LIVER. 



is more common in this country than the -acute ; and is 

 often if) inlidious in its pro^refs, and accompanied by fo 

 few fymptoms of ferious indiipofition, as to have advanced 

 to a complete fiippuration, before'its exillence was fufpected. 

 In fome meafure, indeed, a fimilar oblervation applies to all 

 'the chronic derangements of the fubilance of the liver, 

 •which often excite no alarm, by the fymptoms which might 

 be expected to accompany them, until they are fully formed. 

 The (ligkt indifpofition that occurs is attributed to indigef- 

 tion, flatulence, or fome other affedlion of the ilomach ; the 

 pain of which the patient occafionally complains is fallcly 

 referred to that organ ; and its continuance is fo (hort, and 

 the degree of it frequently fo inconfiderable, as to demand 

 'bat a flight attention. The relief obtained by erudation 

 and the difcharge of air aifo tends to confirm the opinion, 

 that the feat of the difeafe is in the ftoraach : but this relief 

 may be explained on the principle of removing tlie diftention 

 of the ftomach, and fo taking' off the preffure of this organ 

 from the liver. 



Where this flow inflammation and gradual obftru£tion is 

 going on in the liver, the patient is lubjeft to occafional 

 pain in the right hypochondrium, extending to the fcapuls, 

 or to the top of the flioulder, a quick pulfe, an increale of 

 heat, alternating with chilly ferifations, difficult breathing 

 on quick motion, fome difficultv of lying on the left lide, 

 flatulence, indigeftion, acidity, ooftivenefs ; and, together with 

 a gradual diminution of ilrength and flelh, he has a pale or 

 •fallow complexioTi. The complexion, indeed, of a perfon af- 

 fetted with chronic oliftruction in the liver, although often 

 not wearing the appearance of jaundice, yet has frequently 

 a. peculiar ialiownefs, or a dirty-greenifh hue, which Dr. 

 Darwin, frcna its refemblance to the colour of a full-grown 

 filk-worm, has aptly enough denominated bombycineus. The 

 extent and duration of pains. Dr. Saunders obferves, ariling 

 from difeafe of the liver, are fo various, as frequently to 

 deceive both the phyfician and patient ; they extend to the 

 fhoulder, fcapuloe, mufcles of the neck, along the arm, even 

 to the joints of the wrilt. Every change of pofture either 

 relieves an old pain, or induces a new one, as does the mere 

 bending of the body in any direction, or even extending the 

 arms. The paics are greater in a fupine, than in an ereft 

 pofture. 



Thefe fymptoms, af:d fome others which make their ap- 

 pearance in the more advanced ftages, are fufBcient to point 

 out the exillence of chronic difeafe in the liver : but it is to 

 be regretted, that they are not pectihar to chronic inflam- 

 mation of the organ ; and that the varieties of hepatic 

 obftruction are not diftinguiihed from each o.her by any 

 particular combinations of fymptoms ; for it muft be ob- 

 vious, that the fame remedies cannot be adminiftered with 

 advantage in difeafes, which are effentially fo different in 

 their nature, as thofe which we are about to defcribe. 



The term fchirrus, when applied to the hver, has been 

 employed in two acceptations, or at leail to denote two 

 different ftages of a difeafe, if not two different difeafes : 

 aamely, an induration of the fobftance of the liver generally, 

 and the formation of tlie common tubercle in it ; the former 

 of which is', in the opinion of Dr. Baillie, the firft ftep to- 

 wards the latter. When an indurated liver is examined by 

 diffeaion, no peculiar alteration of llrudure is obferved ; 

 only the fubftancc of the gland is found uniformly of a 

 inore compaft and folid confidence, or lefs foft and porous, 

 it is fomewhat diminifhedin bulk, and the lower edge is 

 bent a little inwards ; the colour, too, is fomewhat paler, ia 

 confequetice of a diminirned fecretion of the bile, or of a 

 lefs free admiffion of blood into the fubftance of the. organ. 

 UpoB the furface of fuch a liver, Dr. Baillie remarks. 



" there is not uncommonly a thready appearance of mem- 

 brane, difpofed lomewhat in a radiated form. This, I be- 

 lieve to be the firft flep in the progrijfs towards the forma- 

 tion of the common tuberculated liver. I have fometimes 

 feen fmall tubercles formed upon a part of the furface of 

 fuch a liver, which were exactly of the comm.on fort, &c. 

 This hardened llate of the liver is fometimes accompanied 

 with a beginning afcites, and fometimes is without it.'' 

 Loc. cit. 



Dr. Saunders obferves, that in thefe cafes of induration of 

 the Hver, there is, together with a diminution of bulk, alfo 

 fome degree of lofs of weight. This, however, he believes, 

 occurs only in the latter ftages of the difeafe, ivhen it is 

 ufiially feen by the anatomift. For, confidering that the 

 dilcafe is commonly the refult of one of the two following 

 caufes, Mz. a'longrefidence in a hot chmate, or the immo- 

 derate ufe of fpirituous liquors, both of which tend to pro- 

 duce an over-excitement of the circulation, and a hurried 

 fecretion, he deems it moit probable, nay he is perfuaded, 

 that in the more early fla'jes of fchirrofity, the liver is 

 not only not fenfibly diminilhed in bulk, but that there is 

 at that period an increafeboth of bulk and weight, which is 

 followed by a gradual diminution of both. *' To produce 

 an increafed fecretion of bile,'' he argues, " it is plain tliat 

 there muft be an increafed aSion of the brandies of the 

 vena portarum, and an acceleration of fluids through thofe 

 branches ; hence a condition of veffels is induced, approach- 

 ing in fome refpeds to that of inflammation; with this 

 dilterence, that- it is an inflammation in which the vein, or 

 fecreting veflel, i« more concerned, than the artery or nu- 

 trient veffeL The effect of this action, efpecially when 

 protraited for a confiderable time, muft neceffarily be that 

 of inducing ah alteration in the ilrufture of the part ; an 

 alteration fimilar to what obtains in other organs, labouring 

 under indolent and chronic iuflammatioii. 'I'his change of 

 ftrufture, from its (Jolidity and compactnefs, feems to de- 

 pend on the effulion of the coagulable lymph into the 

 pareuchymatous fubftance of the liver ; with this peculi- 

 arity, that while it is, in active inflaminations, depofited by 

 arteries, it is, in the chronic kind, effufed by tlie veins, &c." 

 This effufion, however, he adds, impedes the fecretion of 

 bile ; and, where a part has loll the power of performing 

 its functions, the abforbcnts often become active, and re- 

 move it ; whence the diminution of weight as the difeafe 

 advances. ( Saunders's Treatife on Structure and Dif. of 

 the Liver, ijdedit. p. 282, etfeq.) At all events, the view 

 of the dileafe, which alcribes the cfFuilon of the interiiici;d 

 matter, and the cor.fequent induration, to a previo\!s ex- 

 citement of the veffels and hurried fecretion, accord both 

 with the general laws of the animal economy, and with the 

 known ordinary' caufes of tliis difeafe. 



With refpect to the other modification of fchirrous liver, 

 which is one of the moft common of its difeaies, we can- 

 not do better than repeat Dr. Baillie's accurate defciip- 

 tion. "This difeafe,'' he fays, " is hardly ever met With 

 in a very young perfon, but frequently takes place in per- 

 fons of middle or advanced age ; it is likewife more cocunon 

 in men than in women- This feems to depend upon the 

 habit of drinking being nior-e common in the one fes than 

 in the other; for this difeafe is moil frequently found ia 

 hard drinkers, although we cannot fee any neceffary con- 

 nection between that mode of life and this particular difeaf?" 

 in tlie liver. It happens, however, very commonly, that we 

 can fee little connection between caufe and effect in changes 

 which are going on in every other part of tlie body. 



•" The tubercles, which are formed in this dileafe, oc- 

 cupy generally the whole mafs cf the liver, replaced very. 



ccsr 



