On the Causes and Symptoms of Acute Diseases (2.7)

IN the affections of the liver, the patients do not die, indeed, more quickly than in those of the heart; but yet they suffer more pain; for the liver is, in a great measure, a concretion of blood. But if the cause of death happen to be situated in its Portæ, they die no less speedily than from the heart; for these parts are tissues formed of membranes, of important and slender nerves, and of large veins. Hence certain of the philosophers

have held that the desires of the soul are seated there. In hemorrhage it greatly surpasses all the others; for the liver is made up from the roots of veins. Wherefore a great inflammation does form in it, but not very frequently, nor in its vital parts, for the patient would die previously. But a smaller inflammation often takes place, whence it happens that they escape death, indeed, but experience a more protracted state of disease. For of its office, as regards sanguification, there is no stop nor procrastination, as from it a supply of blood is sent to the heart, and to the parts below the diaphragm.

If from a greater cause—a stroke, or continued indigestion of much and bad food, and intoxication, or great cold—an inflammation forms in the portal system, a very speedy death is the result. For there is a latent, smothered, and acrid heat; pulse languid; the kind of pain varied, and every way diversified, sometimes darting to the right side, so as to resemble a sharp weapon fixed in the place, and sometimes resembling tormina; again, at other times the pain is deep—nay, very deep; and, intermediate between the pain, atony and loss of utterance. The diaphragm and succingens (pleura) are dragged downwards; for from them the liver is suspended as a weight. For this reason, a strong pain extends to the clavicle on the same side; an ineffectual cough, or only a desire thereof, and when it comes to a conclusion, dry; respiration bad, for the diaphragm does not co-operate with the lungs, by assisting them in contraction and dilatation. They draw in a small breath, but expire a larger; colour, a dark-green, leaden; they loathe food, or if they force themselves to take any, they become flatulent in the epigastrium; eructations bilious, acid, fetid; nausea, retchings, belly mostly loose, discharges bilious, viscid, small in quantity. The affections always go on increasing; mind not very much deranged, but torpid, unsettled, stupid; much timidity; coldness of the extremities, tremblings, rigors,

hiccup of a spasmodic nature, jaundice, bile intense, the whole body tinged with bile. But if it appear before the seventh day, it proves fatal in many cases.

But those who have escaped a fatal termination, either by a hemorrhage, or a rapid discharge from the bowels of bilious matters, or from frequent discharges of intense urine, in these cases, after three weeks, the liver is converted into a purulent abscess. But if it pass considerably this period without an abscess, it ends inevitably in dropsy; the patients are thirsty, drink little, are dried in body, lose fat; there is a desire for acids, and an insensibility to taste.

Autumn engenders this affection, along with the indigestion produced by much summer-fruit and multifarious food. Of all ages, the adult is most subject to it.