SYMPTOMS REFERABLE TO DISTURBED FUNCTION.—Jaundice.—One of the most constant symptoms of portal cirrhosis is a slight icteroid tinge of the conjunctive accompanied by a bright, watery appear ance of the eyes. The skin, in general, save where there is frank development of ascites, is pale rather than icteroid, but as the disease progresses the face gains a sallow, ashy ting-e. In the very rare ex treme cases of pigmentary cirrhosis the skin may assume a slaty-blue or in some cases, as in diabetic cirrhosis, a bronzed appearance similar to that seen in Addi son's disease.
Jaundice, however, may show itself in any period of the disease; it is charac terized by not presenting that continuous and progressive severity observable in cases of true biliary cirrhosis. Accord ing to Fagge, at Guy's Hospital, out of 130 cases, only 35 showed this symptom, or just under 27 per cent., and, according to Price (quoted by Graham), the propor tion is lower, namely: 17.5 per cent.
Urine.—In the earlier stages there may be little or no change, but, as the condi tion progresses, the quantity diminishes in amount, the color becomes dark, and, as FIayern and von Jaksch have pointed out, the greatly-increased amount of urobilin is an indication of considerable value where the diagnosis is doubtful. Save where there is a frank condition of jaundice, bile-pigments are absent. The urea is often found diminished; the urates, on the other hand, markedly in creased. Albumin is, at times, present, with casts, apart from those casts which may be associated with jaundice. Kely nack found renal cirrhosis present in a little over 18 1/2 per cent. of his cases.
The carbohydrates in cases of cirrhosis of the liver are not excreted as sugars by the kidneys, although they are found as such in the serous exudates in the pleural and abdominal cavities. Colasanti (Ri forma Modica, Afar. 27, '91).
Study of the urine in cirrhosis of the liver: conclusions: 1. The quantity of urea eliminated in twenty-four hours ia much diminished, but presents variations from (lay to day-. 2. Milk diet augments the elimination of urea and favors diure sis. 3. With the diminution of the elimi nation of urea, that of ammonia in creases; with a milk diet this is re versed. 4. The chlorides keep pace with the urea. 5. Oxidized urochromc and
urobilin a.re diminished during a milk regimen. Ajello and Solaro AIor gazni, Feb., '93).
Case of a patient in whom cirrhosis of the liver was combined with diabetes mellitus. He was under observation for nearly eight and a half years. The first symptom to appear WO. S slight jaundice, followed Some months afterward by cer tain diabetic symptoins, namely: thirst, and sugar in the urine, to the amount of 11/2 to 2 per cent. This yielded to appro priate treatment. but five years after ward ascites appeared, along with slight jaundice, enlargement of the liver and spleen, and some dropsy of the feet, etc. At the necropsy, marked cirrhosis of the liver, with enlargement of the spleen and kidneys. as well as tubercular de posits (both old and recent), were found. lIepatic cirrhosis in such cases is of a special kind and holds an intermediate position; it is characterized by marked increase in the size of the liver and spleen, with but little tendency to con traction on the part of the former, and also by the presence of pigmentation in the skin. Pusinelli (Berl. klin. Woch., No. 33, '96).
The Blood.—There is very little that is characteristic about the condition of the blood in portal cirrhosis. There is na marked increase in leucocytes, no ex tensive diminution either of the hemo globin or of the number of red blood corpuscles, but the tendency toward epis taxis and the development of petechie in connection with the general, as op posed to the portal, circulation would seem to indicate that either the blood is of such a poor quality or contains such abnormal and toxic substances as to lead to degeneration of the capillary walls, aud, as already pointed out, the occa sional occurrence of cedema preceding ascites is another indication of this toxic or impoverished condition of this fluid. While the hospital is of such relatively recent establishment, and the number of cases of portal cirrhosis in post-mortem records too few to establish definite state ment, I have been struck by the fre quency with which, during life, the clin ical records at the Royal Victoria Hos pital, 'Montreal, note an apical systolic murmur, recognized as functional, the post-mortem confirming its functional nature.