LIVER. 



covering tlic liver. Thefe adhefions are formed from the 

 coagulable lymph of the blood, which undergoes a gradual 

 procels of elongation from the motion of the parts, lo as to 

 produce little inconvenience, and in fome circumilances of 

 difeale much advantage. They confift very commonly of a 

 thin tranfparei't membrane, which joins the furface of the 

 liver to the neighbouring parts. This juntlion may either 

 be general over one extended furface of the liver, or it may 

 coniill of a number of procelTes of adhefion : the adhefion is 

 fometimes by a membrane of confiderable length ; and fome- 

 times it is very clofe, the furface of the liver being immedi- 

 ately applied to the neighbouring parts. Thele adhefions 

 are moil coiunionly found on the anterior furface of the liver, 

 by which it is joined to the periionaum lining the mufcles at 

 the upper part of the cavity of the abdomen. When an 



.abfcefs is formed in the fubftance of the liver, and points ex- 

 ternally, thefe adhefions are of great ufe in preventing the 

 pus from efcaping into the general cavity of the abdomen. 

 Adhefions are alio frequently found connecting the polferior 

 furface of the liver to the ftomach and the duodenum : and 

 thefe may alfo be ufeful in abfceffes of the liver, near its 

 pofterior furface, by preventing the matter from pafling 

 into the general cavity of the abdomen, and conduiSing it 

 either into the llomach, or the upper part of the mtetlinal 

 canal. See Hepatitis. 



Profeffor Portal of Paris, an able and fedulous cultivator 

 of morbid anatomy and medicine, has pointed out fome 



.difficulties in forming an accurate diagnoiis, between difeafes 

 of the liver and of lome of the neighbouring organs, elpe- 

 cially of the lungs. On the one hand, he obferves, that 

 obllructions and congeftions in the right lobe of the lungs, 



"and the right cavity of the cheft, fometimes occafion fuch 

 an alteration in the iitnation of the liver, by prefTing down 

 the diaphragm, as to produce a fulpicion of difeafe m it, by 

 occafioning the appearance of a tumour in the right hypo- 

 chofidrium. He relates a cafe of this fort, in which he was 

 deceived, by this apparent tumour, in a patient who died of 

 pulmonary confumption, where little or no expettoration 

 took place : and he cautions praditioners not to be milled 

 by fuch an appearance, which is common in all congeftions 

 of the cheft. He affirms, too, that a degree cf jaundice is 

 occafionally produced, where the bile has free paifage into 

 the intellines, but is there detained, in confequence of me- 

 chanical impediments, as I'olvuliis, ftrangulated hern'ui, ac- 

 cumulations of hardened fxces, &c. when it is taken up by 

 the lacteals, and enters the blood-vcifels. On the other 

 hand, he remarks, if we fometimes attribute difeafes to the 

 liver, which have their ft-at ellevvhere, there are other ma- 

 ladies, actually feated in the liver, which are frequently 

 afcribed to other organs. Thus the contiguous vifcera, 

 fuch a* the right kidney, the diaphragm, the lungs, the 

 ftomach, and the colon, are fometimes fuppofed to be af- 

 fefted with difeafe, which is feated exclufively in the liver. 

 Many examples of this are to be found in the writings of 

 Morgagni and Lieutaud. Mr. Portal relates two cafes of 

 fevere and continued vomiting, connected with difeafed liver, 

 the firft of which proved fatal ; and the other was cured, in 

 confequence of the leflbn taught by the previous diffection. 

 An enlargement of the liver was felt externally, with great 

 tendernefs m the epigaftrium. See Mem. de I'Acad. des 

 Sciences, Ann. 1777 ; or Mem. fur plufieurs Maladies, par 

 Ant. Portal, torn, i p. 228. 



Where there is eviden(;e of the exiftence of a confiderable 

 degree of difeafe in the liver, the progiioific mull be always 

 Ainfavourable, on the whole : for, in the tirll place, it is 

 extremely difficult to afcertain the exact ftate of the organ ; 

 and, fecoiidly, if we actually knew it, the moil judicious 

 Vol. XXI, 



application of the mod powerful remedies would be unequal 

 fometimes to remove the difeafe. The moft favourable 

 fymptoms are, an improvement in the complexion, the 

 ftrer.gth remaining unimpaired by the adtion of the medi- 

 cines, and a return of appetite. Dr. Pembcrton thinko 

 that if the patient decidedly gains bulk in the folids of the 

 body, you may fafely pronounce that he will recover. The 

 molt unfavourable fymptoms are, the colour of the f]<in re- 

 maining the fame, or becoming more fallow, tlie general 

 ftrength being much diminilhcd, the abdomen beginning to 

 fwell, and the patient lofing bulk in the upper extremities, 

 while the lower become more enlarged. Pemberton on Dif. 

 of the Abdom. Vilccra, p. 4^. 



\Vhen the liver is fo far difeafed as to have become 

 fchirrous, tubercular, or in any other way much altered in 

 its ftrucl.ure, it mult be obvious that medicine cannot effeft 

 any effential change. The treatment, therefore, which i;; 

 to be recommended mull be confidered as applying to that 

 flage of difeale, which precedes any extenfive organic al- 

 teration. It is not improbable, as Dr. Saunders fuggefts, 

 that the original mifchief is commonly in the ftomach and 

 bowels, and that the liver becomes difeafed by fyrapathy : 

 for dyfpeptic complaints generally precede the chronic af- 

 fections of the liver ; and they are induced by intemperance 

 in eating or drinking, but particularly by the abufe of vinous 

 and fpirituous liquors, by long falling, by a fedentary mode 

 of life, by grief and anxiety of mind, &c. (See D'is- 

 I'KP.siA.) Whatever weakens the digeftive powers of the 

 ftomach, Dr. Saunders maintains, ultimately weakens alio 

 the power of the liver, and diniinifhes the fecretion of bile. 

 (Saunders on the Liver, p. 192. J And again, he confiders 

 the diminilhed fecretion of bile, or its diminifhed protrufion 

 into the duoJenum-, (which he afcribes to an hypothetical 

 conftrittiou of the bile -ducts,) as reciprocally acling upon 

 the ftomach, and weakening its tone. One proof of the 

 exiftence of the fuppofed fpafmodic conftriction of the ori- 

 fice of the common dudt he deduces from an obfe.rvation, 

 that, in a lit of fick head-ache, if bile is brought into the 

 ftomach, and thence ejedted, by the violent ftraining to 

 vomit, the termination of the fit is much more fpeedy and 

 complete than when this does not happen. 



When the diminilhed or altered fecretion of the bile, then, 

 is preceded by affeftions of the ftomach, fuch as lois of ap- 

 petite, indigertion, and flatulent eruttations, the diet of the 

 patient fhould be attentively regulated, the art of cookery 

 itiould be rendered merely fubfervient to digeftion, and the 

 preparation of healthy chyle ; and the general regimen 

 fliould be fuch as has been already recommended in diforders 

 of the digeftive organs. (See iNDiGivnoN.) The quan- 

 tity of food taken at one time Ihould be moderate, and 

 water fhould be the only liquid drunk with the meals, as 

 more efFeflually promoting digeftion than fermented bquors 

 of any kind. AH raw or unboiled vegetables fhould be 

 avoided ; but ripe fruits may be jnoderately taken, and al- 

 molt all boiled vegetables admittov. Animal food fhould 

 be well boiled, or moderately roalled, and taken with its 

 own gravy. Pye-cruft, every thing fried, butter rendered 

 rancid by being melted, &c. fhould be cautiouily avoided. 

 The patient fhould ufe regular and moderate exercife. 



It is of the higheft importance, in order to keep up a due 

 fecretion of the bile, to adminiller a fucccffion of gently 

 purgative medicines. Upon this principle, the benefits 

 ariftng from the waters of Cheltenham (which cannot be too 

 highly recommended in thefe complaints) are obvioufly to 

 be explained. Ne'vcrthelefs, fo far as the mere operation of 

 thefe waters is concerned, no good reafon can be afllgnjd 

 for any fuperior efficacy to be expected from them rtilu-r 

 ■ Cc tlu=n 



