262 
PATHOLOGY 
which are in fa£l almoft always fatal. We (hould except, 
however, foftening of the liver, which is often unattend¬ 
ed with danger, or indeed indifpofition. 
The caufes of this complaint are various, but the moll 
frequent is indigeftion. It is remarkable that organic 
alterations in the ftru£lure of the liver happen more fre¬ 
quently in drunkards than in thofe whofe hepatic func¬ 
tions are deranged from other caufes. The treatment of 
this has in fome fort pre-occupied our pen while treating 
of Dyfpepfia; it may be fummed up in a few words. The 
adoption of meafures which will enfure daily but mode¬ 
rate alvine difcharges; a ftridl regulation of diet, which 
mull be very fparing ; otherwife, as the febrile fymptoms 
are more clearly or more oblcurely marked, leeching to 
the region of the liver or to the anus, or even general 
bleeding if the hardnefs of the pulfe calls for it; and the 
cautious introduction of mercurial medicines, which may 
on fome occafions be puftied to the extent of falivation ; 
form the whole of the treatment. If mercury is expell¬ 
ed to difagree with the conllitution, or if, after being 
tried, it is found ufelefs, the nitro-muriatic acid both 
offers a means of correcting hepatic derangement, plea- 
fant in its modes of application, and often fuccefsful in 
its effeCt. We have anticipated a full account of the 
mode of applying it under the article Nitro-Muriatic 
Acid, vol. xvii. p. 104. 
In organic derangements of the liver, a regular and 
ItriCt attention to what we call, for the fake of brevity, 
the dyfpeptic treatment, with abllinent living, and, if no 
great nervoufnefs be prefent, counter-irritation by means 
of an iflue, offer the only means of palliation. The ad- 
miniftration of mercury, fo commonly reforted to, often 
aggravates the difeafe ; that is, if the alteration of ftruc- 
ture be of long Handing; for, while nothing but coagu- 
lable lymph is effufed in the interftices of the ftruClure 
of the liver, falivation will undoubtedly be of much fer- 
vice. 
13. Emprefma fplenitis, inflammation of the fpleen : 
heat, fulnefs, and tendernefs, in the region of the fpleen; 
pain upon preflu re. 
The fpleen is an organ which from its ftruClure is lia¬ 
ble to congeftion, or accumulation of blood, before aClual 
inflammation occurs. Thus in the earlieft ftage of the 
diforder, the organ is fwelled from the paflive ftate of its 
veflels, which receive a greater proportion of blood than 
they can return. No fever or pain accompanies this ftate, 
but leads to inflammation by the tenfion and irritation 
of the membranes that inveft the fpleen, a fenfe of ful¬ 
nefs in the left epigaftrium being the chief fymptom. 
In the fecond ftage, the pulfe becomes quicker, and 
it is long in convalefcence before it is reduced to its na¬ 
tural ftandard. The increafed pulfe is produced by pain¬ 
ful irritation at firft, and next by the aClual tenfion of 
the membranes, proceeding to inflammation and adhe- 
fion of the adjoining parts. The quicknefs of the pulfe 
will aflift in diftinguiftiing the degree of progrefs of this 
difeafe; for it will be found, by reference to hiftories, 
that in a great proportion of cafes there was no warning 
of the growing mifchief in the earlieft ftage; and that 
painful affeClion of the left fide exifted in many other 
cafes long before fever was induced, though thefe ended 
fatally. In the firft ftage the patient can lie upon the 
left fide, but not upon the right. In the fecond ftage it 
is impoftible to lie on the fide afteCted. The fpafmodic 
aClion of the diaphragm is more likely to come on in the 
fecond ftage, and may be much aggravated by ftimulant 
treatment. There is no emaciation in the firft ftage of 
a morbid kind ; nor any confiderable emaciation in the 
fecond ftage, notwithftanding the large and continued 
evacuations. 
In the third and lalt ftage of fplenitis, emaciation is 
always an attending fymptom, combined with heCtic or 
flow fever, particularly in middle-aged and elderly people. 
In this third ftage diarrhoea fupervenes, as well as dylen- 
tery, and difcharges of grumous and dark blood take 
place, by vomiting and by ftools: thefe difcharges give 
temporary relief in many cafes, and occur long before 
the final event. 
The treatment of this complaint is fimilar to that of 
the other fpecies of this genus. Bleeding mud generally 
be the firft ftep, to relieve the congeftion of the portal 
fyftem, and draftic cathartics for the fame purpofes. A 
derivation to the capillary fyftem of the fkin and mufcu- 
lar fyftem muft be attempted by antimonials a^id the 
warm bath ; but, after the bleeding, our chief dependance 
muft be on draftic cathartics. Mercurial remedies are of 
ufe if the fpleen becomes permanently enlarged. 
The Splenalgia of authors is ufually a flight attack of 
this fpecies with fome fmall degree of fever. Parabyfma 
fplenica, or ague-cake, is a frequent fequel of Splenalgia. 
14. Emprefma nephritis, inflammation of the kidneys ; 
pain in the region of the kidneys and ureters ; frequent 
mi&urition; vomiting; numbnefs of the thigh on the 
afteCted fide; retraction of the tefticie. 
The chief difficulty, in this complant, is to difcover 
whether the inflammation be idiopathic, or whether it 
arife from the irritation of calculi. The following 
fymptoms, drawn chiefly from Dr. Hall’s work On Diag- 
nofis, may afford fome information as to this dittinCtion. 
Inflammation of the kidney is accompanied with a 
pain in the lumbar region, and often along the courfe of 
the ureter; a feeling of numbnefs of the thigh: retrac¬ 
tion and pain of the teftis ; there is a frequent defire 
to void urine, which is ufually high-coloured. There 
are generally naufea and vomiting; pain, and conftipa- 
tion of the bowels. There is more or lefs of an expref- 
fion of pain in the countenance. The motions of the 
body are fomewhat impeded ; and certain motions are 
particularly painful; as bending to one fide, or lifting 
up the thigh, efpecially if the hand be prefi'ed forci¬ 
bly on the knee at the lame moment. Preflure between 
the fhort ribs and ilium, and fometimes along the courfe 
of the ureter, induces an aggravation of the pain. The 
general furface is foft, warm, but moift. The pulfe is 
accelerated. Sometimes the pain and other fymptoms af- 
feCt one fide only; fometimes both fides are affeCted. 
Now, in calculus in the kidney or ureter, we find, at 
fi rft, paroxi/fms of excruciating pain in thefituation of the 
kidney or ureter, attended by great mufcularcontra&ion 
of the countenance; dillortion of the body; holding 
and forcing of the breath; copious perfpiration ; a fre¬ 
quent defire of micturition, or retention of urine ; the 
urine itfelf is fometimes mixed with a mucous, puriform, 
or bloody, fluid. The tongue and pulfe are little affeCt- 
ed. Thefe paroxyfms are apt to be induced by the vio¬ 
lent motions of running, jumping, riding, See. Some¬ 
times the fymptoms of calculus are more infidious and 
continued, and lefs violent. They are apt to afl'ume the 
character of inflammation, or of chronic difeafe of. the 
kidney. 
When the kidney is chronically inflamed, it is attended 
with fome of the fymptoms juft detailed, though in a 
minor degree. At length perhaps a tumor is perceptible 
on examination of the region of the kidney and of the 
fpace between the falfe ribs and the ilium. Difeafe of 
the kidney is diftinguiflied from organic difeafe of moll 
of the other abdominal vifeera, by obferving that the de¬ 
gree of emaciation is much lefs, or its progrefs much 
flower ; efpecially when the latter affections are attended 
by an equal degree of fuffering. There is generally pale- 
nefs of the countenance and general furface. The pulfe 
is accelerated. 
The terminations of nephritis are the fame as thofe 
of other inflammations. In flight cafes, refolution 
may be obtained; but, where the difeafe has con¬ 
tinued with confiderable violence for upwards of a 
week, fuppuration may be apprehended. It may hap¬ 
pen however, that, when the difeafe has been kept down 
by proper remedies, refolution may take place as late 
as the fourteenth day. It is marked by the difap- 
pearance 
