CIRRHOSIS OF THE LIVER. 679 



emaciated and exhausted. During the last days of life, delirium and 

 sopor not unfrequently develop. 



DIAGNOSIS. Cirrhosis would not readily be mistaken for any of the 

 previously described diseases of the liver, but its diagnosis from cancer 

 or tuberculosis of the peritonaeum may be very difficult. In these de- 

 generations, as in cirrhosis, there is often ascites, which has been pre- 

 ceded by no other symptoms of dropsy. The patients also soon be- 

 come emaciated and cachectic, and, as the tumors not unfrequently com- 

 press the ductus choledochus, we may have icterus accompanying them. 

 The following points are particularly important in the diagnosis be- 

 tween cirrhosis and these diseases of the peritonaeum : 



In doubtful cases the dependence of the ascites and other symp- 

 toms common to the two diseases on cirrhosis may be suspected 

 1. When there is swelling of the spleen. "We have learned that this 

 is an almost constant symptom of cirrhosis ; on the other hand, the 

 spleen is almost always unaffected by tuberculosis and carcinoma, and 

 these are not more likely to cause any other form of enlargement of 

 the spleen. 2. The urine is saturated with abnormal coloring matter, 

 and urates. While this symptom also is rarely absent in cirrhosis, the 

 urine of cancerous or tuberculous patients, like that of all hydraemic 

 persons, is usually very clear and watery. When the degeneration of 

 the peritonaeum is accompanied by fever, or when compression of the 

 kidneys and renal blood-vessels by the ascites limits the secretion of 

 urine, the scanty urine may, it is true, be quite concentrated, but there is 

 usually no sediment, and the urine is not so dark as in cirrhosis. 3. The 

 knowledge that the patient was given to drinking. In far the greater 

 number of cases, as we have seen, cirrhosis may be referred to the 

 misuse of spirits, while this has no influence on the development of 

 cancer or tuberculosis. 



On the other hand, the following symptoms speak for degeneration 

 of the peritonaeum, and against cirrhosis : 1. Extensive sensibility of 

 the abdomen to pressure. 2. Rapid development of ascites. 3. Rapid 

 loss of strength. 4. Recognition of cancer, or tubercles in other or- 

 gans. 5. Tumors in the abdomen, which may not be felt till after 

 *apJ5ing. 6. Occurrence of fibrin, which does not coagulate for a long 

 time, uVthe fluid evacuated by tapping. 



The peculiar color, usual in cancerous persons which is of some 

 importance in distinguishing cancerous degenerations from othei 

 diseases is of little value in diagnosing carcinomatous degeneration 

 of the peritonaeum from cirrhosis ; for in the latter also the patient 

 has the dirty-yellow, so-called cancerous hue. 



TREATMENT. If, as rarely happens, interstitial hepatitis be recog- 

 nized or suspected in its first stage, we should attempt to arrest ita 



