INFLAMMATIONS. 79 



" Icterus has been commonly mentioned, by practical writers, 

 as a symptom of hepatitis, and it may be bold indeed to re- 

 ject it. But that opinion has proceeded upon this, that hepatitis 

 is very frequently symptomatic of a remittent fever ; and we know 

 that in warm climates these fevers seldom take place without 

 more or less affecting the liver : but it is not owing to this, 

 but to another effect of the disease that they induce a yellow 

 colour of the skin." 



CCCCXVI. The remote causes of hepatitis are not al- 

 ways to be discerned, and many have been assigned on a very 

 uncertain foundation. The following seem to be frequently 

 evident. 1. External violence from contusions or falls, and 

 especially those which have occasioned a fracture of the cran- 

 ium. 2. Certain passions of the mind. 3. Violent summer 

 heats. 4. Violent exercise. 5. Intermittent and remittent 

 fevers. 6. Cold applied externally, or internally ; and there- 

 fore, in many cases, the same causes which produce pneumo- 

 nic inflammation, produce hepatitis, and whence also the two 

 diseases are sometimes joined together. 7- Various solid con- 

 cretions or collections of liquid matter, in the substance of the 

 liver, produced by unknown causes. Lastly, The acute is 

 often induced by a chronic inflammation of this viscus. 



CCCCXVII. It has been supposed that the hepatitis may 

 be an affection either of the extremities of the hepatic artery, 

 or of those of the vena portarum ; but of the last supposition 

 there is neither evidence nor probability. 



CCCCXVIII. It seems probable, that the acute hepati- 

 tis is always an affection of the external membrane of the liver ; 

 and that the parenchymatic is of the chronic kind. The acute 

 disease may be seated either on the convex or on the con- 

 cave surface of the liver. In the former case, a more pun- 

 gent pain and hickup may be produced, and the respiration is 

 more considerably affected. In the latter, there occurs less 

 pain, and a vomiting is produced, commonly by some inflam- 

 mation communicated to the stomach. The inflammation of 

 the concave surface of the liver may be readily communicated 

 to the gall-bladder and biliary ducts ; and this perhaps is the 

 only case of idiopathic hepatitis attended with jaundice. 



" A distinction has been made of parenchymatous and mem- 



