LIVER. 349 LIVER. the symptoms of languor, headache, dizziness, tuned tongue, a teudeney to constipation, with |irihaps slight yellowing of the skin, and a gen- rial sense of atony, depression, and discomfort,
- iiid which is popularly supposed to he due to
derangement of the liver. It depends not upon an excessive secretion of bile, but upon some per- version of its function or its retention in the bile- ducts. Moreover, most of the symptoms do not depend directly upon changes in the bile, but upon interference with digestion in the stomach and intestines, together with the development and absorption of an infinite variety of poisonous products of decomposition, many of which are muscular poisons. Normally these are not allowed to form, owing to the presence of the bile, but when this is retained in the bile-ducts, its secretion is impaired, and its composition al- tered, by the disorder of the liver which is a reflex result of the gastric and intestinal irri- tation. Biliousness is best treated by careful regulation of the diet, avoiding what are called 'rich foods,' sweet wines, and malt liquors. He- patic activity is to be maintained and stimu- lated by vigorous outdoor exercise. Massage over the region of the liver and gymnastics which contract the abdominal muscles are use- ful. Drugs which have an especial action on the liver (cholagogues) are given to promote the flow of bile, and to overcome the constipation. Among the more important of these are mercury in the form of 1)1 ue mass and calomel, podophyl- lin, nitro-muriatic acid, and the saline purga- tives. Laxative saline mineral waters may be taken in the morning. See Bile. Acute yellow (ilrophy is a remarkable disease of the liver in which the gland undergoes rapid degeneration, and diminishes to two-thirds or one-half its normal size. The malady is com- paratively rare, and occurs after severe mental emotions, and in ]ieople whose constitutions are weakened by dissijiation. by syphilis, or ( in women) by pregnancy. After a period character- ized liy indefinite gastro-intestinal symptoms, such as nausea, vomiting, and irregularity of the bowels, the characteristic features of the disease appear. These consist of jaundice and marked cerebral disturbances, viz. headache and restless- ness, then delirium and gradually developing coma, with convulsive twitchings toward the end. The disease is almost invariably fatal within a few days after the severe symptoms begin. Congestion of the liver may be active or pas- sive. Active congestion occurs in the course of fevers, and must form a part of acute inflamma- tory processes. Passive congestion is causecj by diseases of the heart or lungs, which interfere with the return of blood through the gland. A srvcrc form of passive congestion is known as nutmeg liver, and results from valvular disease of the heart. The organ enlarges considerably and becomes darker in color and in advanced con- ditions acquires a peculiar appearance of red, villow, and white mottling. Inflammatory processes in the liver may be acute or chronic, and comprise perihepatitis, abscess, and cirrhosis. Perihepatitis is a gradual thickening of the capsule of the liver caused usually by chronic alcoholism, syphilis, or the chronic peritonitis that sometimes accompanies Bright's disease. In some cases the thickened capsule contracts and produces marked interfer- ence with the circulation of the organ, which as- sumes an almost globular form. The portal cir- culation in particular may be obstructed, and symptoms similar to those mentioned under cirrhosis result. AbsccHS of the liver arises from the introduc- tion into it of some septic agent through the circulation or through the bile-ducts, and may be multiple or single. The single or solitary abscess is common in tropical countries, often follows an attack of dysentery, and is thought to be caused by the Amceba coli. Solitarj' abscesses often reach an enormous size, and the pus may make its way into the peritoneal cavity, or into the ])lciiral cavity, where it may perforate the lung and be discharged by coughing; or it may point through the skin. These abscesses are best treated by evacuating the pus by surgical means. Multiple abscesses arc usually a result of pyiemia (q.v. ) and are very fatal. Cirrhosis (ki/S^os, yellow), or chronic inter- stitial hepatitis, is a slow inflammation of the liver which results in an extensive growth, usually in the course of the portal canals, of a fibrous contractile tissue which compresses and destroys the secreting cells and seriously ob- structs the circulation of the blood through the portal system of veins. The disease may assume two forms: hypertrophic cirrhosis, in which the organ is greatly enlarged and its surface smooth ; and atrophic cirrhosis, in which the gland is re- duced often to less than half its normal size, and the surface is rough or nodular ('hobnail liver) fnmi the irregular contraction of bonds of fibrous tissue. In the great majority of cases cirrhosis is caused by the excessive use of alcohol in the form of beer, wine, or spirits. The sym|)tom3 are characteristic, especially in advanced cases. Obstructive circulatory disturbances are mani- fested in the stomach by nausea and vomiting, sometimes of blood; in the lower intestinal tract by hemorrhoids, and in the abdominal cavity by ascites. In this form of dropsy the ef- fused fluid may amount to three or four gal- lons. .Taundice is a symptom more apt to occur in the hypertrophic than in the atrophic variety of cirrhosis. The disease is very intractable, but some jiatients live for years in comparative com- fort with proper treatment. The taking of alcohol must be stopped entirely; the diet must be light but nutritious; and the bowels kept active. When ascites supervenes, attempts are made to promote its absorption by giving diuretic and purgative drugs; hut it is often necessary to draw the fluid off repeatedly by puncturing the abdominal wall. Fatty liver may be the result of an excessive deposit of fat cells in the organ, in cases of gen- eral obesity, or" in emaciating diseases such as phthisis, or it may be a true degeneration in which the tissue elements are replaced by fat. The latter change takes place in acute yellow atrophy (see above), and not.ibly in phosphorus poisoning. The liver is enlarged, smooth, its edges are rounded, and it is j'ellowish-white on section. Amyloid or ivnxy liver occurs in association with lardaceous disease in otherorgans— the brain, spleen, stomach, kidneys, and intestines. It is attributed to long-standin;; suppuration from phtsisis, syphilis, tubercular disease of the bones or joints, and to empyema. Treatment depends upon removing the cause of suppuration. See Waxy Degf.xeration. The liver mav be the seat of tuberculosis, can-
