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covered to have happened, by our finding in the liver, upon dissection, large abscesses, which were presumed to be the effect of some degree of previ. ous inflammation. As this chronic inflammation is seldom to be certainly known, and therefore does not lead to any determined practice, we omit treating of it here, and shall only treat of what relates to the acute species of the hepatitis.
415. The acute hepatitis may be known by a pain more or less acute in the right hypochondrium, increased by pressing upon the part. The pain is very often in such a part of the side as to make it appear like that of a pleurisy; and frequently, like that, too, is increased on respiration. The disease is, in some instances, also attended with a cough, which is commonly dry, but sometimes humid; and, when the pain thus resembles that of a pleurisy, the patient cannot lié easily except upon the side affected.
In every kind of acute hepatitis, the pain is often extended to the clavicle, and to the top of the shoulder. The disease is attended somtimes with hickup, and sometimes with vomiting. Many practical writers have mentioned the jaundice, or a yellow colour of the skin and eyes, as a very constant symptom of the hepatitis ; but experience has shown, that it may often occur without any such symptom.
416. The remote causes of hepatitis are not always to be discerned, and many have been assigned on a very uncertain foundation. The follow. . ing seem to be frequently evident. 1, External violence from contusions or falls, and especially those which have occasioned a fracture of the cranium. 2, Certain passions of the mind. 3, Vio. lent summer heats. 4, Violent exercise. 5, Intermittent and remittent fevers. 6, Cold applied externally, or internally ; and therefore, in many cases, the same causes which produce pneumonic inflammation, produce hepatitis, and whence also the two diseases are sometimes joined together. 7, Various solid concretions or collections of liquid matter, in the substance of the liver, produced by unknown causes. Lastly, The acute is often induced by a chronic inflammation of this viscus.
417. It has been supposed that the hepatitis may be an affection either of the extremities of the hepatic artery, or of those of the vena portarum ;, but of the last supposition there is neither evidence nor probability.
418. It seems probable, that the acute hepatitis is always an affection of the external membrane of the liver ; and that the parenchymatic is of the chronic kind. The acute disease may be seated either on the convex or on the concave surface of the liver. In the former case, a more pungent pain and hickup may be produced, and the respira
tion is more considerably affected. In the latter, there occurs less pain, and a vomi ing is produced, commonly by some inflammation communicated to the stomach. The infiammation of he concave surface of the liver, may be readily communicated to the gall-bladder and biliary ducts; and this perha , is he only case of idiopathic hepatitis attend. ed with jaundice.
419. The hepatitis, like other inflammations, may end by resolution, suppuration, or gangrene; and the tendency to the one or the other of these events may be known from what has been delivered above,
420. The resolution of hepatitis is often the consequence of, or is attended with, evacuations of different kinds. A hemorrhagy, sometimes from the right nostril, and sometimes from the hemorrhoidal vessels, gives a solution of the dis, ease. Sometimes a bilious diarrhæa contributes to the same event, and the resolution of the hepatitis, as of other inflammations, is attended with sweating, and with an evacuation of urine depositing a copious sediment. Can this disease be re. solved by expectoration ? it would seem to be sometimes cured by an erysipelas appearing in some external part,
421. When this disease has ended in suppuration, the pus collected may be discharged by
the biliary ducts; or, if the suppurated part does not anywhere adhere closely to the neighbouring parts, the pus may be discharged into the cavity of the abdomen : but if, during the first state of inflammation, the affected part of the liver shall have formed a close adhesion to some of the neighbour. ing parts, the discharge of the pus after suppura. tion may be various, according to the different seat of the abscess. When seated on the convex part of the liver, if the adhesion be to the peritonæum lining the common teguments, the pus may make its way through these, and be discharged outwardly: or, if the adhesion should have been to the diaphragm, the pus may penetrate through this, and into the cavity of the thorax, or of the lungs; and, through the latter may be discharged by coughing. When the abscess of the liver is seated on its concavę part, then, in consequence of ada hesions, the pus may be discharged into the sto. mach or the intestines ; and into these last, either directly, or by the intervention of the biliary ducts,
422. The prognostics in this disease are established upon the general principles relating to inflammation, upon the particular circunstances of the liver, and upon the particular state of its inflammation,
The cure of this disease must proceed upon the general plan ; by bleeding, more or less, according to the urgency of pain and pyrexia ; by the application of blisters ; by fomentations of the ex: ternal parts in the usual manner, and of the internal parts by frequent emollient glysters ; by frequently opening the belly by means of gentle laxatives; and by diluent and refrigerant reme. dies.
423. Although, in many cases, the chronic hepatitis does not clearly discover itself; yet, upon many occasions, it may perhaps be discovered, or at least suspected, from those causes which might affect the liver (416) having been applied; from some fulness and some sense of weight in the right hypochondrium; from some shooting pains at times felt in that region ; from some uneasiness or pain felt upon pressure in that part ; from some uneasiness from lying upon the left side ; and lastly, from some degree of pyrexia, combined with more or fewer of these symptoms.
When, from some of these circumstances, a chronic inflammation is to be suspected, it is to be treated by the same remedies as in the last paragraph, employed more or less, as the degree of the several symptoms shall more distinctly indicate.
424. When from either kind of inflammation a suppuration of the liver has been formed, and the abscess points outwardly, the part must be opened, the pus evacuated, and the ulcer healed, ac