acid, and half a drachm of the tincture of hop, with a little syrup, three times a day, instead of the alkali; or two minims of the nitric acid may be added to two of the hydrochloric acid for a dose. Various combinations of the bitters and the mineral acids will be found useful, but we must in such cases be cautious in the use of any preparation of mercury; indeed, during the administration of the mineral acids, the mercury had better be entirely relinquished, as the bowels are apt to be irritated in spite of any precautions we may take. In this disease, where the stomach and liver are generally both involved, and where total change in all the previous habits is the best security, we frequently see the full advantage derived from the use of the gently purgative mineral waters, taken at their springs with all their accompaniments of air and exercise, and carefully-regulated diet and cheerful social intercourse; and waters which, like some of those of Cheltenham, combine a moderate infusion of the chalybeate with their saline ingredients, are particularly advisable.

Unfortunately, however, a large proportion of those affected with chronic inflammation of the liver are altogether unable to take advantage of means such as these; and another very large proportion are unwilling to leave for a sufficient length of time their occupations or their amusements, as long as they have the slightest hope of retaining them, and thus lose the opportunity of cure, which early care might have afforded. In such cases nothing remains for the physician but to palliate and relieve; and in chronic disease affecting this very important organ, circumstances are continually arising which require almost endless modifications of treatment, into the minutiae of which it would not be possible to enter in an elementary work: but throughout, and under every change, it must be a great object to allay irritation, and to reinstate as far as possible in their healthy functions those organs which have suffered. The

extract of conium, the hyoscyamus either in extract or in tincture, and the hop, are all very applicable as allaying irritation without constipating the bowels; and the extract of poppy will be very useful in the same way when the bowels are inclined to be relaxed; the more decided opiates are generally objectionable. When the stomach shows great evidence of irritability, the hydrocyanic acid in doses of two minims of Scheele's strength, with a little carbonate of soda and some stimulating water, may be prescribed; or effervescing draughts, with ammonia or with magnesia. Should the urine become very scanty, the vegetable diuretics, in decoction, infusion, and tincture, with carbonate or acetate of potash, will often act well; and taraxacum, in its various forms, has been much used, to all of which the nitric æther, and the ammonia, are often added with much advantage in the broken constitutions we have to treat.

As external applications, cupping and leeches are occasionally called for when tenderness and pain are experienced; and blisters, and warm plasters either of a mercurial character or not, appear to give relief to internal uneasiness, if they do not essentially promote cure; the external use of a bath for the feet or hands, impregnated with the nitro-hydrochloric acid, has been much praised. Thus by the most careful and varied management we may hope to retard, and, if seen very early, even to remove the chronic inflammation of the liver, and all its various consequences: but more frequently the result is otherwise; the disease is already too confirmed for cure; and the patient will obstinately or involuntarily continue in his bad habits, or at most will but inefficiently modify them; and we are called upon to sustain life for a few years or months, amidst all the miseries of general dropsy, or of chronic jaundice, or to see the remaining powers of the system gradually exhausted by successive attacks of hemorrhage.

SPLENITIS.

The SPLEEN, in common with the other organs of the body, is subject to inflammation, and, as in the case of the liver, the inflammation may attack either the peritoneal covering of the viscus or its substance. Judging from the appearances which often show themselves after death, we should be led to infer that the former was by no means uncommon in a more or less active form, while the acute inflammation of the organ itself is, in this climate, probably of rare occurrence.

INFLAMMATION OF THE PERITONEAL COVERING OF

THE SPLEEN.

The symptoms accompanying inflammation of this portion of the peritoneum differ chiefly from those which attend the membranous inflammation of the liver, in the situation of the pain and tenderness on pressure, which, in this case, are of course confined to the left hypochondrium. The same chills and rigors, with quickened, hard, and frequently small pulse, and white tongue, will occur, and the diaphragm and stomach will both participate; so that occasional sickness and some degree of diaphragmatic convulsion, and possibly of palpitation of the heart, will be present.

Morbid Appearances. The peritoneum covering the spleen presents all the usual results of inflamed serous membranes, varying according to the period and the character of the inflammation. In the earlier periods, vascularity in various degrees, and sometimes ecchymosis, occurs, and in the more advanced stages, adhesions take place to the surrounding viscera: when the inflammation has assumed a less active character, the spleen is found covered with a fibrinous coat, or with considerable cartilaginous or even

bony deposits; and where the tubercular diathesis prevails, the deposit on the surface of the spleen assumes that peculiar character.

The causes as well as the treatment of this local peritoneal affection, differ very little from those which have been described in connection with inflammation of the peritoneum of the liver; and the diagnosis turns in a great degree upon the situation of the pain and the influence of the diaphragm in increasing it, while the stethoscopic signs of pleuritis or pericarditis are absent.

INFLAMMATION OF THE SUBSTANCE OF THE spleen.

When acute inflammation takes place in this organ, it is accompanied by symptoms of general pyrexia, and the usual symptoms of inflammation, with a reference of pain, more or less acute, to the left hypochondriac region. It is also occasionally marked by great disturbance of the heart's action, with spasm of the diaphragm and sickness; and a peculiar sallowness of complexion is apt to come on in the more advanced stages of the disease, when the lower extremities often show an inclination to ædematous enlargement. If the disease be not checked chills and rigors succeed, and all the symptoms indicate important internal suppuration, under which the patient gradually sinks; or such slow and imperfect restoration follows, marked by feebleness and anæmia, that there is reason to believe some permanent change has taken place in the structure of the organ.

The Morbid Appearances in this organ are often equivocal; for, owing to its peculiar structure, and to the varying quantities of blood which it contains, no viscus is more liable to changes of colour and consistence where no symptoms have existed to excite a fear lest inflammation should

have been set up, and when, even after death, no such symptoms can be referred to. When, however, we discover the structure of the spleen unusually soft and friable, and when we perceive it of a light reddish or lilac colour, we are perhaps not wrong in suspecting that inflammatory action has been going on; at other times, the inflammation having subsided, we find the organ hardened and fleshy, and considerably enlarged; and when less fortunate terminations have ensued, we find abscesses filled with a more or less unhealthy pus, generally mingled with blood; sometimes the abscesses assume a gangrenous aspect, and sometimes they form communication with the large end of the stomach, or with the colon, or some other viscus, or burst into the abdominal cavity; occasionally we discover traces of abscesses in the structure of the spleen, which seem to have contracted and formed cicatrices. It is not uncommon to find in connection with the inflammation and suppuration of this organ, that coagula have formed in various veins, either those belonging to the viscera or to the extremities; such coagula undergo changes and assume some variety of appearance, sometimes containing a large proportion of red particles, sometimes forming yellow fibrinous masses, and sometimes passing, in their centres, into a state of softening resembling suppuration.

The Exciting causes of splenitis are, injuries from blows or falls; alternations of heat and cold, especially after great exercise; febrile complaints, particularly of the intermittent and remittent character; and the application of certain miasmata to the body, such as are yielded by marshy districts under circumstances of intense heat, or great diurnal variations of temperature.

Diagnosis. Splenitis may be confounded with pleuritis; pericarditis; the neuralgia accompanying hysteria