(596 DISEASES OF THE LIVER. 



this is often only slightly enlarged, and even when it projects from 

 beneath the ribs we do not find the characteristic peculiarities of its 

 surface, on palpation. There is little or no pain, as the serous covering 

 is not inflamed, and there is usually no ascites or icterus, as neither the 

 branches of the portal vein nor the gall-ducts are much compressed. In 

 such cases we often have no sufficient grounds for suspecting the dis- 

 ease, till our suspicion of cancer is awakened by a gradually increasing 

 cachexia, for which we can find no other explanation, as all the func- 

 tions are undisturbed ; and when cancer of the uterus, stomach, etc., 

 where it is more readily recognized, can be excluded. The probability 

 is still greater when the suspicious marasmus has developed after the 

 operative removal of an external cancer. If, besides the cancer of the 

 liver, which runs its course without decided enlargement and pain of 

 the liver, or icterus, or ascites, there be cancer of the stomach, morbus 

 Brightii, or some other disease, to explain the marasmus, the disease 

 may often escape suspicion. 



TREATMENT. We cannot expect any successful radical treatment 

 of cancer of the liver. In most cases we must satisfy ourselves with 

 maintaining the strength of the patient as long as possible by careful 

 nourishment. If the liver become very painful from intense hepatitis, 

 we apply a few leeches, and cover the region of the liver with warm 

 poultices ; these means almost always remove or at least relieve the 

 pains. The ascites complicating cancer of the liver may require tap- 

 ping under the previously-mentioned conditions. 



CHAPTER IX. 



TUBERCULOSIS OF THE LIVER. 



TUBERCULOSIS of the liver is never primary, but always accompa- 

 nies an already existing tuberculosis of other organs, or else forms one 

 symptom of miliary tuberculosis. In the latter case, we only find dull, 

 translucent granulations, as large as grains of sand, which occur par- 

 ticularly on the surface of the liver, with advanced tuberculosis of the 

 intestines and lungs. On the other hand, we occasionally find yellow, 

 cheesy, tuberculous masses, as large as a hemp-seed, pea, or even 

 larger. These very rarely break down into small vomicse, filled with 

 tuberculous pus. But they often compress capillary bile-ducts, and 

 lead to then* dilatation behind the compressed parts ; thus forming 

 cavities as large as a hemp-seed or pea, which are filled idth bile and 

 mucus, and which we must not confound with tuberculous cavities. 

 Tuberculosis of the liver cannot be recognized during life. 



