unfavourable in the male subject than in the female, who has not yet passed the period of menstruation; because, in the latter, an evacuation, highly salutary with respect to the morbid liver, may be operated at the menstrual period, or in the process of fortunate parturition.

Unfavourable appearances in hepatitis: Hæmorrhoidal flux, occurring late in the disease, and preceded by shiverings and softening of the pulse; discharge of blood by the anus, proceeding from destruction of the hepatic vessels in consequence of suppuration; frenzy; profound stupor. Favourable appearances: Copious discharge of blood from the hæmorrhoidal vessels early in the attack; abundant evacuations of healthy bile by the bowels, or of blood issuing from the dilated hepatic arteries; nasal hæmorrhage, especially when occurring from the right nostril.

Disease of the liver may be suspected, and its consequences are justly to be feared, when, after morbid affections of the head, falls, or blows, particularly such as implicate the encephalon, jaundice ensues, with disorder of the digestive functions and colic.

Dropsy, the frequent consequence of hepatic inflammation, is to be dreaded, when after this disease the countenance remains discoloured; when adema of the lower extremities, obstinate indigestion, emaciation, slight fever, muscular debility, disordered respiration, and a slow, soft and unequal pulse are noticed. The danger of this termination will be more urgent in proportion as the secretions of the skin and kidneys may be diminished.

The last section of this chapter comprehends the treatment of hepatic inflammation. Abstraction of blood from the right arm, from the foot, from the hæmorrhoidal vessels by leeches, or from the right hypochondrium by cupping-glasses, injections, fomentations, blisters, constitute the principal remedies in French practice, during the active stage: afterwards, mild aperients, as the neutral salts, the waters of Vichy, either alone or mixed with whey or chicken-broth, tepid baths, &c. Purgatives are only indicated when disgust for food, or loaded tongue, shows that digestion is faulty; and then they must be of the mildest kind, as manna, tamarinds, cream of tartar. VOL. VI. No. 21.

L

"Purgatives are to be dreaded, lest they should increase or re-excite the irritation of the liver."-The stimulating system of Brown, and the modern mercurial practice of the English schools, in the inflammatory stage of hepatitis, are equally reprobated by our author. When shivering and irregularity of the pulse denote impending suppuration, he prescribes infusion of cinchona with nitre (nitrate of potass).

With the view of removing obstructions of the liver, consequent on inflammation, and preventing suppuration and scirrhus, our author administers internally assafoetida, bitter extracts, aloes, the juices of borage, succory, and other antiscorbutic plants, with or without the acetate of potash, vegetable aperitives, mercurial preparations, mineral-waters, of the laxative and diuretic rather than those of a purgative and tonic. quality: and employs externally mercurial frictions.

Some remarks upon suppuration and scirrhus of the liver terminate this chapter. Symptoms of inflammation undiminished at the end of from four to eight days after their accession (the time varying according to their intensity); pulse continuing hard and irregular; absence of cutaneous moisture; constipation; region of the liver indurated; sensation of deep pulsatory motion in that part, or discovery of it by external examination; these are the signs which portend the formation of matter in hepatitis. The last of these phenomena has sometimes been mistaken for aneurism.

The following appearances prove, Leyond doubt, that suppuration has taken place:-Sensation of weight, and of obtuse, instead of the preceding acute, pain in the right hypochondrium; irregular shiverings succeeded by hot fits; evening-heats in the palms of the hands and soles of the feet; nausea; vomiting; nocturnal, or rather morning sweats; extreme weakness; syncope; and real hepatic phthisis. Sometimes, the abscess may be distinguished by external examination, in the epigastric region, below the inferior border of the last false ribs of the right side. A pasty softening, more or less extensive, surrounded by a firmer substance, indicates its situation; but if this correspond to the site of the gall-bladder, the diagnosis may become difficult. The existence of an abscess would, however, be clearly demonstrated by the concurrence of three circumstances:-a

pre-existing state of inflammation, the sudden formation of the tumour, and the certainty that the patient had never suffered from hepatic colic, nor had passed biliary concretions.

Opening its way through the diaphragm, commonly in the interval surrounded by the coronary ligament, the pus of an hepatic abscess may be effused into the thorax, or it may escape into the cavity of the peritoneum, and death is the consequence: Sometimes, however, it is discharged externally by a fistulous opening between the abdominal and lumbar muscles: or is evacuated into the duodenum by the cysto-hepatic duct; or, aided by the fortunate process of adhesion between the liver, peritoneum, and other neighbouring parts, it is poured into the stomach or the colon, and thus passes off by vomiting or stool.

Our author enumerates, among the principal symptoms of hepatic scirrhus, colic; sensation of dragging in the epigastric region; constipation of the bowels or diarrhea, sometimes alternating; disordered respiration; swelling of the inferior extremities, sometimes in the right foot only, particularly towards evening; the face puffed in a morning; urine scanty, red, with sediment; ultimately ascites. At other times, the scirrhus terminates in suppuration and ulceration. Hectic fever, diarrhea, night sweats, and marasmus, signalize this fatal process.

An eighth chapter, upon hepatic phthisis in general, closes the first part or division of the work. We, perhaps, cannot convey to our readers a more correct notion of what is meant by wasting or consumption of the liver, than by presenting our author's definition of the symptoms in his own language.

"The symptoms are, in the first place, those which are common to phthisis of the other organs, as emaciation, hectic fever, sweats, colliquative diarrhea. Secondly, those which are proper to this species of phthisis, as pain, of various duration, in the region of the liver, of the stomach, the spleen, the kidnies, and thorax; about the lower part of the neck, and top of the right and sometimes of the left shoulder, extending to the arms, or felt transversely in the middle of the chest, or confined to the lower boundary of this cavity; indigestion; loathing of food; flatulence; colic; difficulty of reclining upon the left side; jaundice or yellow tinge of the complexion; urine red;

countenance red and bloated; itching of the skin; tightness of respiration, especially in ascending stairs; in many cases, palpitations of the heart; syncope; edema of the extremities, sometimes of the right only, but more frequently of both inferior, and afterwards of the superior limbs, with effusion into the cellular membrane of the trunk; and commonly, at last, into the various cavities."

These symptoms vary somewhat in their combination and intensity.

In hepatic phthisis, the prognosis is, for the most part, unfavourable. When purulent secretion is once established in the structure of the organ, the case may be considered, with some very uncommon exceptions, hopeless. Several of its species, especially if the hectic fever be established in a decided manner, seem utterly incurable; some, even in their earliest stages.

Yet a feeble hope of a fortunate result may be indulged, if suppuration of the liver have taken place in a strong man, consequent on an external cause, and without hectic fever; if the abscess burst externally, or present so as to become accessible to surgical operation; but even here, the result must be exceedingly dubious. The only chance of treating with success the disease from an internal cause, is to assail it immediately on its origin; but the termination will be, in general, fatal. Diarrhea and colliquative sweats announce approaching dissolution. Wasting of the liver is very frequently the consequence of unsubdued hepatitis.

The liver, in persons who have died from hepatic phthisis, is found variously diseased; sometimes in a state of suppuration so universal, that the whole internal structure of the organ is destroyed, the investing membrane remaining entire, or ruptured in one or more places, and the pus consequently evacuated into the abdomen, stomach, intestines, or thorax. One centre of suppuration, variously sized, may exist alone, or there may be great numbers of them, superficial or deeply seated; isolated or communicating together. These abscesses are frequently contained in excavations of the liver, the parietes of which are irregular, and more or less corroded. The pus contained in them varies greatly in colour, consistence and other physical properties. Different parts of the liver often fall suc

cessively into a state of induration and suppuration; so that on examining, after death, a victim of this disease, the process of morbid alteration may be seen in all its various degrees and stages. Sometimes the liver is partially or universally indurated; sometimes interspersed with graniform concretions of different sizes and consistence, of a reddish or white colour, entire, or affected, more or less completely, with suppuration.

M. Portal has seen, in subjects who have died of the most clearly-marked form of hepatic consumption, "the liver greatly hardened, and full of variously-sized granulous concretions; their consistence such as to resemble verrucous indurations of the skin." He has observed" other portions of the liver, the internal structure or surface of which displayed a kind of caruncles, red or black in colour: from which a quantity of blood flowed on light pressure, as from compressed piles."

The liver may be greatly enlarged in hepatic phthisis, so as to occupy an enormous space in the abdomen, and produce alarming or fatal symptoms by compression and derangement of the other abdominal, or of the thoracic viscera. This enlargement may implicate one lobe, or one part of the liver only, so that the figure of the organ may be variously altered. On the other hand, the liver may be diminished to a fifth or sixth part of its original size. This change may take place irregularly, and be complicated with softening, rather than induration, of the organ, though the latter frequently occurs in a very great degree. The liver has been found nearly destroyed by ulceration, commencing internally or externally, either upon the convex or concave surface. The substance of it has been seen affected, at the same time, with softening and induration in different parts.

Adhesions of the liver to the several abdominal organs are very common in hepatic phthisis; whether it be the consequence of hepatic inflammation, or result from a scrofulous taint. These adhesions may be formed between the original membranes of the different viscera, or by intermediate membranes of new formation. The latter are very common, and are often in a state of ulceration.

The liver, in hepatic phthisis, is rarely in a solitary state of disease. Either itself has become affected by some morbid