G70 DISEASES OF THE LIVER. 



tines, or even when it enters the bronchi and is coughed up, the pa- 

 tients usually feel instantaneously relieved ; the improvement rarely 

 remains permanent, however, and, when it does so, it is only in cases 

 where the abscess was small. Budd only saw closure of the abscess 

 and perfect cure of the patient in one case after the evacuation of the 

 pus. The abscess usually continues to suppurate, and the patients 

 sooner or later die of exhaustion from the suppuration and fever. 

 Cases of cure after capsulation and gradual decrease in size of the 

 abscess, with inspissation of its contents, are very rare, and during life 

 it must be difficult to decide that this has occurred. 



TREATMENT. It is only in the rare cases of traumatic hepatitis 

 that we can hope to induce resolution of the inflammation by the use 

 of cold compresses, and the application of leeches about the anus. In 

 the subsequent course of the disease, blisters over the liver, and the 

 internal administration of calomel, are very generally employed, but are 

 of doubtful efficacy. 



In all other forms of parenchymatous hepatitis, we have to confine 

 ourselves to the treatment of symptoms, particularly as they are rarely 

 recognized until abscesses have formed. Fortunately for the patient, 

 the views on which it was formerly maintained, that the reabsorption 

 of pus was aided by the internal and external use of mercurials, are 

 no longer held ; although it is said that patients with liver-disease are 

 just the ones who can take large doses of calomel without injury. 



As long as there is no perceptible fluctuation, and we cannot open 

 the abscess, we must limit ourselves to keeping up the strength of the 

 patient by suitable diet, wine, and preparations of iron. For the chills 

 we prescribe quinine, which not unfrequently has a very decided anti- 

 periodical action. 



As experience shows that those abscesses heal best from which 

 pus mixed with blood and broken-down parenchyma of the liver have 

 been evacuated, while those containing good or laudable pus rarely 

 healed, we should make it a rule to open the abscesses as early as pos- 

 sible, before a so-called pyogenic membrane has formed in them. Sur- 

 gery teaches us to be peculiarly careful in opening abscesses of the 

 liver, and that we should use caustics instead of the knife, where we 

 cannot certainly determine that the liver has become adherent to the 

 abdominal walls. 



CHAPTER III. 



CHRONIC INTERSTITIAL HEPATITIS, CIRRHOSIS OF THE LIVER, GRAND 



LAR LIVER. 



ETIOLOGY. Interstitial hepatitis affects the fibrous covering of the 

 liver and the scanty connective tissue, which, as the continuation of 



