260 P A T H O 
the action of the inieftines downwards being at the fame 
time folicited by emollient clyfters, which alfo contribute 
to the fame relaxant purpofes as the external fomenta¬ 
tions. A purgative medicine has often been known to 
operate as foon as a blifter, applied to the belly, began to 
rife, though it had not acted previoully : and this obfer- 
vation is (till more commonly verified, after a free evacu¬ 
ation by blood-letting. 
Though it is not advifable to irritate the bowels by 
draftic purges, it is improper to allow conftipation to 
continue in this complaint. Clyfters therefore, and the 
following mode of purging, will be found ufeful. Five 
grains of calomel may be given with one of opium ; and, 
an hour afterwards, a large dofe of caftor-oil. This will 
be retained on the ftomach in confequence of the feda- 
tive operation of the calomel and opium ; and the bowels 
will be opened without pain or irritation. 
| 3 . E. erythematica, exhibits various gradations of fe- 
verity of danger. It has already been amply treated of 
under the heads of Diarrhoea and Dyfentery. 
i2. Emprefma hepatitis, inflammation of the liver. 
Tenfion, forenefs, and pain, in the region of the liver; 
pain about the right fnoulder ; difficulty of lying on the 
left fide. This fpecies has two varieties. 
a. Hepatitis acuta : the fpecific character decifive, and 
the fymptoms clearly marked. 
( 3 . H. chronica : the fpecific character obfcure, and the 
exiftence of the difeafe only to be fufpefted from an ex- 
pofure to its caufes, and an occafional recurrence of the 
pathognomonic fymptoms accompanied with a flight de¬ 
gree of fever. 
The caufes of this difeafe are often obfcure. Befides 
the ufual ones of Emprefma, we find hepatitis frequent 
and fevere in fituations where extreme heat, or extraor¬ 
dinary viciffititdes of heat and cold, are met with. The 
difeafe comes on with a fenfeof chillinefs preceding pain 
in the right hypochondrium, fometimes dull, fometimes 
fliarp, extending up to the clavicle and fhoulder of that 
lide molt ufually, which is much increafed by preffing 
upon the part; and is accompanied with a cough, opprel- 
ii'on of breathing, and difficulty of lying, except on the 
tide afrefted ; together with naufea and ficknefs. The 
inteftines are generally inaftive, and the llools ffiovv a 
deficiency of biliary lecretion, or at lealt of any inter¬ 
mixture of it with them ; the urine is of a deep faffron 
colour, and fmall in quantity; there is lofs of appetite, 
great third, and coftivenefs, with a ftrong, hard, and fre¬ 
quent, pulfe, of from 90 to 100 in a minute, and fome¬ 
times intermitting ; the Ikin is hot and dry at the fame 
time, and the tongue covered with a white, and fome¬ 
times a yellowifti, fur; and, when the difeafe has conti¬ 
nued for forne days, the Ikin and eyes often become 
tinged of a deep yellow. 
The appearance of the blood is fomewhat remarkable 
juft before it coagulates, when, the red part falling to the 
bottom, and the buffy coat not yet being formed, it ap¬ 
pears of a dull green colour. This it owing to the mix¬ 
ture of the yellow-coloured bile with the purple-co¬ 
loured venous blood, as yellow' and purple form green : 
the coagulable lymph contains none of the purple colour; 
therefore the buffy coat is not green, but yellow. The 
lame appearances are obferved in the blood of a perfon 
labouring under jaundice. 
In hepatitis, as well as in other fpecies of Emprefma, 
we do not always find the fymptoms of the fame degree 
of violence as they are defcribed in the definition : thus 
in fome cafes the fever is fevere, in others it is fcarcely 
perceptible : in fome inftances, the pain is very acute and 
violent; in others, collections of pus have been found 
after death, when no pain had been felt. When the 
pain is feated deep in the fubftance of the liver, as that 
poffeffes little fenfibility, the pain is ufually obtufe ; but, 
when the furface is affeCted, it is acute, and apt to fpread 
to the diaphragm and lungs, producing cough. 
Many authors have made a diftinCtion between the 
LOGY. 
fymptoms that occurwffien the inflammation occupies the 
convex furface of the liver, and thofe that are prefent 
when the difeafe affefts the concave. It is faid, when 
great difficulty of breathing, and cough, accompany the 
pain in the region of the liver, that thefe fymptoms in¬ 
dicate the inflammation to be feated in the fuperior or 
convex part; but, where the inflammation occupies the 
concave or inferior furface, which lies contiguous to the 
ftomach and duodenum, there is more ficknefs and vomit¬ 
ing ; and moreover, the pain is not fo violent in that re¬ 
gion of the organ as in the other inftance. But thefe 
fymptoms are not unequivocal. 
Hepatitis, when it occurs in India, exhibits many ano¬ 
malies which are very unufual in this climate. Dr. 
Johnfon, in his well-known work on Tropical Climates, 
ftates, that in many cafes, if we expert to find the pa¬ 
thognomonic fymptoms of acute hepatitis, as it appears 
or is defcribed in Europe, we (hall be greatly deceived. 
“ In comparatively few inftances have I feen the violent 
rigors, high fever, hard, quick, and full, pulfe, acute 
pain, See. which we would naturally look for as preced¬ 
ing the deftruCtion of fuch a large and important vifcus.’*' 
It accords, however, with Dr. Johnfon’s experience, 
that fuch cafes do occur during the firft twelve or eigh¬ 
teen months after arriving in the country. He men¬ 
tions the cafe of a young gentleman, who, defpifingall 
rules of temperance or precaution, ran about in the fun 
for fome days at Malacca, indulging in all forts of li- 
centioufnefs or inebriety; and was feized, in a day or 
two afterwards, with rigors and heat alternating ; fuc- 
ceeded in a few hours by pain in the right fide, extend¬ 
ing acrofs the pit of the ftomach, accompanied with fome 
difficulty in refpiration. He did not fend lor Dr. J. till 
twelve or fourteen hours after the attack. He had then 
high fever, hard quick pulfe, great dyfpncea, a (hort 
cough, and the moft excruciating pain in the region of 
the liver; and a flux foon terminated his life. But our 
author met with few cafes in India fo exquilitely marked 
with acute European fymptoms as this. In general, he 
fays, the difeafe makes its approach in a much more quef- 
tionable fliape, though equally pregnant with danger as 
the foregoing, and not feldom more rapid in its courfe. 
“A man comes to us, complaining of having a flux. He 
fays he is frequently going to ftool ; that he is griped, 
but paffes nothing but flime; that his ftools are like wa¬ 
ter, or fome fuch remark. It is ten to one if he men¬ 
tions any other fymptom at this time. But, if we come 
to interrogate him more clofely, he will confefs that he 
has had fome forenefs at the pit of the Jlomach, or perhaps 
in the right fide. If we examine the part, a fulnefs will 
fometimes appear; if we prefs upon it, he Harts back, or 
Ihrinks at leaft from the preflure. If we look into his 
countenance, befides a certain anxiety we fliall obferve a 
dark kind of fallownefs in his cheeks, and a yellowifti hue 
in his eyes. The latter is feldom abfent in hepatic dif- 
eafes, both in India and Europe. The temperature of 
the furface will probably not be much increafed; but the 
Ikin will have a dry feel; his mouth will be clammy, and 
his tongue have a whitifh or yellow fur towards the back 
part. His pulfe, though neither diard nor very quick, 
will have an irritable throb, indicative of fome internal 
affe&ion. His urine, if infpedted, which it always flsould, 
will be found to tinge the bottom and fides of the pot 
with a pink fediment, or turn very turbid a few hours 
after it is voided ; and he will generally complain of 
fome heat and fealdingin making water. Thefe are all 
the external marks we can perceive ; and the few fymp¬ 
toms at the head of the lift are all that the heedlefs fol- 
dier or failor has noticed, or at leaft recorded. Happily 
for the patient, as well as his phyfician, the degree of 
violence in the bowel-cornplaint, where other fymptoms 
are not confpicuous, will be almoft always a fure index 
to the rapidity or danger of that in the liver. Whereas 
in thofe cafes where the fymptoms are of the violent or 
European caft, particularly pain, fever, and dyfpncea. 
