder, 

 and along the neck. Sense of uneasiness at the stomach, and 

 nausea or vomiting ; short, dry cough ; hiccup ; bowels constipated ; 

 pulse frequent and hard ; and the urine high coloured. The patient 

 commonly lies on the right side, and the skin is often tinged with the 

 yellow colour of jaundice. Rigors indicate suppuration. 



Morbid appearances. — In this climate, it is rather the peritoneal 

 covering than the liver itself which is the seat of the disease. When 

 the substance of the liver is inflamed, it becomes brittle and friable ; 

 the granulations are larger and more red than natural, and the lining 

 membrane of the biliary ducts is injected and of a reddish brown 

 colour. In most cases, abscesses are found in difl^erent parts of the 

 liver, or the greater part of the organ may be converted into one 

 large cyst containing pus. In other cases, the purulent matter is in- 

 filtrated into the substance of the gland. Dr. Budd has called atten- 

 tion to the fact, that the abscesses in the liver, following dysentery, 

 are often owing to an inflammation of the hepatic veins. 



Treatmeyit. — General bloodletting ; leeches, or cupping over the 

 region of the liver, followed by a large blister. The bowels must 

 be kept constantly free by saline cathartics. The Indian practition- 

 ers are very partial to mercury, which they administer in large 

 doses to produce salivation as quickly as possible ; but in this country, 

 when mercury is given, it should be exhibited more with a view of 

 restoring the biliary secretion than of exciting salivation. 



CHRONIC DISEASE OF THE LIVER. 



This is denoted by more or less pain and tenderness, or weight 

 and fullness in the right hypochondrium, with sallowness of the skin, 

 emaciation, and depression of the spirits. 



It may be a consequence of acute inflammation, or of long resi- 

 dence in unhealthy climates, or of diseases of the heart ; one very 

 frequent cause is intemperance. 



Sometimes the liver increases greatly in bulk, and may be felt low 

 in the abdomen, or its limits be ascertained by percussion. Some- 

 times, on the contrary, it is shrunken and atrophied. 



One common form of disease, which is oflen a precursor of ascites, 

 is what is called the hob-nailed liver. This disease originally con- 

 sists in an inflammatory thickening of Glisson's capsule, which 



