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change of the neighbouring organs; or the malady, originating in it, has been subsequently propagated to them. The vena portarum too, in these cases, is commonly found more or less dilated, and gorged with black blood. Nor to the abdominal organs only are these morbid alterations confined: the lungs, heart, and brain, are frequently found diseased in the subject of hepatic phthisis; but whether the lesions, detected in them, took place simultaneously with, or subsequently to, that of the liver, it is often difficult, if not impracticable, clearly to determine.
Effusions of various fluids in the peritoneal cavity have been noted in this disease, and probably decided the fatal termination; as, under these circumstances, the morbid alteration of the liver has many times been far from having attained its most advanced and mortal stage.
While some patients pass on to the last stage of hepatic consumption, and perish with all the symptoms characteristic of that advanced period, marasmus, diarrhea, and colliquative sweats; others there are, suddenly cut off by morbid affections arising in some contiguous or more remote organ, during the progress of the primary, or at least predominant, disease; such as vomiting of blood, melæna, anasarca complicated with ascites, hydrothorax, effusion into the brain, dysentery, choleramorbus, iliac passion, &c. Thus hepatic phthisis, in its progress and in its close, is alike dangerous.
The treatment of this affection will not detain us long. As this is rarely an essential or independent malady, it is necessary to investigate its causes, so as, if possible, to obviate them, to retard its progress, or attempt its radical cure. Each peculiar species, if it can be determined, must be combated by appropriate treatment. The occurrence of the disease from hepatitis will be most certainly prevented by repeated bleedings. Sioapisms, blisters, sudorifics, and alteratives, are indicated in hepatic phthisis with a gouty or rheumatic diathesis: aperients and diuretics, when it is complicated with dropsy: the prompt re-establishment of certain evacuations, when the hepatic disease is induced by their suppression.
The external remedies are relaxing, anodyne, or stimulating cataplasms; counter-irritation by blisters, moxa, setons, to prevent internal suppuration. If this process be, however, determined, notwithstanding every effort to prevent it; and the collection of matter, presenting externally, can be clearly distinguished from the tumour formed by a distended gall-bladder, its contents should immediately be discharged by a surgical operation.
We had nearly forgotten to mention that M. Portal, in citing the general results of dissection in hepatic phthisis, makes the following assertion: "sometimes, no trace of ulceration or suppuration can be detected in the liver: in the same manner, pulmonary consumption may occur without any suppuration of the lungs." This sentence we do not accurately comprehend. We wish that our author had entered into an explanation of it. Here the first division of the work terminates.
The second part, upon the condition of the liver in various maladies, which are believed to have their origin in other organs, and which terminate, for the most part, in phthisis of the hepatic viscus, occupies three hundred and twelve pages: twenty-two articles, of considerable interest and merit, are comprehended in it. They are thus arranged and entitled:
ART. 1.-On the condition of the liver in some catarrhal affections, and the hepatic phthisis consequent on them.
ART. 2.-On the condition of the liver in eruptive diseases, and the hepatic phthisis which frequently succeeds them.
ART. 3. ---On the condition of the liver from a scrofulous taint, and the scrofulous phthisis.
ART. 4.-On the state of the liver in syphilitic diseases, and hepatic phthisis from the same cause.
ART. 5.-On the state of the liver in scorbutic disease, and on the hepatic phthisis succeeding it.
ART. 6.-On the state of the liver in gouty and rheumatic affections, and on the hepatic phthisis frequently succeeding them.
ART. 7.-On the state of the liver in rickety subjects, and on phihisis of the liver from this cause.
ART. 8.-On the state of the liver after violent emotions of the mind and severe pain.
ART. 9.-On the state of the liver before, during, and after intermittent, remittent, or continued fevers; and on the phthisis of the liver frequently supervening.
ART. 10.-On the condition of the liver in some dropsies.
ART. 11.-On the condition of the liver in some persons who have experienced great difficulty in respiration.
ART. 12.-On the state of the liver after palpitations of the heart, syncope, and angina pectoris (stenocardia.)
Art. 13.-On the condition of the liver in some persons who have been troubled with nausea, indigestion, and different evacuations by stool and vomiting.
ART. 14.-On the condition of the liver after bilious vomitings.
ART. 15.-On the condition of the liver after yomiting blood.
ART. 16.-On the condition of the liver in some persons who have suffered from melæna.
ART. 17.-- On the condition of the liver after diarrhea.
ART. 18.-On the condition of the liver in persons who have died of dysentery.
ART. 19.-On the condition of the liver after evacuations of pus by stool and vomiting.
ART. 20.-On the condition of the liver in persons dead of the hepatic flux (hepatirrhca.)
ART. 21.--On the condition of the liver in persons dead of cholera-morbus, or of the iliac passion.
ART. 22.-On the condition of the liver after contusions of various parts, or violent exertions of the body.
It would afford us pleasure to exhibit to our readers, in an English dress, some of the more luminous and instructive of these articles. But our examination of the work has already been extended to a great, perhaps, by some considered an unprofitable, length: hence, we must content ourselves with a sim ple enumeration of them.-Probably, the selection department of our subsequent 'numbers may be enriched with extracts from some of the most valuable. The motives which have excited us to an examination thus protracted and minute are, at least, laudable. They who, unacquainted with the language, or scared by the bulk of the original work, would have remained strangers to its contents, may find much of its most important matter concentrated in our pages.
In perusing the labours of M. Portal, various feelings have
been excited within us. We have found much cause for admiration and applause-too much for reprehension and regret. Wearisome diffuseness and repetition in style, cast a deep and unfriendly shade over a production, the intrinsic value and excellencies of which yet shine conspicuous amid these accumulated defects. The author is probably far advanced in years. We imagine that, throughout his work, may be descried the traces of a mind, which, although damped by age and infirmity, must have been splendid in its meridian. The “ Maladies du Foie” may, in fact, be regarded as a valuable accession to the records of morbid anatomy. And we are persuaded that any man, who, sufficiently versed in pathology, and expert in
, the art of translation, should present this work, stripped of all superfluous ornament and circumlocution, to the English reader, would acquire credit for himself, and confer an important benefit upon the profession. Arrangement of the numerous cases and varieties of organic lesion, according to the essential phenomena exhibited by them in the living subject, would, perhaps, enhance the utility of such a work. And these, with all the valuable observations of the celebrated professor, properly condensed, might be comprehended in a volume, little more than half the bulk of the original. In the mean time, the long and laborious analysis we are just closing, will, it is presumed, afford to our readers an impartial and tolerably correct view of the French doctrine and practice in morbid affections of one of the most important and frequently deranged organs of the animal economy.
Traité des Poisons, tirés des Règnes Minéral, Végétal, et Ani
mal, ou Toxicologie Générale, considérée sous les Rapports de la Physiologie, de la Pathologie, et de la Médecine légale. Par M. P. ORFILA, Naturaliste Pensionnaire d'Espagne, Docteur en Médecine de la Faculté de Paris, Professeur de Chimie et de Physique; Précédé du Rapport fait à la Classe des Sciences Physiques et Mathématiques de l'Institut de France.-Tome I. Ire Partie. pp. 304. Ile. Partie. pp. 325. 8vo. Paris, 1814. [From the Edinburgh Medical and Physical Journal for January, 1815.]
THESE two volumes treat of the corrosive and exsiccant poisons, and are but part of a complete treatise on poisons which the author intends to publish. From the specimen he has given us, we shall be impatient to possess the whole, although we can by no means agree with the committee of the Institute of France, appointed to report on M. Orfila's manuscript, in the general censure thrown upon all preceding writers on toxicology. It is evident that both the author and the reporters were unacquainted with some of the best writers on the subject, and especially with the laborious and correct compilations of Gmelin,* whose research scarcely a single fact then known has escaped. In correcting this historical error, we have not the least intention of detracting from M. Orfila's merit, which we fully appreciate.
In his general arrangement and classification of poisons, M. Orfila has followed Fodéré; but as he seems to be sensible of its errors, and only to have adopted it because he was not prepared to substitute one of his own, we shall not stop to criticise it.
M. Orfila begins his work on corrosive poisons, with an account of their general action, the general symptoms, and the organic lesions produced by them, and their general treatment.
Gmelin (Johann Friedrich) Allgemeine Geschichte der Pflanzengifte. 2 weite vermehrte Auflage. 852 pp. 8vo. Nurnberg, 1803.
Allgemeine Geschichte der thjerischen und mineralischen Gifte; mit einer Vorrede von Blumenbach. Zweite Auflage. 391 pp. 8vo. Erfurt, 1811.