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JOHN G. COFFIN, M.D., EDITOR.
THE BEST PART OF THE MEDICAL ART, IS THE ART OF AVOIDING PAIN.
TUESDAY, APRIL 3, 1827.
TRÁNSACTIONS OF THE MEDICAL at a time, and under circum
SOCIETY OF VIRGINIA. stances which can require none to An Inquiry into the Functions of be present in the intestines for
the Liver, in preserving the the purposes of digestion, the Health, and removing the Dis- quantities of this fluid poured out eases of the Animal Economy. at all periods of life, after the diBy Robert Briggs, M.D. gestive apparatus has been called
The liver is viewed by the into action; when not at all regreat majority of physiologists, as quired in consequence of their merely an auxiliary organ to the being no materials present to be stomach and intestines, in per- digested, and when there are maforming the work of digestion. A terials, if the system is laboring variety of considerations lead to under disease, bile not producing the conviction, that its primary the effect of changing them into operations are of a different kind; that state necessary to afford nuand that if it contributes at all, trition ; chyle, the form to which directly to the digestive process,
all nutritious articles mnst be rethis is but a secondary effect.
duced, before they enter the When we take into considera- lacteals, being as readily and eftion the magnitude of the liver, fectually formed when the biliary its situation, its connections sym- duct is completely obstructed, as pathetically with every orgán of when most free, urges on us the the body, its contiguity to, and conviction, that this organ is dedirect communication with, what signed for other purposes. may justly be considered the great The doctrine which is attemptcentre of the involuntary nervous ed to be maintained in this essay, system, its large supply of blood is, that the liver acts the part of from venous sources, and this de- a guardian to the general system, rived almost entirely from diges- preserving the purity of the cirtive organs, and the comparative- culating fluids in a state of health, ly unimportant effects produced and freeing them from the contaby the fluid secreted, we shall be mination induced by disease. led at least to doubt, whether The placenta performs for the this great viscus does not perform fetus the offices of both respiraother offices, more essential to tory and digestive organs. The the preservation of life than those blood sent by the circulatory sysgenerally attributed to it. tem of the fetus, is freed by the
The great size of this viscus in placenta from certain impurities, the fetus, when compared with as it is by the lungs subsequent to every other, the secretion of bile birth. Nutritious matters are
BOSTON MEDICAL INTELLIGENCER.
also furnished by the placenta, thrown off. By what organ is the mingled with the blood returned office performed, of separating by the umbilical vein. Far the these matters from the circulatgreater part of this blood circu- ing mass, and climinating them lates through the liver, in the from the system? When the bosame manner which the blood dy has acquired its full growth, from the digestive organ does af- the quantity daily thrown off, ter birth, when the supplies of must be equal to the amount of digested materials furnished by nutrition taken in, otherwise a the placenta are cut off, and now continued increase must progressupplied by the stomach and in- sively go on, ad infinitum. We testines. M. Magendie has es- know, that the several secretions tablished the fact, that veins per- taken together, amount to about form the office of absorbents. the quantity of food and drink The branches which when united taken in, and bile is known to conform the vena portæ, arise from stitute a very considerable part the surface of the digestive or- of the feces in a state of health. gans, and must necessarily carry The skin, the kidneys, the mucous blood of qualities very different follicles of the intestines, &c., from any other portion of the vas- secrete fluids composed princicular system.
The lacteals all pally of oxygen and hydrogen in pass through glands before they the form of water, holding cerreach the thoracic duct; the flu- tain saline substances in solution ; ids which they carry undergo a whereas bile contains the greater decided change in passing these number of the salts held in solubodies. The lymphatics are be- tion, by the more fluid secretions, lieved by Dr. Chapman to con- in addition to which, the substance vey matters formed by the waste contributing most largely to its of the body, and unfit for further composition is carbon, one of the use. The fluids which they car- principal ingredients in animal ry, find their way out of the sys- solids. tem by no direct route, but pass The humoral pathologists laagain into the general circulation. bored to account for every phe
If the fluids conveyed by the nomenon exhibited in disease, by lymphatics, can no longer serve changes in the Auids. A number any valuable purpose in the body, of circumstances remained unexthey must be thrown off by some plained on these principles, and a emunctory, or they would soon more rational theory was brought produce disease. Portions of into view by admitting the solids these fluids may be thrown off in to a participation in the producthe form of perspiration, urine, tion of morbid action. It is a uni&c., but for reasons which will versal disposition in the mind of be presently assigned, it is be- man, to go to extremes with evelieved the larger part passes out ry new and favorite theory. The elaborated into the form of bile. system ascribing the production of
In the continued wear of the disease to the action of the solids, various machinery of the living ultimately usurped entirely the body, large quantities of matter place of humoral change, and the worn out and unfit for the pur- latter when admitted, was viewposes of animal life must be ed as but the consequence of the
former, but most frequently de- glands greatly diminished, some nied to exist at all.
entirely suspended. The salivaWithin comparatively a few ry glands cease in a great degree years, however, the humoral doc- to pour out their fluid, the gastric trines have been again called into juice is no longer supplied by the requisition, and from the wreck coats of the stomach, the bowels of former opinions, a newly modi- become torpid, the quantity of fied system has been reared. urine lessened, the skin dry and
That there are changes pro- parched, while the liver is found duced in the circulating Huids of to assume an increased action, the body laboring under disease, and bile is poured out in larger cannot be denied ; whether we quantities. admit them as cause or effect, is When the liver is in a diseased not material to the present in- situation itself, at the time the quiry.
general system is invaded by disThe sentiment insisted on in ease, not produced by the hepatic this essay is, that the liver by its affection, or any individual organ increased secretion, frees the becomes deranged in its functions, general system from some offend- or the diseased action of the geneing matter ; or by its own action ral system is such as to suspend in forming its fluíds, changes the the functions of the liver; these action of the nervous and vascu- diseases are found under such cirlar systems, from disease to health. cumstances much more difficult What it is that constitutes dis- to control, and impossible to be ease, or what the proximate cause removed, till the liver is so far is, we know not; why bloodlet- restored to a healthful condition, ting tends to reduce diseased ac- as to be able to resume its wonttion in inflammatory affections, or ed action. why certain stimulants have the In yellow fever, one diagnostic effect of restoring a more saluta- symptom is the absence of bile, ry condition, in the advanced the appearance of which is viewstages of typhus, or indeed why ed as a favorable circumstance. any particular agent produces an In cholera morbus and dysenteeffect peculiar to itself, and dif- ry, no amendment is discoverable ferent from others, we know as till bile is freely formed. little. But from experience and Cholera infantum belongs to observation, it has been ascer- the general class of febrile distained, that such is the law of the eases, the remedies for which are animal economy, and such is all those calculated to correct the we know of it. Why an increas- vices of the biliary functions. ed hepatic secretion should have
In dyspepsia, the liver is found the effect of relieving the system in every instance to be excited at large, or any particular organ into increased action. from that condition which consti- cases of this disease, the stomach tutes a departure from healthy is relieved from its disorder, but action, we are equally ignorant. the task imposed on the liver is That this, however, is the fact, will such, that it is often goaded into now be attempted to be shown. disease itself. If no remedial
In fevers of every character, course is adopted, to relieve it we find the action of all the other from its increased burthens, struc
tural derangement is at length tion whieh constitutes disease, no produced, and it consequently benefit is derived. That a state of ceases to carry on that process, the fluids exists in these and many by which the system was pre- other diseases, differing from that served from destruction. Under presented in health ; or a modifithese circumstances, the stomach cation of action tantamount in efdoes not usually return to that fect, is inferrible from the chacondition from which it had been racter of the biliary secretions, relieved by the vicarious office of when the hepatic functions are the liver, but assumes a new dis- brought to assume the curative eased action, by which an effort process. The fluids discharged is made, if the expression may be from the biliary ducts, at first allowed, to personate the liver bear but a distant resemblance to relatively to the general system, healthy bile, and the patient is in the secretion of bile. It has found to improve, in proportion to been ascertained by Sir W. Phil. the approach of this fluid to a lip, that the green watery fluid healthy character. ejected from the stomachs of dys The increased quantities of bile peptics, who have been long dis. thrown out at the termination of eased, is not a secretion of the a paroxysm of intermittent, has liver, but an imitative process of been attempted to be accounted the stomach itself.
for, by the quantities of blood In hydrocephalus, whether we driven to the interior organs, by view the state of the liver as the spasms affecting the skin. This cause or effect, the reasoning still position cannot be maintained. holds good, as to the essential ne Under this view of the subject, cessity of the biliary secretion, in continued fevers, after all coldto the restoration of health. What- ness of the surface ceases, and uniever mode of practice may be versal increase of temperature adopted, till the biliary secretion pervades the exteriors, the quanis duly excited, no mitigation of tities of bile should be greatly recerebral disease is ever evinced. duced ; instead of being increased,
Obstinate ulcers of the surface, as is almost invariably the case. indurated tumors affecting the The application of cold water breasts of females, and exhibiting to the skin at the height of the all the threatening characters of febrile paroxysm, should have the incipient scirrhus ; are frequent- effect, in soine degree, of proly removed by correcting the ducing the same result as the cold state of the hepatic functions. stage of an intermittent, by driv
In chlorosis, hysteria, hypochon- ing the circulating blood in greatdria, chorea, &c., diseases be- er quantities to the interior, and longing to the class of nervous af- thus increasing the quantity of fections, the principle governing bile. That which is contrary to the remedial course is still the all this takes place. In propor
Whatever may be the tion as the heat is reduced, we plan of treatment, till the liver is find the quantity of bile lessened. brought to assume an action suffi- In this process the heat is reducciently vigorous to free the gene- ed, and consequently a morbid ral system from the offending ma- stimulus is removed, which when terial, or that modification of ac- present, though generated by the
action of the system itself, reacts urine would be the consequence on this system and increases the of increased action of the kidneys, violence of disordered action. In a free perspiration from the cuproportion as this violent action is taneous vessels, and in short, we diminished by the abstraction of should have every febrile patient any stimulating agent, the de- thriving and fattening in a direct mand on the liver as an emuncto ratio to the violence of his disease. ry is reduced.
In different diseases, and difAnother theory attempts to ac- ferent stages of the same disease, count for the increased flow of the character of the hepatic sebile, particularly in idiopathic fe- cretion is discovered widely to vers, by supposing the miasmatic differ ; under all, or any of which or effluvial poison, to be taken in- circumstances, no local affection to the stomach, and there first of the liver itself is found to exist. producing gastric irritation, that How shall we account for these the liver is called into action sym- various products of the same orpathetically, and increased quan- gan, while itself is not diseased ; tities of bile are the consequence. but by supposing its action to be
Another mode of accounting for accommodated to the necessities increased quantities of bile is by of the system over which it exconsidering this as the result of erts a protecting and delivering general increased action of the power. vascular system, and of the liver In forming its secretions, wheas a part of this whole.
ther it derives the materials from If the first of these suppositions offending matters circulating with were correct, we should as the the fluids of the body, or whether first effect of the morbid poison, it is by changing the ordinary bave an increased secretion of state of the fluids into something gastric juice, hunger, vigorous different, so as to act salutarily and rapid digestion ; the reverse on a morbid condition of the soof all this is found to exist. lids, and thus effect a restorative
Under the second hypothesis, change, or by what other mode the secretion of every glandular the result is produced, remains viscus of the body should be in- yet to be ascertained. In differcreased. We should be justified, ent diseases, that the hepatic seunder this theory, in expecting cretion is widely variant, is a during the existence of acute fe- truth known to every tyro. ver, a display of increased men We find the liver throwing out tal energies, a larger flow of sa- various fluids, from those transpaliva, greater quantities of gastric rent, colorless, and tasteless, juice, consequently keen appetite through all the varieties of yeland larger quantities of bile; and low, green, blue, black, and red; if this contributed as essentially these possessing every degree of to the process of digestion as is consistency, from the fluidity of generally conceived, food taken water, to the firmness of coaguin obedience to the appetite, cre- lated blood ; and lastly blood it. ated by an abundance of gastric self. The blood discharged from juice, would be rapidly converted this organ is viewed as a secreinto chyle, and conveyed into the tion. Among other reasons for system ; an increased flow of this opinion, are those that arise