A gall-stone in the hepatic duct will cause great pain over the liver (chiefly in one spot), much sickness and intense distress, and a feeling of faintness. A hot bath and the administration of chloroform will ease the pain, or hot fomentations constantly renewed may be applied to the affected side, and 25 drops of laudanum (for an adult) in half a glass of water given, repeating the dose in two hours if the agony still continues. Jaundice will come on from the obstruction to the flow of the bile, but this will disappear when the stone has escaped from the duct into the intestine, or has become dislodged and returned to the gall bladder, thus leaving the bile duct open.
Amongst chronic changes of the liver may be enumerated cancer, cirrhosis, fatty and waxy degeneration, passive congestion, syphilitic deposits, and the presence of hydatid cysts.
Cancer of the Liver is a most fatal and serious disorder, carrying the patient off within a year, or a year and a half, from the first appearance of any symptoms. These are, at first, loss of appetite and pain over the abdomen; the latter begins to swell as the cancer increases in size, and becomes extremely tender; rapid emaciation goes on, but the temperature is generally no higher than usual, and there is no attendant fever. The loss of flesh, the hollow temples, the great prostration, the pain and swelling or enlargement of the liver, are the chief symptoms: these gradually become worse, and finally cause a lingering and painful death. Jaundice is not often present, nor does the patient suffer from shivering. Cancer of the liver may occur in both sexes, and be met with at any period of life ; more frequently, perhaps, between 30 and 50 years of age.
Treatment.—The treatment must be directed to the relief of the patient, as cure must hardly be looked for. The pain may be alleviated by the administration of opium or morphia, given internally as a draught, or injected under the skin in small quantities with a hypodermic syringe. The diet must be light and nourishing, and must be varied from day to day to please the fancy of the patient, whose appetite will be small and capricious.
Cirrhosis of the Liver comes on more generally in middle life; at first it may be mistaken for cancer, as there is loss of flesh and appetite and pain in the abdomen, but the symptoms come on more gradually. The liver does not increase in size, but rather shrinks; dropsy of the abdomen soon comes on, and the distended abdomen becomes marbled over with blue veins as the stream of blood through them is impeded.
Fatty degeneration of the Liver is common in many disorders. A liver may be very fatty, and yet give rise to no symptoms, as in cases of consumption. The symptoms in any case come on very gradually, so that the organ is generally much diseased before any notice is taken of the mischief. The disease is often very chronic, and will last for years unless there be much mischief in other organs; dropsy is a bad
