HEPATITIS. ^ 439 



evidence, though oue whose presence we are not, perhaps, at 

 this moment, in a situation to demonstrate during life. I 

 have, in the course of my dissections, found the membrane in 

 question variously altered in texture — its shining transpa- 

 rency turned into opacity and dead whiteness ; its substance 

 thickened ; its surface studded with tubercular eminences ; 

 strong adhesions contracted between it and the diaphrag- 

 matic expansion of the peritoneum. According to Hurtrel 

 d'Arboval, hepato-peritonitis only occurs in conjunction with 

 hepatitis or inflammation of the substance of the liver ex- 

 isting either as a cause or effect : I cannot, however, agree 

 with him, having from dissection received sufficient proof to 

 the contrary. 



Symptoms. — The expression of pain will probably be 

 more decided in this than in any other form of hepatic 

 disease. The respiration is likely also to be more dis- 

 turbed ; so much so as, without other collateral signs, to 

 render the disease liable to be confounded with pneumonia 

 or pleurisy. There will probably be likewise more fever 

 in the system : the pulse evincing greater quickness, and 

 being rather contracted than full and bounding. 



Our Diagnostic, however, must, after all, be founded 

 chiefly upon local symptoms, or such as have a more direct 

 reference to the liver ; such as tenderness or manifest heat 

 of the right side ; any indication of lameness or appearance 

 of spasm ; and any appearance of bile in the system, or of 

 the redundance or deficiency of it in the excretions — the 

 dung and urine. 



The Treatment will be the same — allowing for any addi- 

 tional activity that may be required in the use of the fleam 

 — as that prescribed for acute hepatitis. 



COMPLICATED HEPATITIS. — Of this disease, of my 

 own personal experience, I pretend to no knowledge what- 

 ever : I am wholly indebted for what I am about to offer on 

 the subject to Hurtrel d'Arboval. 



This writer informs that among the complicated forms of 

 hepatitis, the best known is that in which the appendices 

 and tendinous portions of the diaphragm are involved with 



