RIGHT-SIDED PLEURISY with a serous Or sero-sanguineous exudation. This con dition has not, as yet, been thoroughly worked out; so far as I can see it is not of a tuberculous nature, for I have come across cases showing such pleurisy in which there has not been a sign of tuber culosis at the post-mortem. -Where it is present I hav6 also noted a co-existence of adhesions between the upper surface of the liver and the diaphragm, which might indicate an extension of the in flammatory process from the liver to the pleural cavity. Were this so, it would be evidence in favor of microbic origin or microbic complication in the hepatic con dition; but, as already stated, this sub ject requires much further study; oc casionally there is evidence of bilateral pleurisy.
Pleuritic effusion on the right side only-, in Laennee's, generally considered as an exceptional symptom is, however, a constant symptom. Found in nine cases of cirrhosis. It is of value in the diagnosis of doubtful cases, when it is difficult to determine whether ascites is due to cirrhosis of the liver, to throm bosis of the portal vein, or to compres sion of that vessel by tumors or swelled glands. G. Villani (Riforma Medico., Mar. 9, '95).
Another frequent complication is NE PIIRITIS, either of the granular type or not infrequently as a mixed interstitial nephritis, of what Formad has termed the "hog-backed" type, the organ being enlarged, more especially from before backward, and showing microscopically a condition of mixed interstitial and parenchymatous nephritis. The inter stitial type is, in general, associated with evidences of some degree of general ar teriosclerosis and with other complica tions due to this process. Both the inter stitial and the hog-backed kidney are, it need scarcely be said, characteristic of alcoholism. The statistics of the various authorities with regard to the frequency of renal complications are not sufficiently extensive to arrive at any very satisfac tory conclusion. G. Foerster, in his 31 cases recorded at Berlin, found nephritis 3 times, granular atrophy 4 times, and "indurated" kidney 4 times. Kelynack found renal cirrhosis in a little over 181/2 per cent. of his cases. Giirtner found 11 out of 12 to show "chronic nephritis" ; 10 of these were habitual drinkers of brandy.
Other alcoholic complications may also be present, notably some extent of chronic pachymeningitis and thickening of the dura mater, and fatty degeneration of the heart-muscle.
Lastly there is a liability for acute in flammatory processes to supervene: pneu monia, acute bronchitis and pericarditis, erysipelas of the cedematous skin, and acute peritonitis; this last often second ary to paracentesis.
Prognosis.—The condition. begins so insidiously that it is difficult to make an accurate statement concerning its dura tion. It will be generally agreed that Fitz is not too hopeful in stating that the fatal result may be expected within a year after hmmorrhage or other sign of portal obstruction. Von Kahlden in stances a case (Miinch. med. Woch., 48, '97) of a very acute development of the disease in which death occurred three and a half months after the first symp toms presented themselves. The forra of cirrhosis in this was of a mixed type. If the cases of Carrington and Cayley are to be regarded also as examples of portal cirrhosis, we have further evidence that the disease may be fatal in three months after the first occurrence of dyspepsia and of epigastric fullness, or two months after the first onset of ascites. At the other extreme, we come across many cases, in the post-mortem room, of well developed portal cirrhosis which had given rise to no symptoms during life. Thus, clearly the condition may be pres ent in a latent or it may be in an arrested form for months and it may be for years. It is difficult to explain otherwise a case such as that of Taggert's, in which the cirrhotic tissue had undergone calcifica tion. It is difficult, also, to know how to regard those cases in which, cirrhosis being diagnosed, after one or two tap pings the symptoms disappear and the patients apparently recover, because these cases may have been conditions, not of true cirrhosis, but of subacute perihepa titis. If, by palpation and by other phys ical signs and symptoms, and more es pecially by the character of the urine, it is determined that portal cirrhosis is present, prognosis is very bad.