DISEASES OF THE LIVER. 181 



doses may be one drachm to one and a half of the former, and 

 one to two scruples of the latter. Mr. S. Brown, in an ex- 

 cellent essay on tlie subject, recommends, when there are 

 symptoms of pain, tincture of opium in moderate doses, with an 

 alkali and linseed oil, in order to allay the irritation of the 

 mucous coat of the bowels ; after which he administers calomel 

 and opium, two thirds of the former, and one of the latter; 

 the latter to retain the former in the system. When purging 

 is present, a greater quantity of opium should be given. In 

 the latter stages, when great debility exists, he gives tonics and 

 stimulants, with small doses of nitre and tartarized antimony. 



Chronic injlammation of the liver may either follow or pre- 

 cede an acute attack, or it may exist independent of it. The 

 symptoms are, — pulse somewhat quickened, loss of appetite, 

 hidebound, and staring coat, and dull and dispirited appearance. 

 The faices hard, and of a pale colour. The treatment must be 

 similar in its nature to that recommended for the acute attack, 

 the dose, however, being more moderate. Bleeding is to be 

 avoided in the majority of cases, unless, indeed, the symptoms 

 urgently demand it. 



Mr. Cupiss observes, " In post-mortem examinations, the 

 liver is sometimes found to be attached to the surrounding 

 pai-ts, and is generally interspersed more or less thickly with 

 white scirrhous patches. After acute hepatitis, I have found 

 the liver quite yellow, and weak in its texture." 



Mr. Cupiss describes three other affections of the liver, which 

 he terms unnatural enlargement, decayed structure, and unhealthy/ 

 secretion ; and, without acknowledging the entire correctness of 

 his divisions, believing that deca,yed structure is very frequently 

 the consequence of an inflammatory action, yet, as his observa- 

 tions are full of practical utility, we cannot do better than 

 quote them at length : — 



" Unnatural enlargement of the liver sometimes takes place. 

 It is swollen to two or three times its natural size. It presents 

 an appearance of general congestion ; it becomes gradually filled 

 with a black bloody fluid. The progress of this variety of liver 

 disease is uncertain, generally slow, and almost invariably fatal. 



" The symptoms are, an enlarged and tense abdomen ; the 

 bowels sometimes constipated, at other times relaxed ; there is 

 sometimps considerable thirst; the pulse is accelerated to 100 or 

 more, loud and thumping, and easily mistaken for a primary 

 affection of the heart. 



"The most effectual treatment will consist in a cautious ad- 

 ministration of laxatives, accompanied by diuretics and counter- 

 irritanfs. To this tonics may succeed. In my opinion, the 

 ioduret of iron, in doses of half a drachm, two or three times 

 every day, would be preferable to any other medicine. 



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