INFLAMMATION OF THE LIVER. 95 



which are located in the centre of the acini ; or we may notice 

 peripheric zones (nutmeg liver) alternating with lighter colored 

 spaces. The liver gradually becomes smaller and its surface dull, 

 and later on the parenchyma becomes finely granular. 



Clinical Symptoms. It is not possible to make a positive 

 diagnosis of this disease, we can only suspect it by great tender- 

 ness on pressure in the region of the liver, and perhaps slight 

 icterus ; but as these symptoms may all be caused by catarrh of 

 the bowels, it is well to be very cautious before making a positive 

 diagnosis. 



Therapeutics. This consists in mild purgatives followed by 

 saline laxatives. 



Inflammation of the Liver. 

 {Hepatitis.) 



This disease appears in two forms — acute parenchymatous au(( 

 chronic interstitial. 



1. Acute parenchymatous hepatitis accompanies various in- 

 fectious diseases, probably in the same way that we see congestive 

 hypersemia of the lungs; it is also seen as a symptom of acute 

 phosphorus-poisoning. 



The pathological-anatomical alterations are as follows: Enlarge- 

 ment, softening, and a friable condition of the tissue, which breaks 

 easily to the touch. At first it is dark red, but later on it becomes 

 a yellowish clay color, with a roughened appearance of the external 

 surface, due to the enlarged acini ; the capsule (Glisson' s) is dull 

 and thickened, due to a certain amount of peri-hepatitis. If the 

 disease lasts any time, the volume of the liver is greatly lessened. 



The clinical symptoms are : Evidences of catarrh of the stom- 

 ach, pain on pressure in the region of the liver, icterus. 



The therapeutic treatment consists of light, easily digested food, 

 with little fat, and saline laxatives. 



2. Chronic Interstitial Hepatitis (Cirrhosis of the Liver). 

 This disease or'ginates from causes that are at present unknown. 

 Friedberger and Frohaer surmise that it is caused by valvular 

 disease of the heart. 



Pathological Anatomy. There are two stages of change 

 in this disease. In the first stage the liver is very much enlarged 



