G32 DISEASES OF THE LIVER. 



above-described spots is almost the only symptom which will prevent 

 our mistaking syphilitic induration of the liver for cirrhosis ; but the 

 more regular homogeneous appearance of the cut surface and the ab- 

 sence of the granulations, which are rarely never wanting in cirrhosis, 

 furnish some points for the diagnosis. Besides the fact that syphilitic 

 perihepatitis usually complicates the above-described parenchymatoua 

 diseases, it is somewhat characteristic of this affection that the thick- 

 enings of the serous covering caused by it are more decided than in 

 other forms of perihepatitis, and that they are peculiarly hard and 

 tough. 



SYMPTOMS AND COURSE. In many cases syphilitic hepatitis can- 

 not be recognized or suspected during life. Occasionally we may make 

 the diagnosis from the peculiar form of the enlarged liver, on whose 

 surface prominences and retractions may be distinguished, and from 

 the coexistence of other symptoms of constitutional syphilis. In one 

 patient in Greifswald, who complained of the symptom's of chronic 

 peritonitis, from the peculiar form of the liver I was able to diagnose 

 the probable existence of hepatitis, before the patient acknowledged 

 to being infected, and before examination of the throat had shown a 

 decided defect in both sides of the soft palate. This patient has since 

 died, and, according to a notice that I have found in the Griefswalder 

 Medicinischen Ifeitragen, the autopsy confirmed my diagnosis. In 

 the former editions of my book I asserted that it was not improbable 

 that, where the process was very extensive, compression of the portal 

 vein and bile-ducts might induce a series of symptoms similar to those 

 from cirrhosis. I was then obliged to add that, in the cases then pub- 

 lished, there had been a moderate ascites in only one, while icterus 

 had not occurred in any case. Since then I have had the opportunitv 

 of observing one case that has fully sustained my conjecture : A pa- 

 tient, who denied ever having had syphilis, was received into the 

 clinic with icterus, excessive ascites (which required repeated tapping), 

 and very dark urine, which contained quantities of abnormal coloring 

 matter. The liver was enlarged, and on its surface could be felt distinct 

 round protuberances, which were not puffy or in the form of ridges. 

 The diagnosis of carcinoma of the liver, with consecutive closure of the 

 portal vein, was not confirmed by the autopsy. The liver was typi- 

 cally lobulated, its covering much thickened in some places, a large 

 amount of its parenchyma diffusely indurated ; deep in the right lobe 

 of the liver were three or four still fresh, medullary-looking gummy 

 tumors. 



TREATMENT. There can hardly be a question of treatment in syph- 

 ilitic hepatitis, for, even in those cases where the disease is recognized 

 during life, it is only toward its end. We cannot depend on relaxing 



