CHAPTER XXXIII
TROPICAL LIVER
THE subject of liver disease is everywhere a difficult and complicated one. It is especially difficult in tropical countries; for not only is the resident there liable to all the forms found in temperate climates, but he is exposed, in addition, to various potent predisposing and exciting causes of liver disease not present, or only present in a very mild degree, in more temperate latitudes. These additional causes of liver disease, inseparable from the tropics, are heat, malaria, and, especially, amoebic dysentery. To these, too often, have to be added injudicious personal habits, a tendency to over-full and over-rich feeding, to over-stimulation by alcohol, and deficiency of muscular exercise.
The young European who finds himself in the tropics for the first time is surrounded very often by luxuries in the shape of food, wine, carriages, servants— luxuries to which he had not been accustomed perhaps in his home. At first the change, the excitement of novelty, and the high temperature act as stimulants to appetite, and the excessive loss of fluid by cutaneous transpiration creates a powerful thirst. Little wonder, therefore, that in such circumstances the youth, having the appetite and the opportunity of gratifying it, is apt to indulge in food and drink beyond safe physiological limits. He is made lazy by the heat ; he cannot exercise during the day, and when evening comes he prefers lounging on the veranda or hanging about the club bar to walking or riding or games. Very likely he sits up late at night, drinking and smoking, so that in the morning he is too sleepy to ride out or take any other form of exercise. And so it comes about, what with a surcharge of aliment and alcohol, and the diminished activity of lung
