Imatges de pÓgina
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Albuminous obstructions.-Morbid appearances: The maxillary glands; those of the absorbent system, situate beneath the platysma myoides and between the trachea and jugular veins; the glands of the lungs and mesentery, enlarged and filled with a plastry substance; the lungs themselves much shrunk and hardened. The liver enormously large; its anterior margin greatly indurated; the substance, when stripped of its membrane, whitish; more so internally than on the surface: layers of a dark gray colour disposed here and there. Many lymphatic vessels, gorged with a thick substance, appearing like hard slender cylinders, both in the interior and on the surface of the organ. The substance distending the liver equally white. Symptoms: Extreme emaciation; disgust for food; maxillary glands and absorbents of the neck enlarged; abdomen indurated; liver evidently projecting in the epigastric and right hypochondriac regions; and hectic fever. The subject, a boy of eight years.

The matter forming these obstructions, our author was led to consider as extravasated albumen. He supports this conclusion by some rather coarse experiments. A slight acquaintance with modern chemistry would surely have suggested tests more delicate and unequivocal. Different portions of the morbid liver were found to harden on exposure to a brisk fire, and on immersion in boiling water or alcohol. These results are confirmed by the examination of a second analogous case.

“ The albumen,” it is subsequently observed," which forms these lymphatic obstructions, is hardened by the action of fire or alcohol. The gelatine, on the other hand, liquifies by heat, and remains permanently in solution, when dissolved in boiling water; while mucus, thus treated, rises to the surf and differs from fat, which in the former respect it resembles, in not being inflammable.”

Our author, in his treatment of lymphatic congestions of the liver, prescribes preparations of ammonia; mercurials with antiscorbutics and bitters. Pills, composed of muriat of am. monia and oxymuriat of quicksilver, are a favourite remedy. Mercurial frictions are likewise recommended, and the mineral waters of Barèges, of Cauterêts, and Aix-la-Chapelle, especially after the administration of mercurials.

Gelatinous obstructions.-Morbid appearances: Liver weighing twelve pounds, and of a rounded figure. The fissure, separating its two great lobes, well-nigh obliterated. Several variously-sized eminences on its external surface. Internal structure of uniform consistence, rather relaxed than condensed; colour irregularly gray and red. The parenchyma, in some parts, unchanged; in others, appearing confounded with a foreign substance, which formed tumours on the external surface of the liver, and filled some unnatural cavities in the interior of the viscus. Symptoms: Gradual emaciation without evident cause; light yellowness of the skin; hiccough; severe colic; high-coloured urine; whitish fæces; depraved taste; pains, with remarkable protuberance in the epigastrium; excessive vomiting and marasmus; evening accession of fever; the abdominal tumour becoming, before death, very hard and unequal, and occupying all the right side to the corresponding ileum and Davel. The subject, a boy of four years.

The substance occupying this liver became liquid, on exposure to gentle heat; did not take fire or crepitate on burning coals; did not coagulate in alcohol or boiling water, and remained permanentlydissolved in the latter: the undoubted characteristics, in our author's opinion, of gelatine. Other cases and dissections of the same nature are recorded.

Mucous obstructions.-No history is given in elucidation of this species. The substance forming them dissolves in warm water; but rises to the surface on the reduction of the temperature, and becomes a dry pellicle upon exposure to air: it does not inflame on burning coals. This will be found generally, though not always, the predominant principle in very indurated livers.

Liver gorged with serum and containing hydatids.--Of this form of disease five histories are detailed. The shortest and most interesting we transcribe. Morbid appearances: A large cavity in the great lobe of the liver, filled with hydatids; the colon ulcerated, and adherent to the liver around the morbid excavation, and communicating with it by a common aperture. Symptoms: Constant pain in the region of the liver; griping in various parts of the abdomen; bodies, resembling vesicles, voided by stool; disease lingering. Subject, a man, aged 40.

In the third and fourth sections on obstructions of the liver VOL. VI.

H

No. 21.

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by fat, and on compound obstructions, nothing occurs to arrest our attention. The characteristic properties of the obstructing matter in the former, are its rising to the surface after solution in hot water, and its inflammability. We must be careful not to mistake a white and fatty appearance of the liver for its total conversion into adipose substance. The latter are formed by a combination of two or more of those simple species of obstruction which we have been considering.

The sixth section contains remarks on various morbid conditions of the liver, indurated, diminished, softened.-Eleven illustrative cases are quoted from divers sources. But these remarks are, like the concluding article of the chapter on hepatocele or hernia of the liver, destitute of peculiar attraction.

How, we would ask M. Portal, are the varied forms of hepatic obstruction, which he has with such labour and minuteness been exposing, to be detected in the living subject of disease? Is each variety of organic lesion characterized by a peculiar set of external phenomena, which can enable us to decide with correctness upon its precise nature, and influence our therapeutic views? We apprehend not: or surely M. Portal could scarcely have so far forgotten the great end and aim of all pathologic research, as to neglect the opportunity thus afforded of throwing new light upon the dark and perplexing paths of diagnosis. After reiterated examination of the sections, in which the several species of hepatic congestion are described, no pathognomonic symptom, no peculiarity of external feature, calculated to serve as a base of practical distinction, has arisen upon our view; and it moreover appears, that in the several varieties of lymphatic obstruction, even dissection itself, unaided by a ray from the torch of experimental chemistry, is inadequate to illustrate the precise differences of morbid structure. Subtle distinctions too frequently serve rather to clog, than accelerate the march of science: yet, on the other hand, it is unwise to condemn rashly, new facts or discoveries, because we see not, or are incapable of directly appreciating their applicability to the improvement of that branch of science in which they have arisen.

Jaundice constitutes the subject of the third chapter. Twen

ty-two dissections are brought together in elucidation of its various causes. As this disease, or rather symptom, is referable to morbid affections of the internal organs, so different in seat and character, we deem it better to arrange and generalize the results of these dissections, than to enter minutely upon any individual history.

Morbid affections, giving rise to jaundice, may reside immediately in the liver or its appendages; or in some neighbouring or remote organ. In the latter case, the biliary secretion

may be obstructed in its course to the duodenum by the direct and evident mean of mechanical pressure; or is disturbed in a manner inexplicable upon obvious principles, and probably referable to the trackless and mysterious influence of sympathetic irritation.

Of these twenty-two cases, fifteen came under the first class; and in all of these, dissection showed, as the origin of the morbid phenomenon, biliary concretions: an enlarged, indurated, scirrhous, tuberculous, purulent or sphacelated state of the liver:-or one or other of these forms of organic lesion, complicated with concretions. The other seven cases belong to the second class; and here, indurated pancreas, scirrhous duodenum, tumours of the mesentery, enlarged spleen, or dilated colon, were detected. Amid several histories, subsequently quoted, to prove that jaundice is not the invariable consequence of biliary concretions, however large or numerous, we shall transcribe one, conspicuous for its singularity; and subjoin our author's explanation of the phenomenon, as it appears to us alike rational and correct.

• Upon inspecting the abdomen of an irritable old man, no gall-bladder could be discovered. A large biliary calculus occupied its place."

“I cannot believe," observes M. Portal, “ that the subject of this case was without a gall-bladder, as Fernal (from whose writings it is quoted) represents. More probably, the concretion being so large as to completely fill the reservoir, the parietes of the latter acquired an intimate adhesion to it; and hence appeared to be wanting. Thus the heart has been said to be destitute of pericardium, when this membranous sac has

become closely and universally adherent to the external surface of the contained organ.”

After some observations on the name and symptoms of jaun. dice, its most clearly-ascertained causes are enumerated in the following order: 1st. Bilious plethora. 2dly. Sanguine plethora. 3dly. Inflammation of the liver and neighbouring organs. 4thly. Diminution or suppression of natural or morbid evacuations. 5thly. Severe or protracted pain. 6thly. Acrid poisons or the bite of venomous animals. 7thly. Violent affections of the mind. 8thly. Fevers. 9thly. Congestions or obstructions of the abdominal viscera, particularly the liver. 10thly. Falls, contusions, severe compressions of the abdomen; and the catalogue of exciting causes is closed, with an obvious and inexplicable want of correctness, by infantile jaundice.

Upon each of these subjects our author enters separately. Amid the various causes determining sanguineous congestion of the liver, pregnancy is mentioned, as causing the blood to be retained in the vena portarum. But how the obstructed cir. culation of a vessel should operate in producing a state of sanguineous congestion in any organ which derives from such vessel its principal supply of blood, we profess ourselves utterly unable to comprehend.

Şuppression of accustomed evacuations, or the injudicious repulsion of cutaneous diseases, is frequently succeeded by jaundice. M. Portal knew a lady, who having, by the application of powdered alum, removed a very copious and offensive discharge from the axillæ, was immediately seized with jaundice; from which she did not recover until the salutary excretion had been restored. In referring the jaundice, which frequently arises during an attack of gout or rheumatism, to the pain attendant upon these diseases, an error is surely committed; of which we could scarcely have suspected an intelligent observer like M. Portal. It will, we believe, be found, upon rigid examination, that disturbance of the biliary system forms a common, if not essential, feature in the origin of all gouty and rheumatic affections. We, perhaps, go too far, in hazarding an opinion, that the day may not be far distant, when these insatiate focs of human comfort, their dependence upon certain forms of abdominal derangement clearly and invaria

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