4.  Another disease of the liver, which I have several times observed, consists in the inability or paralysis of the secretory vessels.  This disease has generally the same cause as the preceding one, the too frequent potation of spirituous liquors, or the too sudden omission of them, after the habit is confined; and is greater or less in proportion, as the whole or a part of the liver is affected, and as the inability or paralysis is more or less complete.

This palsy of the liver is known from these symptoms, the patients have generally passed the meridian of life, have drank fermented liquors daily, but perhaps not been opprobrious drunkards; they lose their appetite, then their flesh and strength diminish in consequence, there appears no bile in their stools, nor in their urine, nor is any hardness or swelling perceptible on the region of the liver.  But what is peculiar to this disease, and distinguishes it from all others at the first glance of the eye, is the bombycinous colour of the skin, which, like that of full-grown silkworms, has a degree of transparency with a yellow tint not greater than is natural to the serum of the blood.

Mr. C. and Mr. B. both very strong men, between 50 and 60 years of age, who had drank ale at their meals instead of small beer, but were not reputed hard-drinkers, suddenly became weak, lost their appetite, flesh, and strength, with all the symptoms above enumerated, and died in about two months from the beginning of their malady.  Mr. C. became anasarcous a few days before his death, and Mr. B. had frequent and great haemorrhages from an issue, and some parts of his mouth, a few days before his death.  In both these cases calomel, bitters and chalybeates were repeatedly used without effect.

One of the patients described above, Mr. C, was by trade a plumber; both of them could digest no food, and died apparently for want of blood.  Might not the transfusion of blood be used in these cases with advantage?

5.  When the paralysis of the hepatic glands is less complete, or less universal, a schirrosity of some part of the liver is induced; for the secretory vessels retaining some of their living power take up a fluid from the circulation, without being sufficiently irritable to carry it forwards to their excretory ducts; hence the body, or receptacle of each gland, becomes inflated, and this distension increases, till by its very great stimulus inflammation is produced, or till those parts of the viscus become totally paralytic.  This disease is distinguishable from the foregoing by the palpable hardness or largeness of the liver; and as the hepatic glands are not totally paralytic, or the whole liver not affected, some bile continues to be made.  The inflammations of this viscus, consequent to the schirrosity of it, belong to the diseases of the sensitive motions, and will be treated of hereafter.