§ 211. Hepatitis, inflammation of the liver. Most physicians distinguish an acute and chronic inflammation of the liver. The inflammatory process does not involve the whole liver; it is limited to one lobe, or to only a portion of a lobe. We know from post-mortem examinations, that at the end of the first stage the liver is filled with black blood, and enlarged; this condition of the liver is soon followed by the stage of red softening, which terminates in suppuration; hence the frequency of abscesses of the liver in hepatitis. Such an abscess corresponds to the extent of the previous inflammation; in recent abscesses the pus is white, creamy; in old ones it is greenish, yellowish, chocolate-coloured, and has a fetid ammoniacal odour. According as the abscess is situated, the pus burrows in various directions, towards the umbilicus, region of the hip, along the dorsal vertebras, or into some adjoining organ, stomach, duodenum, transverse colon, or even into the right lung, in consequence of adhesions with the diaphragm. Recovery may take place in all those cases, except in the latter, where the patient generally dies of hectic fever.

It is difficult to diagnose hepatitis, inasmuch as the pathognomonic symptoms of hepatitis may likewise be supposed to point to some other morbid condition of the liver or of some adjoining organ. The difficulty of a correct diagnosis is increased by the fact, that in most cases only a portion of the liver is inflamed, and that the seat of the inflammation varies a good deal.

The following may be considered essential symptoms of hepatitis: Seated pain in the right hypochondrium, below and around the false ribs, frequently extending to the epigastric region or sternum, and afterwards even to the thorax. The pain is stinging, burning.

cutting, tensive, sometimes very violent, at other times only dull, aching or felt only during a deep inspiration, cough, external pressure, or when lying on the right side. The region of the liver is extremely sensitive, tight, sometimes swollen, hot, dotted with red spots, and a strong throbbing being frequently experienced in that region. The percussion-sound is dull over a large surface. Consensual symptoms are: pain in the top of the right shoulder, in the clavicle, arm, with sensation of paralysis or as if the part would go to sleep; these sensations are sometimes experienced in the whole right half of the body. Breathing is very difficult, anxious, interrupted, sighing; sometimes a dry, deep, and hollow cough is present. Pleuritic stitches, dyspnoea, cough, and other symptoms, resembling those of pleurisy, increase by turning to the left side, so that, in some cases, the patient has to lie on his back, or sit stooping. The patient is unable to sneeze. All these symptoms point to inflammation of the convex portion of the liver. The inflammation is generally attended with a violent fever, which is frequently remittent or sometimes intermittent, the pulse is more or less hard and frequent. Other gastric or bilious symptoms' are: hiccough, loathing, eructations, attended with anguish, occasional retching and moderate vomiting, without relief, or rather with aggravation of the morbid symptoms; a peculiar sensation of fulness, nausea, burning, and anguish in the pit of the stomach, bitter taste, yellow tongue, more or less jaundiced appearance, retention of stool, or else hard, gray, clayey stool, particularly when the concave portion of the liver is affected.

The precursory stage is like that of gastric fevers. It generally sets in with a violent chill, followed by burning heat, which generally abates in the morning hours.

The symptoms of hepatitis differ according to the seat of the inflammation; they will be described more particularly hereafter.

§ 212. The bilious secretion is more or less disturbed by the inflammation, which occurs more frequently in summer. It is occasioned by colds in the abdomen, particularly at a time when great heat alternates with damp and cold weather; it may likewise be caused immediately by a cold drink. Violent emotions, anger, grief, chagrin, may likewise occasion it; or it may be brought on by emetics, drastics, worms, or by the paroxysms of violent colic attendant on gall-stones; or by direct or indirect concussion of the liver, by means of blows on the right hypochondrium, or of a fall from a height on the feet, knees, buttocks, or head; or finally by injuries, wounds, etc.; hepatitis may likewise be occasioned by metastasis in consequence of suppression of piles, of inflammation of joints, chronic exanthemata, erysipelas, diarrhoea, dysentery, etc.

The prognosis under homoeopathic treatment is not unfavourable. It depends upon the extent and degree of inflammation, upon the constitution of the patient, and the morbid conditions with which it may happen to be complicated. An inflammation of the parenchyma, or the concave portion of the liver, is more dangerous than an inflammation of the surface of the liver or of its convex portion. Dangerous symptoms are: great anguish in the precordial region, obstinate vomiting of a leek-coloured substance; pain which cannot be relieved; frequent, small, irregular pulse, delirium.

Hepatitis is distinguished from gastritis by the following symptoms: In gastritis there is no enlargement of the volume of the liver which exists in hepatitis, and can be diagnosed by percussion and palpitation; jaundice is wanting, and the secretions have their natural colour. Pneumonia, pleuritis, and empyema, cannot be confounded with hepatitis, provided we do not overlook the above-mentioned characteristic symptoms of those diseases. In diaphragmitis the pain extends along the insertion of the diaphragm, the breathing is more painful, panting, sighing; there is occasionally singultus, risus sardonius, anguish, del r-ium. A colic induced by biliari calculi is recognisable by the paroxysmal recurrence of the pains. In 6 hepatitis the secretion of urine, which is interrupted in nephritis, is undisturbed.