PATHOLOGY. 
The nature of this complaint was fuppofed by the an¬ 
cients, among whom we may mention Hippocrates, 
Beerhaave, and Van Swieten, to be occafioned by ntra 
bilis. Blit Dr. Home, in his Clinical Experiments, traces 
it to an effufion of blood from the ineferaic veffels, 
which, by its ftagnation and corruption, afi'umes that 
ft range appearance. The difeafe, he fays, frequently 
follows haemorrhage ; and thofe of a fcorlnuic habit are 
moft fubject to it. It is an acute difeafe, and terminates 
fpon 5 yet it is not attended with any great degree of 
fever. Dr. Good confiders that either of theft? caufes 
rhay produce it, and accordingly he makes two fpecies. 
1. Melsena cholcea: the blackdifcharge bilious; the vo¬ 
miting occafionally green and acid ; great languor ; ver¬ 
tigo. It feems to depend upon an organic depravation 
ot the liver, chiefly perhaps in the cafe of habitual glut¬ 
tons and drunkards, who have paralyzed or worn it out 
by perpetual Humiliation : in confequence of which, a 
pitchy and flaky bile is fecreted inltead of the genuine 
and healthy fluid. 
2. Melsena, cruenta : the difcharge confiding of gru- 
snous blood intermixed with bile : pungent tenfive pain 
in both hypochondria; comprCflive pain at the pit of the 
ftomach and fainting. This is probably the refult of 
aCtive or pafllve haemorrhage (mod likely the latter) 
from the liver, the fpleen, the bowels, &c. 
This difeafe has fometimes proved (alutary, and it has 
on other occafions appeared periodically. For the cure 
of this complaint, gentle purgatives and clyfters have 
been recommended from the time of Hippocrates down¬ 
wards; and they are as beneficial in this affection as in 
the hasmatemefis, to which it bears much affinity. Dr. 
Home employed the diluted fulphuric acid, in addition 
to laxatives ; and, as he believed, with confiderable ad¬ 
vantage. Emetics he juftly deems ufelefs, if not inju¬ 
rious ; and fhunned the ufe of opium, as tending to fliut 
up the matter that nature was carrying off. Opiates, 
however, combined with gentle cathartics, tend rather 
to aid the operation of the latter, by removing the fpaf- 
modic conftriCtion which takes place in the bowels, and 
thus alfo afford material relief to the pains. It has been 
fometimes cured very rapidly by fpirit of turpentine in 
large purging dofes. 
Genus III. Chololilhus, [from %oAvi, bile, and Ai 0 o;, a 
ftone.] Gall-ftones. Generic characters—Pain about 
the region of the liver, catenating with pain at the pit of 
the ftomach : the pulfe unchanged; ficknefs ; dyfpepfy ; 
inactivity: bilious concretion in the gall-bladder or 
bile-duCts. 
As this difeafe differs from ICterus only in being unat¬ 
tended with yellow colour of the fkin, it has been con¬ 
founded with it by moft of the nofologifts. Dr. Good 
has, however, feparated them; for he fays the yellow dye 
of the fkin and urine, which is the pathognomic fymp- 
tom of jaundice, occurs often without Chololithus ; and 
Chololithus, even in its parting fpecies oracute ftate, with¬ 
out the yellow dye. The different degreein which its fymp- 
toins are manifelted,accordingas the gall-ftone is ftationary 
or the reverfe, has appeared t.o our nofologifts a fufficient 
reafon for feparating this genus into the two following 
fpecies. 
1. Chololithus quiefcens: pain about the liver and at 
the pit of the ftomach obtufeand occafional ; the bile lefs 
bitter than ufual ; the dejections irregular. 
2. Chololithus means: pain about the liver acute; 
frequent vomitings; dejections white, and at length 
loaded with one or more bilious concretions. 
The reader will find the treatment, &c. detailed under 
ICterus; and the compofltion of the gall-ftones will be 
mentioned when fpeaking of the calculous diatheiis as 
connected with calculi in the bladder. 
Genus IV. Parabyfma , [from irafciGua, male coaccrvo, 
to heap up, or obftruCt.] Knotty or unequal intumef- 
cence of the abdomen from an indurated enlargement of 
Vol. XIX. No. 1295.’ 
one or more of the vifcera contributory to the digcftive 
function ; accompanied'with derangement of the general 
health. This is the Fliyfconia of Cullen, Sauvages, and 
others. 
The whole of this genus, with the fmall exception of 
cafes arifing from inaCtion, may be confidered beyond 
the reach of medicine. Indeed, when we confider that, 
in attempting to remove tumours of long Handing, we 
are endeavouring to alter the aCtions of parts which have 
no analogous ftruCtures in the natural ftate, and with 
the laws of which we are confequently unacquainted, we 
can have little hope of accomplifliing our tafk. To this 
we may add, that, while moft maladies which depend on 
exalted or diminiflied aCtions of the natural parts have 
been found at times amenable to medical agency, expe¬ 
rience furnithes no unequivocal records of the like happy 
termination of the diftempers in queftion. Yet do thefe 
diftant difeafes claim our moft unremitting, moft intenfe, 
ftudyand attention; fince what we cannot cure w>e may 
perhaps prevent. To trace therefore, by dilfeCfion of 
morbid parts, the various appearances which different 
grades of diforganization prefent, and to combine this 
information with clofe and faithful delineations of ac¬ 
companying external fymptoms, are purfuits which, 
though we nnift confefs hitherto almoft ufelefs in regard 
to the complaints in queftion, muft ultimately meet their 
reward. Attempts of this nature have been made, and 
are ftill profecuted with much ardour, particularly on 
the continent. The knowledge at prefent obtained is 
however fmall and unfatisfaftory ; fo much fo indeed, 
that many of the varieties arifing out of the feven fpecies 
of our author we fhall pafs over w ithout comment, merely 
referring our readers to fome of the numerous hiftories 
which the learned Dr. Good has noticed ; and to the 
article Tumours for an account of the probable ori¬ 
gin and mode of growth obfervable in diforganization in 
general. 
1. Parabyfma hepaticum : hard tumour in the right 
bypochondrium, verging towards, and fometimes appear¬ 
ing at, the pit of the ftomach ; general languor ; pale or 
yellow countenance ; dyfpepfy ; dejections irregular, 
often whitifh. There are four varieties of this fpecies. 
a. P. coaCtum; from infarction. Found in feeble 
children, who fecrete lefs bile, and have the cells of the 
liver clogged with mucus from atony of the abforbents. 
Found alfo in intemperate livers; and in foreigners who 
refide in hot climates: an unequal atony, and at times 
paralyfis, being produced in the organ from the exceffive 
ftimulus antecedently excited by the rays of the fun or 
the ufe of fpirituous potations. (See Hepatitis in this ar¬ 
ticle.) In this cafe, gentle dofes of calomel, or blue 
pill, ftriCt regulation of the bowels, abftemious regimen, 
&c. are generally followed, after due perfeverance, by 
reftoration to health. The fame remarks are applicable 
to the treatment of the infarCted fpleen ; for by thefe 
means a fpleen fo\enlarged as to occupy the major part 
of the abdomen has been effectually removed in a few 
months. 
| 3 . P. fcirrhofum; the tumour affuming a fcirrhous 
character. 
7. P. cololithicum; accompanied with bilious concre¬ 
tions. 
( 5 1 . P. helminthicum ; accompanied with flukes, hyda¬ 
tids, or other worms. See Winker’s Difp. de Hydat. 
apud Bonet, Med. Septentr. ii. Darwin, vol. iii. 
Other morbid ftruftures of various forts and fizes are 
occafionally built up in the liver; but, as there is little 
evidence of their feparate origin, it is needlefs to multi¬ 
ply the varieties. They are fo thickly interfperfed in 
our periodical journals, that all reference feems unnecef- 
fary. Some varieties of them will be found in the fu- 
perb wmrk of Dr. Farr, (Morbid Anat. Liver, 1812.) 
2. Parabyfma fplenicum; ague-cake: an indurated 
tumour below the falfe ribs on the left fide, and towards 
Z z the 
