cation with a large one situated on its convex surface. This abscess extended through the diaphragm and poured its contents into the cavity of the thorax. About two quarts of pus, mixed with blood, were found in the chest. The under surface of the lungs was abraded, and there can be no doubt of pus having been taken up by them and carried out by the trachea. phragm was universally altéred, and its muscular fibres had lost their redness. The lungs adhered to the pleụra, and the heart to the pericardium.

Remarks.

The texture of the dia

During the illness of this patient, he was never suspected to have any disease of the liver, as that organ performed all its functions with regularity; neither was he at any time heard to complain of the sympathetic pain in the shoulder, which so frequently occurs in a diseased state of that viscus. I am inclined to think that an abscess, seated in the liver and extending itself through the diaphragm into the thoracic cavity, much more frequently occurs than is suspected; and that many of the cases, which have been considered truly pulmonic, originated in the liver. I have since met with a case in its progress and termination very much resembling the case above related. Its precise nature however was clearly pointed out by the additional circumstance of a large quantity of bile being mixed with the expectorated blood and pus.

Upon examination after death, it was found that the right lung had an immediate communication with a large abscess situated in the liver, the interposing diaphragm having been removed by the absorbents. Upon pressing the gall-bladder, bile flowed freely and copiously into the cavity of the abscess.

Bile was likewise ejected from the stomach in immense quantity, distressing the patient exceedingly; it

was also universally diffused through the circulating system.

In cases where disease of the liver has extended itself into the lungs, the expectorated matter has often assumed a reddish fleshy aspect. This appearance of the discharged fluid may sometimes enable us to distinguish the disease from true phthisis pulmonalis.

Chronic Hepatitis.

CHRONIC HEPATITIS requires a judicious administration of mercury for its removal. Blood may likewise be from time to time advantageously taken away from the hypochondria by means of leeches or cuppingglasses.

Where an indurated or enlarged state of the liver can be distinguished mercurial frictions over it must be directed.

CHAPTER XIII.

On the Function of the Liver.

THE anatomical researches of Mr. Abernethy and Mr. Laurance, have confirmed an opinion I have for a great length of time entertained. These Gentlemen found two children, in whom the vena portæ instead of ramifying through the substance of the liver, terminated immediately in the vena cava. In these subjects, bile was met with in the gall-bladder; and there was reason to believe that it had been regularly secreted during life. These cases indisputably prove that the hepatic artery is destined for the secretion of bile, as well as for the nourishment of the liver.

To affirm that bile is formed by a vein, is so directly in opposition to the general and known laws of the ani

mal economy, that it is a matter of surprise how such an assertion should have gained almost universal credence.

It appears to me that the vena portæ is intended to preserve an equilibrium in the circulation of the blood. If the blood which is sent to the abdominal viscera were returned immediately to the heart, instead of passing through the liver, the same inconveniences would result from it as arise from a too rapid circulation; whereas by being compelled to pass through the liver, about the same space of time is occupied as is taken up for the return of blood from the extremities. In this manner I conceive an equilibrium in the circulation to be preserved.

upon

The idea of a balance in the circulation has been treated with levity by some authors, by others it has been seriously entertained. My own opinion is, that its preservation health depends; that from its general or partial destruction many diseases originate; and that our curative intentions must be directed to its reestablishment. The occurrences of every day confirm this opinion, and until I discover something in the great volume of nature in opposition to it, I shall cherish it.

CHAPTER XIV.

Peritonitis.

Pyrexia; dolor abdominis, corpore erecto auctus; absque propriis aliarum phlegmasiarum abdominalium signis.—Cl. i. O. ii. G. xiv. CULLENI.

THE most vigorous and decisive practice ought to be adopted in the early stages of this disease. We must use the lancet with an unsparing hand, and cover the abdomen with leeches. These remedies must be per

sisted in as long as the patient complains of excessive pain or tenderness in the abdomen.

The superiority of this practice over the inert, half measures but too frequently relied upon, was strikingly exemplified a short time since.

CASE XXVIII.

A young woman, eighteen years of age, was suddenly attaked with the symptoms of acute peritonitis. She complained of extreme pain over the whole abdomen, which was greatly aggravated by pressure. Her pulse was hard, small, and frequent; her countenance anxious; her tongue white, her skin hot and dry. From thirty to forty ounces of blood were taken away for five days in succession, and afterwards a few ounces occasionally, when a febrile disposition was perceptible. The total quantity of blood abstracted was two hundred and forty ounces.

She remained in a debilitated state for some weeks, but ultimately perfectly recovered.

CASE XXIX.

A boy aged seventeen years, labouring under precisely similar symptoms, had fallen under my observation a short time previously. I never saw two cases bear a more striking resemblance to each other.

Sixteen ounces of blood were taken from his arm; some leeches applied to the abdomen, and half an ounce of the infusion of digitalis was directed every six hours. The boy died at the end of three days from his first seizure. The digitalis produced no effect either upon the head, pulse, or stomach.

The peritoneum and intestines exhibited traces of the most active inflammation. The intestines were glued together; flakes of coagulable lymph were deposited upon

their surfaces; and nearly a gallon of serum had been poured into the cavity of the abdomen, in which globular transparent pieces of lymph were also floating.

Remarks.

The violence of the pain, tenderness, &c. form the best criteria for estimating the danger of the patient; and our practice must be regulated by their intensity. If we pay any regard to the pulse, we shall be more frequently deceived than assisted by it. I have seen cases of peritonitis, in which it remained perfectly natural; others, in which it was as strong and full as in pneumonia, acute rheumatism, or any active inflammatory disease; others in which it was small, feeble, fluttering, and almost imperceptible.

A remarkable instance of the insidious nature of the disease happened about two years ago.

CASE XXX.

A young woman, for five days after a natural labour, appeared to be getting well without the occurrence of one unpleasant symptom.*

On the evening of the fifth day, she complained of a little tenderness above the pubes, slight nausea, and the abdomen felt rather tense. The pulse was soft and equal; the tongue clean; the skin moist; the bowels confined. She was directed to take an aperient. For three succeeding days she remained in nearly the same state; her pulse then sunk so low as to be scarcely perceptible; the surface of the body became cold, and covered with a clammy perspiration; the abdomen tense and inflated; and the stomach rejected every thing.

* After delivery, the uterus did not contract upon the placenta with sufficient force to effect its expulsion; and the funis was so very slender that it would have given way, had efforts for the extraction of the placenta been made with it; I was therefore under the necessity of detaching it with my fingers from the

uterus.