38 
CASE OF HEPAT1IIRHCEA. 
most essential point gained. I, therefore, gave tinct. opii and spts. 
nit. seth. in rather considerable doses, with strict injunctions that 
he should be left perfectly quiet, to be warmly clothed, and have 
his legs bandaged. This treatment was continued for three days, 
the patient to all appearance about the same as at first, with the 
exception of a slight tinge of pink again being visible in the mem- 
branes, and perfect freedom from pain or uneasiness. On the fourth 
day the pulse at the jaw could be easily counted, being 55, but 
still of a very weak character : he ate some carrot, and drank freely 
of gruel. Thus he continued until the evening of the fifth day, when 
a relapse took place, and he died on the morning of the sixth day 
from the time I first attended him. 
During my attendance, I learned from the coachman, a very 
intelligent man, who had driven him for more than twelve years, 
that about seven years ago he was not expected to recover from an 
attack similar in all appearance to this; and that about four years 
since he experienced another attack, though much milder than the 
first. He frequently of late had been unwell, but not bad enough to 
require medical assistance. With these assurances, combined with 
the nature of the symptoms now presented, I hesitated not to give 
my opinion that the liver was the seat of the present ailment, and 
the post-mortem appearances proved my opinion to be correct ; for 
upon opening the abdomen, four hours after death, a quantity of 
black serous blood escaped through an incision made in the linea 
alba, and quite two pailfuls and a half more were taken from the 
abdomen in which the intestines might be said to float. On re- 
moving these viscera, so as to get a view of the liver in situ, it had 
a most beautiful appearance : a ragged surface lay exposed full six 
inches square, the peritoneal and capsular coverings being drawn 
completely on one side and folded up. The liver appeared of 
immense magnitude, and, being closely adherent to the diaphragm, I 
had the two removed together, and taken to my own home. Nothing 
else could be discovered of the slightest importance affecting any 
other part. Upon farther inspection of the liver, I found the left 
lobe much enlarged by an accumulation of apparently semi-organiz- 
ed coagulum, which was contained in a perfect sac formed by the 
natural coverings of the liver. This coagulated substance had the 
appearance of, as nearly as I can describe, a sponge soaked in black 
serosity, which was continually oozing from its surface. The right 
lobe was still more enlarged than the left: it exhibited a rupture in 
its tunics from eight to nine inches in length, taking the precise 
direction of its outer circumferent margin. Several broad patches 
of adhesion had taken place between the liver and diaphragm, but 
no trace could be found of a positive rupture ever having taken 
place before, at least not of the nature of the one just described. 
