The division of hepatitis into acute and chronic, facilitates the treatment, It is likewise useful to distinguish a synochal, erethic and typhoid form, and not to overlook the sporadic, endemic or epidemic character of the disease.

This inflammation terminates as all other inflammations. I ought to observe, however, that no disease, after the use of leeches, is more liable to metastasis than an inflammation of the liver, and that these me-tatastic diseases are more difficult to cure than the primary affection.

§ 213. I know from experience that it is best to commence the treatment with Aconite. If the inflammation should have been occasioned by violent chagrin, with gastric and icteric symptoms, Chamomilla is a specific remedy, and frequently relieves the disease in a few hours. Chamomilla is likewise indicated when there is more anguish than pain, or when the pain is dull-aching, and is not aggravated by pressure, turning from side to side, or drawing breath; when the pain is accompanied by oppression of the stomach, tightness and feeling of heaviness in the praecordial region, occasioning oppression of breathing; when bilious symptoms, jaundice, etc., are present, showing that the concave surface of the liver is more particularly inflamed. If the paroxysms of anguish should occur more frequently or at night, if there should be green, slimy, diarrhoeic stools, and a disposition to vomit, Pulsatilla may prove useful.

If the inflammation be attended with retention of stool, and spasmodic symptoms of the chest, Bryonia will generally be found a specific for that condition. Bryonia is, in fact, suitable for all congestive inflammations with violent fever and great vascular and nervous excitement; or for inflammations which had been occasioned by a cold or chagrin, or which are characterized by exacerbations occurring at night, or on waking, or during motion, etc. Bryonia deserves consideration when the fever has an erethic character.

and is attended with bilious symptoms; but particularly when the right hypochondrium is swollen and tight, with burning or stinging pain during contact, cough, or breathing.

Belladonna, in alternation with one of the above-mentioned remedies, will prove curative in chronic hepatitis, characterized by chronic sensitiveness in the region of the liver, by a yellowish complexion, altered stool, sensation of pressure or tightness in the epigastric region, irregular appetite, increased thirst, restless nights. An inveterate chronic hepatitis requires to be treated with the antipsorics, principally with Natrum, Muriate of Magnesia, Natrum mur., Antim. cr., Sal. ammon., Lycop., Kali carb., Sulph., Sep., Curb, an., Asa, etc.

An acute inflammation of the liver can sometimes be cured by Belladonna alone, particularly when the convex surface towards the diaphragm is inflamed, in which case the pain is superficial, stinging, aggravated by pressure, inspiration, cough, or by lying on the affected side, when the pain resembles pleurisy, and extends to the shoulder and neck. Accompanying symptoms are: dry. cough, dyspnoea, hiccough, congestion of blood to the head, dulness of the head, obscuration of sight, vertigo, as if one would faint. Sometimes these symptoms are accompanied with distention of the pit of the stomach, and an intolerable tightness across the abdomen above the umbilicus, occasioning difficulty of breathing and anxiety. If considerable thirst, agonizing tossing about, sleeplessness, etc., should be present, Belladonna is more suitable than any other remedy.

Nux vomica is particularly suitable when gastric symptoms are present, and the patient has a lively, sanguine, or choleric temperament. It is more suitable to males than females. Nux is indicated by a stinging pain in the region of the liver, which is exceedingly painful to contact, with occasional beating , or throbbing in the right hypochondrium; by constipation, sour and bitter taste, loss of appetite, inclination to vomit or vomiting, tightness, pressure, shortness of breathing, with sensation as if the clothes were too tight, although the oppression of the chest increases on removing them, great thirst, frequent and hard pulse, bright-red, scanty urine, pressing headache, exacerbation of the fever, and pains early in the morning. I ought to add in this place, that Aconite is much more useful in hepatitis when the pulse is accelerated, soft, full, or even irregular, than when it is frequent and hard.

Mercurius solubilis is a valuable remedy when the patient complains of bitterness in the mouth, with more thirst than hunger, constant chilliness, aching pain in the right epigastric and the praecordial region, (which is likewise very sensitive to contact,) when the patient is unable to lie on the right side, has a jaundiced appearance, and complains of frequent paroxysms of anguish. Antim. cr., China, Puls., are likewise suitable for the above group of symptoms.

I have used Cocculus with benefit for stinging and violent aching pains in the right hypochondrium, getting worse on stooping, coughing, or breathing; the pain extends to the pit of the stomach and stomach, and does not admit of the least contact; the abdomen is distended, with frequent vomiting of water and mucus, which increases the pain extremely; attended with burning heat and redness of the face, great thirst, and small, rather hard pulse.

Cantharis seems to be indicated by a full and hard pulse, by violent, vague (perhaps stinging) pains in the right hypochondrium, attended with constipation.

I have found China an admirable remedy for a sticking pain in the region of the liver, with sensation of subcutaneous ulceration on touching it, swelling of the right hypochondrium, diarrhoea, quick and hard pulse, redness of the cheeks, swelling of the veins of the head, etc.

Lycopodium and Sulphur are excellent remedies for chronic hepatitis. Sepia is indicated by an aching-sticking tightness in the right hypochondrium, aggravated by contact, deep breathing, or turning to one side; it is particularly indicated by a bland and genthe disposition, when chagrin is the exciting cause, by-restless night-sleep, with paroxysms of anguish, arrest of breathing, anxiety, and palpitation of the heart.