CIKRHOSIS OF THE LIVER. 677 



the formation of sugar in the liver, or on the arrest of some other un- 

 known function. In isolated cases, severe brain symptoms appear 

 shortly before death ; some patients fall into delirium, and finally into 

 deep sopor ; others have symptoms of depression, coma, or sopor, from 

 the commencement. On autopsy, we find no palpable changes in the 

 brain to explain these symptoms ; hence we are justified in referring 

 them to an intoxication ; but we do not know what substances cause 

 the intoxication. Formerly it was universally supposed that these 

 brain-symptoms depended on the absorption of the constituents of the 

 bile, and they were, consequently, termed choloemic intoxications. But 

 the fact that their frequency is not at all in proportion to the icterus, 

 that, on the contrary, where there is but little jaundice, convulsions, 

 coma, and sopor not unfrequently occur suddenly, while they are often 

 absent in the severest cases where the overloading of the blood with 

 the absorbed constituents of the bile is much more evident, speaks very 

 strongly against the correctness of this explanation. Frerichs has 

 advanced the hypothesis that it is not the reabsorption of bile, the so- 

 called cholaemia, which is dangerous, but the acholia, occurring in ex- 

 tensive degeneration of the liver, i. e., that condition where the exten- 

 sively-diseased liver can no longer prepare bile from the materials 

 supplied to it. When this important process fails, instead of the nor- 

 mal products of interchange of tissue, we have abnormal products of 

 decomposition and poisonous substances. The above severe disturb- 

 ances of innervation are induced by these substances. The correctness 

 of this hypothesis of Frerichs is by no means beyond doubt. When 

 speaking of icterus, we shall return to the relation of the brain-symp- 

 toms in question, to cholaemia, or acholia, and show that some recent 

 observers incline to the first theory, as they regard the reabsorbed bile- 

 acids as the poisonous substances. 



The occurrence of quantities of abnormal coloring matter, and of 

 urates in the urine of patients suffering from cirrhosis, also appears to 

 depend on the destruction of the liver-cells, and the diminished or 

 altered action of the li ver. We do not know what modifications of the 

 change of tissue induce this condition of the urine. The most we can 

 determine is that, if the coloring matter of the urine be derived from 

 the coloring matter of the bile, and this be a derivative from the color- 

 ing matter of the blood, in extensive degeneration of the liver, where 

 the coloring matter of the blood is no longer normally transformed into 

 the coloring matter of the bile, this anomaly must influence the forma- 

 tion of the coloring matter of the urine and its modifications. 



Lastly, as to the physical signs of interstitial hepatitis, in the 

 first stage, palpation and percussion usually show a very decided in- 

 crease in size and resistance. In the second stage, also, the liver if 



