(From the liver, and pain). When pain affects the liver, as well as spleen, it is not often easy to distinguish them from bilious colic during the life of the patient: some practitioners think it unnecessary, since they require the same method of cure; but as they arise from different causes, it may not be useless to describe some of these; viz. scirrhosity of the liver; obstructions of the gall ducts, from very viscid bile; and biliary calculi.

When pain of the liver owes its origin to scirrhosity, it is attended with a tumour and hardness on the right side below the short ribs; a sense of weight, with a constant dull and tensive pain; difficult breathing; a dry cough; a sense of weight on the stomach after eating, with an increase of the difficulty of breathing; uneasiness from lying on the left side; the countenance yellow, or pale, and sallow; and the urine often of an orange colour, depositing a thick mucous sediment. If the complaint continues, as is too frequently the case, the feet swell, the body is emaciated, a dropsy of the belly, with a remittent fever, comes on.

When the cause is obstruction of the gall ducts, from viscid biliary matter, the symptoms of a scirrhous liver, which comes on in the beginning, are much slighter; to which are added a Hushing heat of the face, with occasional redness and heat in the palms of the hands; an irregular thirst; dryness, and bitter taste in the mouth; a dry cough; viscid saliva; loss of appetite; heart burn; weariness and heaviness of the limbs; increase of pain on touching and pressing the left side, or the pit of the stomach; and costiveness. The hardness on the right side is not so firm as in the former case, nor do the cedematous swellings, or hectic symptoms, appear.

When it arises from gall stones, there is a deep seated and excruciating pain on the right side, or at the pit of the stomach, extending through the body to the back, not constant, but occasionally violent, and attended with faintness, sickness, and often vomiting: the patient complains of sickness; the right side and the epigastrium are tense; the belly costive; the excrements pale and whitish; the pulse weaker, but seldom quickened, even when the pains are very violent and continued. The violent pain without fever, or quickness of the pulse, is considered as the certain symptom of this disease. The patient, either in an erect posture, or laying on the left side, feels very uneasy; is restless; breathes with difficulty; is affected with heart burn, and sometimes convulsions. The urine is pale, afterwards yellow; and the skin and white of the eyes have a jaundice-like appearance: the pain at last vanishes suddenly, a looseness sometimes succeeds, by which the gall stones are discharged, and the yellowness disappears.

Pain in the liver from scirrhosity is apt to attack gluttons; hard drinkers; and those who have led indolent lives. It also arises from suppression of haemorrhages, bruises upon the right side, general concussions from falls; and very often from long continued intermittent fevers. The disease generally proves fatal, when once formed; though, if attended to in the beginning, it might perhaps be prevented.

When scirrhous liver or viscid hepatic obstructions arise from hard drinking, we have explained its effect from ardent spirits destroying the irritability of the vessels; a change most severely felt, where the circulation is languid, and unassisted by the muscular coats found in arteries. The suppression of haemorrhages throws the blood, as we have seen, on the internal parts; and in elderly persons, where this effect is chiefly conspicuous, the disease equally arises from a want of irritability in the vessels to propel the accumulated contents. When it is owing to general shocks, we have explained its action in the article Concussio, q. v.

Decoctions of vegetable aperients, as grass roots, and dandelion, are serviceable. Gum ammoniacum and myrrh have been recommended on the vague principle of attenuating; but the effects of these remedies are inconsiderable. We must chiefly depend on some stimulant which will act with steadiness on the minuter vessels, and this property is almost exclusively confined to mercury, assisted with the decoctions of guaiacum and mezereon. Small doses of calomel may be given, or, what is preferred, mercurial ointment may be rubbed in on the part affected. At the same time the circulation in the liver may be assisted by gently stimulating the excretory ducts of this organ by rhubarb, or the cathartic mineral waters. Chalybeates are also useful, and they are combined in the present fashionable remedy, the Cheltenham waters. Bath waters, in gouty habits, and when the disease has arisen from long residence in warm climates, are occasionally beneficial.

When spasmodic affections arc the cause, which is known from their succeeding violent passions, sedatives and antispasmodics, as asafoetida, camphor, or opium, may be joined with the aperients; and when by these means the obstruction is removed, bitters and steel will complete the cure. In its course, however, the body must be kept open.

When the disease arises from gall stones, we must endeavour to promote their expulsion by the continued use of emollients and gentle cathartics, with warm bathing, interposing opiates.

Bleeding is sometimes premised to prevent inflammation in strong plethoric habits, and vomits are often useful; but they increase the pain, and are suspected of occasioning inflammation. If, however, they can be borne, they greatly facilitate the passage of a gall stone. As a combination of ether and spirit of turpentine has been found to dissolve gall stones out of the body, the same medicine has been recommended internally. We can scarcely understand how it can reach the object; but it has been said to have been useful.

In order to prevent a return of these complaints, gentle exercise, particularly riding on horseback, should be persevered in; light, easy digestible food taken, avoiding all that is viscid.

The heptalgia, however, has not been established as a genus by the latest and best nosologists; nor should any such be included in a regular system, for the distinguishing symptom, pain, is often absent; and we thus include diseases very different, viz. infarcted and scirrhous liver, chronic hepatitis, and jaundice from all its various causes. In this, as well as many other instances, we have not been able to alter the former arrangement, without disturbing numerous references, and inducing greater confusion than we should remove.

Many parts of this article will be, of course, repeated under these heads.