A practical treatise on congestion and inactivity of the liver: showing some of the effects produced by these disorders on the most important organs of the body

Front matter

F

Mti nii e.

r

Preface

be more generally known, I have been induced to lay this Treatise before the public.

It has been my desire, as far as possible, to avoid technical expressions, and to treat the matter in so simple a style as to come within the comprehension even of those least acquainted with medical subjects. Should the perusal of these pages cause any to attend more carefully to the action of the Liver, or to adopt more rational means for the cure of disorders of that organ than those ordinarily employed, this work will not have been written in vain.

F. J. Mosgrove.

23, Finsbury Place North.

Contents

PA

CONGESTION AND INACTIVITY OF THE

LIVER

Chapter I. Congestion And Inactivity Of The Liver

In order that the subject of the following pages may he more fully understood by my non-professional readers, I shall first explain the meaning of the term “ Congestion,” and then proceed to give, in as clear and concise terms as possible, a description of the anatomical structure of the Liver, its connexion with other important organs of the body, and the function it is required to perform.

The term “ Congestion ” implies an overdistended state of blood-vessels, whereby their elasticity is weakened or destroyed, and the circulation of the blood n in them impeded;* the necessary effect of which is, either a partial or total suspension of the functions of the part so affected, depending on the degree of congestion, in consequence of each organ of the body requiring a certain rapidity in the circulation of its blood, to enable it properly to maintain its action.

The Liver is the largest secreting organ of the body, and contains a much greater proportion of blood than any other part of the human frame. It is

* Although the action of no inanimate matter can fully explain the rules by which the living body is governed, yet the following illustration may somewhat assist the reader in comprehending the subject. Thus if a fluid were forced by means of a pump through an India-rubber tube, at each jet of the fluid the tube would first dilate, but again immediately resume its former size, and, by its contraction, assist in the propulsion. Should the tube be obstructed at any part, or the forcing power be much increased, the tube would become distended much beyond its original size ; and in proportion to the degree of distention, would its power of contraction become diminished.

OF THE EIVER.

situated under the ribs on the right side, and extends towards the left side half way across the abdomen. It is composed entirely of bundles of minute vessels, carrying two descriptions of blood; the one bright red or “ arterial ,” the other purple or “ venous it is from the latter that the “bile ” is wholly secreted.

The “arterial” blood is supplied by an artery, which intimately communicates with those distributed over the stomach. The “ venous ” blood is supplied solely by veins, which return the blood from the stomach and bowels ; indeed those veins have no means of emptying themselves but through the medium of the Liver, and I beg my readers to bear in mind this latter circumstance, as it will enable them to understand much, hereafter stated, which would otherwise appear inexplicable.

The “ Liver ” is immediately connected by the distribution of nerves — the medium by which all sensation is conducted — with the brain, lungs, and stomach.

The function of the “ Liver” is to separate from the venous blood, which is carried to it, certain noxious particles with which it has become charged during its circulation through the body, which particles could not but cause very considerable irritation if allowed to continue in the system. From these injurious particles it forms the secretion which is named “ Bile and it has been wisely ordered, that this substance, which if distributed throughout the body would produce so much derangement of the general health, is destined to perform most important duties in the animal economy. It is also a wise provision made by the “ Great Architect of the Universe,” that although those organs of the body, whose office it likewise is to free the blood from certain noxious ingredients, have an action apparently differing altogether from that of the or THE LIVER.

Liver, yet the secretion of each contains one or more of the constituent particles of the bile ; so that each of those organs, is enabled, by increasing its action, to render to the Liver, when in an inactive state, more or less assistance, in order to remove from the blood every portion of those injurious particles which would otherwise prove a constant source of disorder. Were it not for this arrangement, it is scarcely possible that inactivity of the Liver could exist, even for a short period, without producing effects most prejudicial to the health of the body.

In considering the effect produced by « Congestion and Inactivity of the Liver1’ on other organs of the body, I shall endeavour to show how, by this peculiar provision of nature, the kidneys, lungs, and skin, are especially influenced by any inactivity in the secretion of bile.

The action of the “bile” is to stimulate the intestines to a due performance

v 9 of their digestive functions, to separate the nutritive from the injurious portions of food ; and, by its stimulating effect throughout its course, to act as the natural purgative of the bowels.

It does not require much reflection to perceive how great and injurious an effect must be produced on the health of the body, by any deviation from a healthy action, in an organ on which so many and important functions depend. Nothing is more common than to hear persons complain of being £t bilious of having a bilious head-ache ; of having had a “bilious attack each one admiting a derangement of the Liver, and yet considering it quite as a necessary evil which can only be palliated by medicines, of which each person has some favourite preparation which they imagine acts as a specific in their particular case.

I shall now point out those circumstances which render the Liver more

OF THE LIVER.

liable to congestion than any other portion of the body.

I have before stated; that the substance of the Liver is composed entirely of bundles of minute blood-vessels, all of which are elastic ; they possess in themselves no muscular power by which they are enabled to force on the blood contained in them* but are dependant on their own elasticity, — on the action of the muscles of the abdomen, and on the vis-a-tergo, or force from behind,* to keep up a proper activity in their circulation.

My readers will bear in mind what 1 have before stated, that the blood from which the bile is secreted, and which constitutes much the larger part of that contained in the Liver, is derived solely from the veins, which return the blood from the stomach and intestines. As these veins likewise possess no muscular power in themselves

* The action of the heart, which, assisted by the contractile power of the blood-vessels, keeps up the force of the circulation.

by which they can increase the rapidity of their circulation, but are dependant on the contraction of the bowels, and on the “ impelling force, ” to enable them to maintain their action, it is apparent that the impetus with which the blood is sent to the Liver, must be very slight; indeed so elastic are the vessels of the Liver, and so necessary is it that the blood should circulate through that organ at but a moderate degree of speed, in order to afford a sufficient time for the formation of “ bile,” that the necessary consequence of a rapid circulation in the veins, carrying blood to the Liver, must be, either a preternatural fulness of its vessels, or a diminution of its secreting power.

Bearing in mind the elastic structure of the Liver, and the peculiar manner in which it is supplied with blood for the secretion of bile, it will readily be perceived how immediately its action must be influenced by anything which

OF THE LIVER.

may tend to increase or diminish the general force of the circulation : thus it is that excitement, bodily exertion, the use of stimulating liquors, and sedentary habits, each in their peculiar manner affect the action of the Liver.

From observations which I have attentively made in several hundred cases,

I am led to believe that the changes in the state of the Liver which tend most commonly to impair its functions, and give rise to the symptoms termed “ bilious,” are —

1st. A fulness of blood, with increased irritability (without inflammation), occasioning an increased secretion of bile.

2ndly. “ Congestion,” or such a distention of the blood-vessels, that their elasticity is greatly diminished, and the power of secreting considerably impaired.

3rdly. Inactivity, or a want of sufficient nervous energy to enable it properly to receive the stimulus of the blood, or to perform its allotted function.

The two latter are by far the more common, as it is scarcely possible that the former can exist for any lengthened period without the elasticity of the blood-vessels being overcome, and congestion and inactivity resulting.

The ordinary symptoms of increased secretion of bile are familiar to most of my readers ; they are, — Irritability of the stomach, with occasional vomiting ; “ sick head-ache and relaxation of the bowels, with great prostration of the nervous power.

The symptoms of “ Congestion, and Inactivity of the Liver,11 are those to which I would more particularly direct attention, as they are frequently so obscure, even to the practised eye, as to require much judgment and discrimination in detecting them.

In the course of the following pages I shall point out some of the disordered actions occasioned in other organs by inactivity in the secretion of bile, and

OF THE LIVER. — 'SYMPTOMS.

shall therefore now confine myself to those symptoms which most commonly indicate incipient “ Congestion and Inactivity of the Liver,” and which are too frequently overlooked, until some othei disordered action is occasioned which possesses a more manifest influence on the

health of the body.

Symptoms.

On first rising in the morning, a dull heavy pain across the forehead, with heaviness and disposition to sleep , diyness of the tongue, and unpleasant taste in the mouth; a short cough, which is only relieved by expectoration, generally of a thick dark-coloured substance of an unpleasant taste.

Sleep disturbed by unpleasant dreams ; depression of spirits, and irritability of temper ; disinclination for business and all mental or bodily exertion.

Frequent palpitation of the heart, with a sensation of weight, or even absolute pain, over the region of that organ.

Bowels generally inactive, but occasionally profusely purged by fatigue; anxiety of mind; increased exercise of the body, or any sudden emotion of joy or grief.

A sensation of weight at the pit of the stomach after eating, frequently attended with flatulency.

Irritation at the lower part of the bowels, very commonly accompanied by “ piles.”

Urine thick, and depositing a reddish brown sediment.

Coldness of the hands and feet, with occasional tingling and cramp ; the sleepy sensation occasioned by the legs remaining for a short time crossed in one position.

A dull heavy pain across the loins, frequently extending over the hips.

Irritation of the skin, with a spnsation of heat, especially over the loins, hips, and inner part of the thighs.

Pains in the right shoulder and arm, resembling rheumatism

OF THE LIVER. CAUSES.

Although all the above symptoms are scarcely ever present in a single case, and are constantly much modified according to the different constitutions of the persons affected, the peculiar appearance of the tongue is invariably the same. Whether the part toward the tip be clean or coated (which depends on the state of the stomach and bowels), the back, towards the root, is invariably covered with a brown fur.

Causes.

The causes which induce inactivity of the Liver are various ; for so greatly is that organ influenced by any irregularity in the general circulation of the blood, and by whatever tends to lessen or increase the nervous stimulus communicated to it from the brain, that every powerful emotion of the mind, or increased exercise of the body, will immediately affect the secretion of bile.

The causes most commonly in operation are, — anxiety of mind ; the constant use of stimulating liquors ; excitement ; studious pursuits ; and sedentary habits.

The latter occasions congestion of the Liver, by lessening the general force of the circulation of the blood, as also by not calling into constant operation the muscles of the abdomen, by which the Liver is compressed.

The former induce “ Inactivity,” in consequence of the nervous power communicated by the brain to the Liver (and on which its activity depends) being lessened : this will be explained when considering the action of the brain.

Let us now examine the principle on which derangements of the Liver are ordinarily treated. If a person be labouring under such symptoms as clearly indicate inactivity in the secretion of bile, resource is immediately had to one or other of the many forms of popular bilious medicines, more especially the mercurial pill and black draught,

OF TIIE LIVER. — TREATMENT.

which certainly afford a temporary relief, and the sufferer rests satisfied that the derangement is for the present removed ; but if we consider for one moment the manner in which these medicines act, it will be apparent to every one, that although the temporary relief they afford is great, every dose thus taken tends but to increase the malady which it is given to remove.

I have before explained in what “ Congestion ” consists, viz., in an over distention of blood-vessels, whereby their coats are weakened, and their elastic power more or less impaired. The immediate effect of these medicines is to stimulate the blood-vessels of the Liver to a sudden and violent contraction, whereby the congestion is removed, and an increased secretion of bile occasioned.

It is a well known fact, that any sudden unnatural excitement is invariably followed by a corresponding degree of depression ; if therefore the Liver be suddenly stimulated, whether by powerful emotions of the mind, or by any of the before-mentioned bilious medicines, the after-consequences are, depression and weakness; in which state the vessels of the Liver more easily become distended, and congestion and inactivity again ensue

Those persons who have been in the habit of taking any strongly-stimulating medicines for the relief of bilious symptoms, will bear testimony to the inactive state of the Liver and bowels which invariably follows the first effect of such remedies. »

Seeing then that the medicines thus ordinarily employed, in their ultimate effect cannot but increase the disordered state of the Liver, it will naturally be asked, what course is to be adopted to restore that organ to a healthy action. Reason suggests that such a course should be followed as would if possible stimulate the vessels of the Liver to so gradual a contraction that the usual depression consequent on sudden excitement may be avoided. I have invariably acted on this

OF THE LIVER. — TREATMENT. 1/

principle ; and the experience of ten years, with the success which has attended my treatment of several hundred cases ot inactivity of the Liver, lead me confidently to assert, that it is the only mode which can effect a cure in any case of this very prevalent complaint.

The plan I have adopted has been, to give minute doses of such medicines as tend to stimulate the Liver, frequently and regularly repeated, so that the blood-vessels are gradually contracted, and, by a continuance of such remedies (foi a period depending on the degree of congestion, and the length of time it has existed), are continued in a healthy state ; care also being taken strictly to resulate the diet, and to enforce the habit of regular bodily exercise.

The various degrees of congestion require various kinds of stimulants ; but the medicines I have found the most beneficial, as well as the most certain in their action, have been, minute doses of calomel, blue pill, and ipecacuanha,

18 CONGESTION OF THE LIVER.

combined with the extract of henbane, or decoction of dandelion.

The doses of the former medicines must be regulated by the state of congestion, and the degree of stimulus required ; but never need exceed one sixth of a grain of calomel and ipecacuanha, and a quarter of a grain of blue pill. I have occasionally met with persons who have been so susceptible of the slightest mercurial stimulant, that any preparation of that remedy, even in the most minute doses, has occasioned such general irritation of the system, as totally to preclude the possibility of employing it. In such cases, recourse must be had to other remedies which have a stimulating effect on the Liver ; but in almost every person, the effect produced by these small doses of mercurials is imperceptible on the general health; and so safe have I found them in their action, that out of many hundred cases, I have never yet known any injurious consequences to be occasioned by their employment.

Chapter II. The Brain

The Brain is that mysterious organ by which is secreted the nervous power on which the performance of the functions of both mind and body depend. It may be likened to a treasury, on which each function is enabled to draw for whatever support it may require. lhe power of supplying the demand being limited, it necessarily happens, that if from any cause one function draws moie from the treasury of the Brain than it is fairly entitled to, the supply given to the others must be diminished. Thus is occasioned that extreme sympathy which exists between the mind and body. If the powers of the mind are exeicised in excess, the functions of the body are impaired ; and if there be any disorder of the body, which calls for an increased supply of nervous power from the Brain, the functions of the mind become more or less diminished.

The peculiar nervous sympathy which exists between the Brain and Liver is evidenced by the effect produced on the former by any deviation from a healthy action in the latter, and vice versa : thus head-ache is occasioned by even a slight irregularity in the secretion of bile ; and a diminution in the powers of the brain, whether from congestion or any other cause, will frequently so much impede the action of the Liver and bowels, that they cannot be restored to a healthy state without first adopting means to recover the wonted energy of the Brain. The Liver has also other modes of acting on the Brain, — both immediately by the circulation of the blood, and by the disordered action which any irregularity in its functions occasions in and nervous system.

other parts: to the latter 1 shall have occasion more particularly to allude when considering the derangements of the heart occasioned by inactivity of the Liver.

My readers will remember that the function of the Liver is, to remove from the blood certain impurities from which it forms the bile. If the secretion be not properly formed, in consequence of inactivity of the Liver, more or less of these impurities must continue circulating in the system, thereby causing either general irritation and fever, 01 depression of mind and body. These different effects are produced according to the degree in which the noxious particles aie present in the blood ; the action of some being to irritate the system, while that of others is to lessen that stimulating power of the blood which is so liecessciiy to the proper activity of the mind and body.

If those organs (the kidneys and skin)

which are enabled to remove from the blood some portion of the acrid constituents of the bile, be not stimulated to an increased action proportionate to the degree of inactivity existing in the Liver, irritation or fever is occasioned ; but if those organs (the lungs and skin) whose duty it is to remove from the blood any excess of the particles which exercise a depressing influence on the body, be not increased in action, depression and inactivity result.

AND NERVOUS SYSTEM.

CASES.

The Rev. J. H., aged 35, apparently in robust health, and of active habits, consulted me in consequence of having been subject, for a period of seven years, to severe attacks of head-ache, and occasionally such extreme mental and physical depression, as entirely to deprive him of both power and inclination to discharge his usual pastoral duties. These attacks, I ascertained, occasionally appeared without any assignable cause ; but almost invariably followed any great excitement, or increase in bis ministerial duties. During the paroxysms of head-ache his bowels were inactive, to relieve which he had been in the habit of taking an aperient pill containing calomel, followed by a purgative draught, which, by stimulating the Liver and bowels, generally afforded him relief.

He did not complain of any pain in the region of the Liver, but on examining that organ, I perceived a slight degree of enlargement, with some tenderness on pressure. In answer to my inquiries, he stated, that he had frequently experienced the following symptoms : Pain in the right shoulder and arm ; slight cough with expectoration ; an unpleasant taste in the mouth on first awaking in the morning; urine thick, and depositing a sediment similar to brick-dust ; cramps in the lower extremities ; a sensation of weight over the region of the heart, with occasional palpitation of that organ. The bowels were generally acted on regularly , but not freely relieved ; the tongue was covered at its posterior part with a light brown fur.

In accordance with the plan I have before mentioned, I prescribed, — calomel, 3 grains; blue pill and ipecacuanha, of each 4 grains ; extract of henbane, 30 grains ; to be carefully mixed and divided into 24 pills ; one of which to be taken three times in the day, with a wine glassful of the decoction of dandelion.

The effect produced in this case was such as would have greatly surprised me, had I not been previously aware of the speedy benefit which frequently followed this plan of treatment ; it certainly was much to the astonishment of my patient. For the first three days

AND NERVOUS SYSTEM. — CASES. 25

the activity of the bowels, as well as the pain in the shoulder, were somewhat increased , after that time his spirits returned, and nothing but tbe absence of his usual symptoms indicated the exhibition of any remedy. After four days I directed the medicines to be taken only twice in the day, and at the expiration of a week to be discontinued in the morning. My patient continued taking the pill and decoction of dandelion every night for ten days, when I thought the remedies might be safely discontinued. I then pointed out those symptoms which usually indicate incipient congestion of the Liver, and directed him, on a return of any of them, to have recourse again to my prescription ; by adopting which plan, I am pleased to say, he has for the last three years enjoyed good health, and been entirely free from those painful attacks to which he had before been subject.

Mr. L., a merchant, aged 28, of delicate appearance, had for two years suffered from frequent attacks of severe head-ache, accompanied by derangement of the digestive organs.

During the last six months he had become D considerably depressed, both in mind and body, so as to be almost unfit for business, in consequence of extreme lassitude and susceptibility of the slightest cause of anxiety.

On my first seeing him, in addition to the above symptoms, he complained of a dull heavy pain across the loins, attended with much heat and irritation of the skin ; pain between the shoulders; an unpleasant taste in the mouth on first rising in the morning ; bowels very sluggish ; being scarcely ever acted on freely without the employment of some aperient medicine.

In order to relieve the mental depression his usual medical attendant had prescribed for him a stimulating draught, to be taken twice a day, with a purgative pill at night, as often as occasion required : he had pursued this course for some weeks without any permanent benefit resulting. On examining as to the state of the Liver, I perceived a decided enlargement, but unattended by pain on pressure. I prescribed medicines similar in their action to those adopted in the preceding case, and directed him to abstain altogether from busiand nervous system. — CASES. 27

ness for a few days ; to take regular exercise, and to adhere closely to a strict course of regimen, which I laid down for him. For several days no improvement took place. As the bowels continued very inactive I directed a simple enema to be used every morning, but employed no purgative medicines. After persisting in this plan for three weeks, a more regular action of the bowels, and apparently a healthy secretion of bile became restored ; but still not with the necessary activity. I then directed a stimulating draught to be taken three times in the day, and the pills to be continued every night. He pursued this course for ten days, by which time his natural spirits had gradually returned, the Liver and bowels had recovered their wonted activity, and his general health become perfectly re-established.

In this case the disordered state of the Liver had caused so much depression of the powers of the Brain, that that organ continued inactive, after the cause of its inactivity had been in a great measure removed ; and thus the Liver and bowels, not receiving from the Brain the requisite

‘28

THE Eli AIN nervous energy, were unable to perform their functions with proper activity. Hence arose the necessity of employing a stimulant to restore the wonted power of the Brain.

Mrs. H., aged 38, of a nervous temperament, had for several years suffered from occasional attacks of severe pains in the face and right side of the head, resembling tic-doloreux ; to alleviate which, quinine, and the other remedies usually employed for the relief of that malady, had been constantly resorted to without producing more than temporary relief. I ascertained that these attacks were always accompanied, and frequently preceded, by constipation of the bowels and loss of appetite. In this case I could discover no enlargement of the Liver, neither was there any tenderness on pressure ; but my patient complained of having suffered from head-ache on first rising in the morning; unpleasant taste in the mouth; pain, resembling rheumatism, in the right shoulder and arm ; frequent palpitation of the heart, and a sensation of weight on the left

Asm NERVOUS SYSTEM. — CASES. 29 side ; cramp in the lower extremities ; frequent bilious head-ache; bowels generally acted on regularly, hut not freely.

I laid down for my patient’s guidance strict rules as to diet; enforced the necessity of taking regular exercise, and prescribed very minute doses of mercury and ipecacuanha combined with extract of henbane, to be taken night and morning. I adopted this course for ten days, during which time she experienced an attack of pain in the head and face, but much less severe, and of shorter duration than before. I then prescribed a dose of quinine, to be taken three times a day, combined with other remedies whose action was to increase the powers of the nervous system.

She persisted with these remedies for three weeks, during which period she was entirely free from pain. I then directed her to have recourse to the pills whenever she noticed any symptom indicative of inactivity of the Liver, and to persist in the habit of walking each day should the weather permit. For the last eighteen months she has experienced but two of the attacks of pain (much less intense, and D 2

THE BKAIN of shorter duration than before), which were occasioned by great mental excitement.

Mrs. H., aged 30, consulted me in consequence of suffering from a severe bilious head-ache, accompanied by extreme lassitude, faintness, loss of appetite, and general prostration of strength, to which she had been subject from childhood. I ascertained that there was no enlargement of the Liver, although slight tenderness on pressure. She informed me that she had constantly suffered from severe cramps in the lower extremities ; pain between the shoulders and in the right arm, as also across the loins ; a sensation as if cold water trickled down the back ; a short cough with expectoration, and heaviness on first rising in the morning ; sleeplessness and unpleasant dreams. The bowels were usually acted on regularly, but occasionally much relaxed by mental excitement, to which succeeded constipation.

In this case I thought it advisable to prescribe medicines to act on the Liver, in a much more minute quantity than in either of the preceding cases, and enjoined strict attention

AND nervous SYSTEM. — CASES. 31

to diet, and regular exercise. For several days no improvement whatever took place. As the tenderness over the Liver appeared to be somewhat increased, I recommended the application of a small blister, which produced the most beneficial result. The medicines which had previously produced no apparent effect, now occasioned an increased secretion of bile and relaxation of the bowels, which continued two days. 1 then prescribed tonics, to improve the state of the stomach ; and the pills to be taken every night, in order to keep up a healthy action of the Liver.