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The Paralysis of the Liver.
PARALYSIS OF THE LIVER AND KIDNEYS.
- I. 1.Bile-ducts less irritable after having been stimulated much. 2. Jaundice from paralysis of the bile-ducts cured by electric shocks. 3. From bile-stones. Experiments on bile-stones. Oil vomit. 4. Palsy of the liver, two cases. 5. Schirrosity of the liver. 6. Large livers of geese. II. Paralysis of the kidneys. III. Story of Prometheus.
I. 1. From the ingurgitation of spirituous liquors into the stomach and duodenum, the termination of the common bile-duct in that bowel becomes stimulated into unnatural action, and a greater quantity of bile is produced from all the secretory vessels of the liver, by the association of their motions with those of their excretory ducts; as has been explained in Section XXIV. and XXV. but as all parts of the body, that have been affected with stronger stimuli for any length of time, become less susceptible of motion, from their natural weaker stimuli, it follows, that the motions of the secretory vessels, and in consequence the secretion of bile, is less than is natural during the intervals of sobriety. 2. If this ingurgitation of spirituous liquors has been daily continued in considerable quantity, and is then suddenly intermitted, a languor or paralysis of the common bile-duct is induced; the bile is prevented from being poured into the intestines; and as the bilious absorbents are stimulated into stronger action by its accumulation, and by the acrimony or viscidity, which it acquires by delay, it is absorbed, and carried to the receptacle of the chyle; or otherwise the secretory vessels of the liver, by the above-mentioned stimulus, invert their motions, and regurgitate their contents into the blood, as sometimes happens to the tears in the lachrymal sack, see Sect. XXIV. 2. 7. and one kind of jaundice is brought on.
There is reason to believe, that the bile is most frequently returned into the circulation by the inverted motions of these hepatic glands, for the bile does not seem liable to be absorbed by the lymphatics, for it soaks through the gall-ducts, and is frequently found in the cellular membrane. This kind of jaundice is not generally attended with pain, neither at the extremity of the bile-duct, where it enters the duodenum, nor on the region of the gall-bladder.
Mr. S. a gentleman between 40 and 50 years of age, had had the jaundice about six weeks, without pain, sickness, or fever; and had taken emetics, cathartics, mercurials, bitters, chalybeates, essential oil, and ether, without apparent advantage. On a supposition that the obstruction of the bile might be owing to the paralysis, or torpid action of the common bile-duct, and the stimulants taken into the stomach seeming to have no effect, I directed half a score smart electric shocks from a coated bottle, which held about a quart, to be passed through the liver, and along the course of the common gall-duct, as near as could be guessed, and on that very day the stools became yellow; he continued the electric shocks a few days more, and his skin gradually became clear.
3. The bilious vomiting and purging, that affects some people by intervals of a few weeks, is a less degree of this disease; the bile-duct is less irritable than natural, and hence the bile becomes accumulated in the gall-bladder, and hepatic ducts, till by its quantity, acrimony or viscidity, a greater degree of irritation is produced, and it is suddenly evacuated, or lastly from the absorption of the more liquid parts of the bile, the remainder becomes inspissated, and chrystallizes into masses too large to pass, and forms another kind of jaundice, where the bile-duct is not quite paralytic, or has regained its irritability.
This disease is attended with much pain, which at first is felt at the pit of the stomach, exactly in the centre of the body, where the bile-duct enters the duodenum; afterwards, when the size of the bile-stones increase, it is also felt on the right side, where the gall-bladder is situated. The former pain at the pit of the stomach recurs by intervals, as the bile-stone is pushed against the neck of the duct; like the paroxysms of the stone in the urinary bladder, the other is a more dull and constant pain.
Where these bile-stones are too large to pass, and the bile-ducts possess their sensibility, this becomes a very painful and hopeless disease. I made the following experiments with a view to their chemical solution.
Some fragments of the same bile-stone were put into the weak spirit of marine salt, which is sold in the shops, and into solution of mild alcali; and into a solution of caustic alcali; and into oil of turpentine; without their being dissolved. All these mixtures were after some time put into a heat of boiling water, and then the oil of turpentine dissolved its fragments of bile-stone, but no alteration was produced upon those in the other liquids except some change of their colour.
Some fragments of the same bile-stone were put into vitriolic æther, and were quickly dissolved without additional heat. Might not æther mixed with yolk of egg or with honey be given advantageously in bilious concretions?
I have in two instances seen from 30 to 50 bile-stones come away by stool, about the size of large peas, after having given six grains of calomel in the evening, and four ounces of oil of almonds or olives on the succeeding morning. I have also given half a pint of good olive or almond oil as an emetic during the painful fit, and repeated it in half an hour, if the first did not operate, with frequent good effect.
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 hæmorrhages 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.
6. The ancients are said to have possessed an art of increasing the livers of geese to a size greater than the remainder of the goose. Martial. l. 13. epig. 58.—This is said to have been done by fat and figs. Horace, l. 2. sat. 8.—Juvenal sets these large livers before an epicure as a great rarity. Sat. 5. l. 114; and Persius, sat. 6. l. 71. Pliny says these large goose-livers were soaked in mulled milk, that is, I suppose, milk mixed with honey and wine; and adds, "that it is uncertain whether Scipio Metellus, of consular dignity, or M. Sestius, a Roman knight, was the great discoverer of this excellent dish." A modern traveller, I believe Mr. Brydone, asserts that the art of enlarging the livers of geese still exists in Sicily; and it is to be lamented that he did not import it into his native country, as some method of affecting the human liver might perhaps have been collected from it; besides the honour he might have acquired in improving our giblet pies.
Our wiser caupones, I am told, know how to fatten their fowls, as well as their geese, for the London markets, by mixing gin instead of figs and fat with their food; by which they are said to become sleepy, and to fatten apace, and probably acquire enlarged livers; as the swine are asserted to do, which are fed on the sediments of barrels in the distilleries; and which so frequently obtains in those, who ingurgitate much ale, or wine, or drams.
II. The irritative diseases of the kidneys, pancreas, spleen, and other glands, are analogous to those of the liver above described, differing only in the consequences attending their inability to action. For instance, when the secretory vessels of the kidneys become disobedient to the stimulus of the passing current of blood, no urine is separated or produced by them; their excretory mouths become filled with concreted mucus, or calculus matter, and in eight or ten days stupor and death supervenes in consequence of the retention of the feculent part of the blood.
This disease in a slighter degree, or when only a part of the kidney is affected, is succeeded by partial inflammation of the kidney in consequence of previous torpor. In that case greater actions of the secretory vessels occur, and the nucleus of gravel is formed by the inflamed mucous membranes of the tubuli uriniferi, as farther explained in its place.
This torpor, or paralysis of the secretory vessels of the kidneys, like that of the liver, owes its origin to their being previously habituated to too great stimulus; which in this country is generally owing to the alcohol contained in ale or wine; and hence must be registered amongst the diseases owing to inebriety; though it may be caused by whatever occasionally inflames the kidney; as too violent riding on horseback, or the cold from a damp bed, or by sleeping on the cold ground; or perhaps by drinking in general too little aqueous fluids.
III. I shall conclude this section on the diseases of the liver induced by spirituous liquors, with the well known story of Prometheus, which seems indeed to have been invented by physicians in those ancient times, when all things were clothed in hieroglyphic, or in fable. Prometheus was painted as stealing fire from heaven, which might well represent the inflammable spirit produced by fermentation; which may be said to animate or enliven the man of clay: whence the conquests of Bacchus, as well as the temporary mirth and noise of his devotees. But the after punishment of those, who steal this accursed fire, is a vulture gnawing the liver; and well allegorises the poor inebriate lingering for years under painful hepatic diseases. When the expediency of laying a further tax on the distillation of spirituous liquors from grain was canvassed before the House of Commons some years ago, it was said of the distillers, with great truth, "They take the bread from the people, and convert it into poison!" Yet is this manufactory of disease permitted to continue, as appears by its paying into the treasury above 900,000l. near a million of money annually. And thus, under the names of rum, brandy, gin, whisky, usquebaugh, wine, cyder, beer, and porter, alcohol is become the bane of the Christian world, as opium of the Mahometan.
Evoe! parce, liber?