PATHOLOGY. 
the bowels are very frequently coftive for the firft few 
days of the complaint. If it is not early checked, it will 
frequently run on to fuppuration, and then the chance of 
its pointing, or of the matter finding its way through 
dufts or adhefions, with ultimate recovery, is faint indeed. 
Other fymptoms will occafionally arife in this difeafe, or 
accompany it from the beginning. Thus the fever is 
fometimes fmart; the enlargement, hardnefs, or tender- 
nefs, of the part, more violent; the inability of lying on 
a particular fide may be complained of; a (hort cough 
may attend; or that particular fenfation in the acromion 
fcapulte may be noticed, though it is not very often that 
this lad is prefent, Thefe fymptoms, and the duration 
of the complaint, will vary much. Indeed, the latter is 
very uncertain ; as its continuance may be protrafted to 
feveral weeks, without fuppuration or organic derange¬ 
ment of vital importance following. This, then, is the 
hepatitis of India; and certainly there is no fmall diffi- 
milarity in fymptoms between it and the acute hepatitis 
of Europe. The flux, which may be termed the pathog¬ 
nomonic of the former is almoft always wanting in the 
latter. The one (Indian) partakes more of inflamma¬ 
tory congeftion and obftruftion ; the other of aftive in¬ 
flammation, like that of the lungs, kidneys, &c.” 
The cure of the acute hepatitis, as it occurs in this 
country, may generally be effefted by the ufual cooling 
and depleting plan. Bleeding local and general, blifters 
over the region of the liver, brifk cathartics, and, when 
the violence of the difeafe abates, the exhibition of mer¬ 
cury in full dofes, complete the lift of meafures this dif¬ 
eafe requires. In hot climates it will be necefi'ary to pufli 
the mercury further, to begin with it earlier, and conti¬ 
nue it longer, than is requifite in the hepatitis of this 
country. In the former lituation, indeed, it is often ne- 
ceflary to adminifter calomel in fcruple dofes in the very 
onfet of the difeafe; and bleeding need only be had re- 
courfe to as an auxiliary. This, however, we by no 
means intend to deny, that very extreme bleedings are 
fometimes required in Indian dyfentery ; but mercury is 
the chief dependance : this medicine muft be pulhed till 
it produces falivation, and its aftion kept up till all vef- 
tige of difeafe is extinft. 
Acute hepatitis terminates when not cured, in fuppu¬ 
ration or gangrene. In this country, however, more 
patients die of the inflammation itfelf than of its feque- 
lae. Suppuration is moft common in hot climates. See 
Apcjlema hepaticum, p. 230. But few cafes are known of 
the occurrence of gangrene in the liver. 
The fecond variety, or chronic inflammation of the 
liver, is a difeafe which is more common in this country 
than the acute; and is fo infidious in its progrefs as to 
have fometimes advanced to complete diforganization, 
before its exiftence was fufpefted. In fome meafure, in¬ 
deed, a fimilar obfervation applies to all the chronic de¬ 
rangements of the fubftanceof the liver, which often ex¬ 
cite no alarm, by the fymptoms which might be expedited 
to accompany them, until they are fully formed. The 
flightindifpofition that occurs is attributed to indigeftion, 
flatulence, or fome other affeftion of the ftomach ; the 
pain of which the patient occafionally complains is falfely 
referred to that organ ; and its continuance is fo (hort, 
and the degree of it frequently fo inconfiderable, as to 
demand but a flight attention. The relief obtained by 
eruftation and the difcharge of air alfo tends to confirm 
the opinion, that the feat of the difeafe is in the Jiomach : 
but this relief may be explained on the principle of re¬ 
moving the diftention of the ftomach, and fo taking off 
the preflure of this organ from the liver. 
While this flow inflammation and gradual obftruftion 
is going on in the liver, the patient is fubjeft to occa- 
fional pain in the right hypochondrium, extending to the 
feapulae, or to the top of the ffioulder ; a quick pulfe, an 
increafe of heat alternating with chilly fenfations, diffi¬ 
cult breathing on quick motion, fome difficulty of lying 
on the left fide, flatulence, indigeftion, acidity, coftive- 
261 
nefs; and, together with a gradual diminution of ftrength 
and fleffi, he has a pale or fallow complexion. The com¬ 
plexion, indeed, of a perfan—mTefted with chronic ob¬ 
ftruftion in the liver, although often not wearing the ap¬ 
pearance of jaundice, yet has frequently a peculiar fal¬ 
low n e Ts, or a dirty-greeniffi hue, which Dr. Darwin, from 
its refemblance to the colour of a full-grown filk-worm, 
has aptiy, though pedantically, denominated bombycinous. 
The extent and duration of pains, Dr. Saunders obferves, 
arifing from difeafe of the liver, are fo various, as fre¬ 
quently to deceive both the phylician and patient; they 
extend to the flioulder, fcapulae, mufcles of the neck, 
along the arm, even to the joints of the wrift. Every 
change of pofture either relieves an old pain, or induces 
a new one, as does the mere bending of the body in any 
direftion, or even extending the arms. The pains are 
greater in a fupine than in an ereft pofture. 
Thefe fymptoms, and fome others which make their 
appearance in the more advanced ftages, are fufficient to 
point out the exiftence of chronic difeafe in the liver: 
but it is to be regretted, that they are not peculiar to 
chronic inflammation of that organ. ProfelTor Portal 
points out fome difficulties in forming an accurate diag- 
nofis between difeafes of the liver and of fome of the 
neighbouring organs, efpecially of the lungs. He fays 
that, on the one hand, obftruftions and congeftions in the 
right lobe of the lungs, and the right cavity of the cheft, 
fometimes occafion fuel) an alteration in the fituation of 
the liver, by prefling down the diaphragm, as to produce 
a fufpicion of difeafe in it, by occafioning the appearance 
of a tumour in the right hypochondrium. He relates a 
cafe of this fort, in which he was deceived by this apparent 
tumour, in a patient who died of pulmonary confump- 
tion, where little or no expeftoration took place: and 
he cautions practitioners not to be milled by fuch an ap¬ 
pearance, which is common in all congeftions of the cheft. 
He affirms, too, that a degree of jaundice is occafionally 
produced, where the bile has free paffage into the intef- 
tines, but is there detained, in confequence of mechani¬ 
cal impediments, as volvulus, ftrangulated hernia, accu¬ 
mulations of hardened faeces, &c. when it is taken up 
by the lafteals, and enters the blood-vefi'els. On the 
other hand, he remarks, if we fometimes attribute dif¬ 
eafes to the liver which have their feat elfewhere, there 
are other maladies, aftually feated in the liver, which are 
frequently aferibed to other organs. Thus the contigu¬ 
ous vifeera, fuch as the right kidney, the diaphragm, the 
lungs, the ftomach, and the colon, are fometimes fup- 
pofed to be affefted with difeafe, which is feated exclu- 
fively 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, con- 
nefted with difeafed liver, the firft of which proved fatal ; 
and the other was cured, in confequence of the leflfon 
taught by the previous dilfeftion. An enlargement of 
the liver was felt externally, with great tendernefs in 
the epigaftrium. See Mem. de l’Acad. des Sciences, 
Ann. 17775 or Mem. fur plufieurs Maladies, par Ant. 
Portal. 
It would take up much fpace to detail the immenfe 
variety of organic lefions which are met with in the liver. 
Some of thefe have been clearly accompanied or preceded 
by chronic inflammation; in others, the coincidence of 
this aftion is doubtful. We ffiall not enter into any ac¬ 
count of them,fince we do not find that diagnoftic fymp¬ 
toms, diftinguifhing one particular degeneration of ftruc- 
ture from another, can be laid down; and, moreover, 
becaufe no curative indications can be founded even on 
the flight hiftory of fymptoms with which pathologifts 
have furniftied us. Indeed hydatids, various kinds of 
tubercles, feirrhus, foftening of the fubftance of the or¬ 
gan, adhefion of its furface with contiguous parts, and 
effufion from its invefting membrane, often produced over 
the whole of the peritoneum, and giving rife to dropfy, 
are more rarely followed by death than the former lefions, 
which 
