about the stomach; an aching in the right shoulder-blade;
a dull, disagreeable pain in the shoulder-joint, which may extend down
the arm, and which is sometimes felt in the wrist and joints of the hand
Not unfrequently the complexion becomes pale and sallow, and there is
puffiness under the eye, headache, a bitter taste in the mouth, tongue
coated white or covered with a brown fur, and hardness of the gums;
there is frequent sighing, a hacking cough, fever, restlessness, and
loss of sleep; sometimes an unnatural, greasy appearance of the skin, at
others, it is dry and harsh, has scaly or branny eruptions, pimples,
dark blotches, and troublesome itching. The urine is frequently scanty
and high-colored, but variable as to quantity and appearance; it often
produces a scalding sensation when voided, and, if allowed to stand,
deposits a sediment which sometimes contains albumen. The pulse is very
slow, particularly when the elements of the bile are not eliminated from
the blood. The pulsations of the heart are easily quickened, and
palpitation is excited if the subject be low and anaemic. There is
depression of spirits, and a decided tendency to be discouraged and
despondent. The functional powers of the stomach are impaired; there is
loss of appetite, or it becomes capricious; uneasiness is felt in the
region of the stomach, oppression, sometimes nausea and water-brash, or
there is indigestion, flatulency, and acid eructations; the bowels
become irregular, usually constipated, and occasionally subject to
obstinate diarrhea attended with colicky pains; the stools are of a
light clay color, sometimes hard and dark, again thin and very
offensive, and occasionally green or black. As the disease progresses,
during the day the circulation is sluggish, the feet and hands are cold,
but at night the pulse is accelerated, and a burning sensation is felt
in the palms of the hands and the soles of the feet.

The foregoing symptoms are not all present in one case, nor are any two
cases alike in every respect. They vary according to the organs most
implicated in the hepatic derangement. Thus, when chronic inflammation
of the liver is associated with _heart_ disease, the subject may have
palpitation, excessive or defective action of the heart, attended with
more or less pain and shortness of breath. If the _lungs_ be specially
influenced, then, in addition to the ordinary hepatic symptoms, there
may be a dry cough, asthma, hurried respirat