Diseases of the Liver

bile, jaundice, blood, excess, color, elements, secretion and system

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When the organ is enlarged merely by congestion, the slighter shades of jaundice are occasionally seen: when it has become absolutely increased in bulk by interstitial deposit, the occurrence of jaundice must be due to some extraneous circumstance: when it is enlarged by morbid growth, the presence or absence of jaun dice depends on the position of the abnormal structure, whether it be so situated as to obstruct any of the ducts. In the jaundice of malignant disease the irregular form of the organ sufficiently explains its origin.

With the causes of the emotional and functional forms of jaun dice we are very little acquainted, except when it is produced by the displacement of a gall-stone : still we cannot withhold our belief that such causes act in some unexplained manner; and the difficulty of the explanation is all the greater in that it does not appear that mere suppression of the function can account for the presence of the yellow color.

The condition of the heart, and of the right side of the chest, must each be ascertained in cases of jaundice, because of their association with conges tion of the liver. The feces in the early stage almost always indicate by their paleness a deficiency of bile, while the urine receives a dark porter color from the bile passing out of the system by this channel. It is generally to be regarded as a favorable sign when the clay color of the stools passes off, and bile begins again to be seen in the evacuations ; but this is not always followed by a cessation of the jaundice : and there are also cases in which, while the color of the skin has been gradually developed, the motions have been at no time clay-coloted, or remarkably deficient in bile. In such circumstances. part of the bile finds its way into the intestine, while part is obstructed and absorbed into the blood ; and this might happen when a gall-stone only par tially closed the duct; but the more common cause is when one of its main branches is closed by the pressure of a morbid growth, leaving the remainder free, and then the jaundice continues to increase in intensity.

In addition to these, the more palpable diseases of the liver, there can be no doubt that the secretion must be variously modified under conditions of functional disorder with which we are yet very imperfectly conversant; but, beyond a very few broad principles of diagnosis, there are no rules which can be laid down with sufficient distinctness to form any basis for the classification and arrangement of the symptoms to which they give rise.

The liver, acting as one of the great emunctories of the system, secretes from the blood a large proportion of excrementitious matters, but along with this, the secretion is made subservient to the purposes of intestinal digestion : hence it can readily be understood that in all derangements of function, whe ther connected with organic disease or not, its effects may be traceable either in the one set of actions or in the other. The excrementitious matters may not be properly separated while the elements necessary to digestion continue of proper quality and amount; or these may be either such as to retard the passage of the feces or to accelerate it—to produce constipation or diarrhoea, and so might be spoken of as deficient or in excess. Further, this imperfect elimination may depend either on the blood being surcharged with materials which the liver cannot separate with sufficient rapidity, in consequence of the habits of the individual, or the fault may be in the liver itself : in the one case he may be sallow and bilious, while yet the stools are dark and relaxed ; in the other the sallow hue will be accompanied by costive and rather pale colored evacuations. These terms of excess and deficiency of bile can only be admitted as relative, because of our present ignorance of the actual e which the secretion undergoes ; and in forming a diagnosis we must consider quite as much the habits of the patient, and the probability that the bile forming elements of the food, and consequently of the blood, are in excess or defective, as the actual symptoms under which he is laboring. For example, we know that excessive discharges of bile give rise to diarrhoea; and there fore in disorders of the alimentary canal, when this symptom is present, and is associated with other conditions (headache, sallow complexion, itc.) which we call bilious, we conclude very naturally. and in the majority of instances very rightly, that a state of system exists which is characterized by an excess of bile or bile-formin5 elements: but it is to be remembered that one of the purposes of the bile is to neutralize the acid of the stomach, and if the food continue acid in the alimentary canal, it will excite diarrhoea; and therefore, the true explanation of the case may be that the liver is inactive, and the excrementitious matters exist in the blood, not because of their excess, but because the liver fails to remove them.

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