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Among these may be mentioned fever and the other systemic phenomena of inflammation, certain changes in the urine and faeces, alterations in the spleen, alimentary canal, heart, lungs, age of the patient, emaciation, anaemia, ascites, the local signs of peritoneal irritation, etc., the most important of which will be mentioned when speaking of Pain caused by diseases of the liver and biliary apparatus is of at least two distinct and Parenchymatous pain in these structures varies in intensity from a scarcely appreciable consciousness of the existence of a liver, a heaviness in the right upper abdominal quadrant or epigastrium, through all degrees of harassing agony attended by excruciating tenderness and the local phenomena of peritonitis.

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