78 PRACTICE OF PHYSIC. 



tiguous to the liver. Even the pain, ' saepe pungens et obtu- 

 sus,' will not give a much more certain determination ; for when 

 the membrane of the peritonaeum, extended over the contiguous 

 surface of the liver, is the part affected, it exactly resembles 

 the pleurisy ; for it is attended with cough and difficulty of 

 breathing. I knew a person who had several times been treat- 

 ed for a pleurisy ; he died of another disease ; and, upon open- 

 ing the body, no adhesion was found in the pleura, but a por- 

 tion of the liver was strongly attached to the peritonaeum, with 

 marks of former inflammation. 1 ' 



CCCCXII. The inflammation of the liver seems to be of 

 two kinds ; the one acute, the other chronic. 



CCCCXIII. The acute is attended with pungent pain; 

 considerable, pyrexia; a frequent, strong, and hard pulse ; and 

 high-coloured urine. 



CCCCXIV. The chronic hepatitis very often does not ex- 

 hibit any of these symptoms ; and it is only discovered to have 

 happened, by our finding in the liver, upon dissection, large 

 abscesses, which were presumed to be the effect of some degree 

 of previous inflammation. As this chronic inflammation is sel- 

 dom to be certainly known, and therefore does not lead to any 

 determined practice, we omit treating of it here, and shall only 

 treat of what relates to the acute species of the hepatitis. 



CCCCXV. The acute hepatitis may be known by a pain 

 more or less acute in the right hypochondrium, increased by 

 pressing upon the part. The pain is very often in such a part 

 of the side as to make it appear like that of a pleurisy ; and 

 frequently, like that, too, is increased on respiration. The dis- 

 ease is, in some instances, also attended with a cough, which is 

 commonly dry, but sometimes humid ; and, when the pain thus 

 resembles that of a pleurisy, the patient cannot lie easily except 

 upon the side affected. 



In every kind of acute hepatitis, the pain is often extended 

 to the clavicle, and to the top of the shoulder. The disease 

 is attended sometimes with hickup, and sometimes with vomit- 

 ing. Many practical writers have mentioned the jaundice, or a 

 yellow colour of the skin and eyes, as a very constant symptom 

 of the hepatitis ; but experience has shown, that it may often 

 occur without any such symptom. 



