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Impaired Health Its Cause And Cure by J. H Tilden, M.D.

H. DISEASES OF THE LIVER
I. JAUNDICE

   Definition.--Jaundice is known by the name of icterus. It is characterized by a yellow coloring of the skin of the body; also the mucous membrane and the fluids of the body are tinged with bile pigment. Jaundice is a symptom depending upon a great variety of causes, and the causes are obstructive.

   Etiology.--A foreign body, such as a gallstone, may lodge in the gall-duct, or parasites may pass from the duodenum into the duct. Catarrhal inflammation may cause enough closing of the duct to impede the flow of bile and become a cause of jaundice. Inflammation may also cause stricture of the duct. Tumors may press upon the duct. Tumors of the liver, stomach, pancreas, kidneys, and omentum may, by pressure, cause obstruction; occasionally an enlarged gland. Such enlargements as pregnancy, ovarian cysts, and even fecal accumulations have been described as causes of jaundice. It is barely possible that this may be true, but not very probable. Constipation might be the cause of toxin poisoning, and in this way cause jaundice.

   General Symptoms.--Yellow tinting of the skin; itching of the surface of the body; yellowing of the sclerotic coat of the eye. The tinting of the skin will vary from a very slight yellow to a deep brown or bronze. The exceedingly dark coloring comes from complete obstruction. Under such circumstances the urine is also very dark. The tissues of the entire body are involved in the coloring. In the chronic form of this disease, pruritis, or itching, becomes a very distressing symptom. Sweating is another symptom. The clothing of such patients has the appearance of having been dyed yellow. Skin troubles are not uncommon where there is obstruction of the bile. Piles often occur.

   Where no bile whatever passes into the intestine, the stools are very light-colored--sometimes of a grayish coloring--and the odor is pronounced. The clay-colored stools are common in those who are troubled with inactivity of the liver. This may occur in cases where there is very little coloring of the skin. It cannot, however, exist for any great length of time without the urine showing that the bile is failing to pass into the intestine.

   Constipation is common; yet, on account of the decomposition taking place when the bile fails to enter the bowels, diarrhea may be a constant symptom. Bile is, so to speak, an antiseptic. It has a tendency to prevent decomposition. Where the stools are offensive, and there is hearty eating or overeating to account for it, the probable cause is a lack of the secretion of bile. Many of these cases present irritability and depression of spirits. One of the peculiar influences of bile on the system is to produce melancholia. In acute derangements of the liver, brought on from excessive eating or debauch, the debauchee will have great depression of spirits and gloomy forebodings of the future. While the patient is in this state, the world is all going wrong, his business is going to smash, and he is ready to sell out for a song and get away from the smash-up; but within twenty-four to forty-eight hours after this depression--this influence of bile in his blood--everything is lovely, the goose hangs high, and you could not buy him for one hundred and fifty cents on the dollar.

   In low forms of fever there is a toxemic jaundice which augurs badly. Indeed, it is a symptom that might be avoided by preventing the disease from taking on a septic state. Such fevers as typhoid, if not medicated and fed, will fail to develop septicemia; hence the complications, such as jaundice, will never develop. This is not only true of typhoid, but it is true of every disease. These symptoms are secondary, and are possible only in malpractice. The word "malpractice," as used in this sense, includes the malpractice supposed to be scientific medicine.

   There is said to be a hereditary icterus. In all probability it is due to some anatomical defect, or to some peculiar style of eating, on the part of the families of the various progenitors, all of them having the tendency to eat in such a manner as to bring on liver derangements--to develop a hepatic diathesis, if you please. Why should not this be true when families for several generations live in such a way as to produce engorgement of the liver? Why should not the tendency for developing this derangement become so fixed that it is transmissible? The true definition of heredity is a tendency to take on certain forms of disease. There is no such thing as inheriting a disease.

   lcterus Neonatorum.--New-born children often develop a jaundiced condition within the first week after birth. As a rule, this needs no special attention, even when so pronounced that the urine will dye the diapers an orange yellow. Fatal cases, however, have been known. It is my opinion that such cases come from obstruction of the biliary duct. Where the condition is purely functional, it is aggravated by too frequent and excessive eating. If the error is not suspected, the child may be driven into a fatal illness.

   Anemia of the Liver.--Anemia of the liver cannot be thought of in these days of much starch-eating; for starch, sugar, and fat have a tendency to produce hyperemia. Possibly, after the hyperemia has been developing for years, a hardening may take place that in time will end in anemia. Then the disease would be of a secondary character and come under the head of sclerosis. Hyperemia is divided into two classes--active and passive congestion.

   Active.--After a meal the liver will always be found engorged because of the absorbed food. All the vessels are filled. This state passes away in a few hours--as fast as the food material can be absorbed and utilized by the body. Where the engorgement is excessive there may be a feeling of weight and heaviness in the region of the liver, and, if eating is frequent and excessive, the hyperemia becomes a fixed state. The border of the liver may come down much below the ribs. This state is diagnosed as enlargement of the liver. It is found in those who are steady imbibers of alcoholics, as well as in those who eat excessively.

   Passive.--Passive hyperemia is more common. it is said to result from pressure on the efferent vessels. This affection is found in valvular diseases of the heart, emphysema, sclerosis of the lungs, and thoracic tumors. The skin of patients in this state often has the appearance of having been smoked; or their faces may seem cyanotic or flushed. This affection is brought on more frequently from heart derangement than from liver derangement, but these two conditions are often found together.

   General Treatment.--The treatment for obstructive icterus must be the removal of the obstruction. This may require surgery, and it may be a derangement that surgery cannot remedy. In gallstone obstruction the feeding of eliminating foods, such as fruit and raw vegetables, will in a reasonable time bring about a disintegration of the stone in the gall-bladder. Then there will be a passing into the bowels of the sand that results from the disintegration; and, if this style of eating is persisted in, the patient will make a complete recovery. Where the obstruction is due to a catarrhal inflammation of the gallduct, proper feeding will overcome it. What is proper feeding? Any normal style of eating that will include the necessary amount of eliminating foods, such as fresh, uncooked fruit and vegetables. In severe cases of this character the patient should fast for a week or two, and then live on fruit for a week or two, depending upon the severity of the symptoms and the rapidity of relief. In all these cases--it matters not how severe they are or what the character of the obstruction is--the patient should be kept away from sugar, starch, and fat. That will give the liver--the portal system--rest; and rest is the foundation on which all curative therapeutics must be based. Physiological rest is of more importance than all other forms of rest. Physical and mental rest are also needed, however; for these are allies of physiological rest.

   In the jaundice of children, no hesitancy should be felt about taking the child off its mother's breast and giving nothing but water until the severe symptoms have passed. Then the feeding should be light enough to prevent a return of the icterus.

   Hot baths should not be neglected in the treatment of any of these diseases. Where the symptoms are urgent, the bath water should be as hot as the patient can bear, and the duration of the bath should be in keeping with the patient's resistance. Where patients weaken quickly, the bath should be of short duration; but where they can stand it for fifteen to twenty, and even thirty, minutes, there should be no hesitation in extending it until complete relaxation is secured. Then a bath of from five to ten minutes' duration should be given daily. Absolute rest in bed, and no feeding until it is justified by a decided betterment of all symptoms, should be the treatment in any of these cases.

 

II. GALLSTONES

   Etiology.--There are many causes given by authorities on the subject. According to my way of thinking, the simplest and most correct explanation is that, as a necessary condition for the formation of gallstone, there must first be a primary period of catarrh of the gall-duct and gall-bladder. This must be aided by the gouty diathesis, and then by the habit, on the part of the patient, of eating too much of foods that carry mineral into the system, and too little of foods that eliminate. Excessive eating of starchy foods, sugar, and fat, and overstimulation with alcoholics, cause a sluggishness of the liver. First, the liver becomes hyperemic from an oversupply. This interferes with the nutrition of the organ, and enervation is established. Then we have retention of waste products. In those who eat foods that are potentially acid, to the neglect of those that are potentially alkaline, and then, as stated before, add a gouty diathesis, there is developed a condition that favors the building of stone in the gallbladder. This is further aided by a catarrhal thickening of the gall-duct, which to a certain extent impedes the passage of bile. With partial obstruction of the gall-duct, the gallbladder is inhibited in its housecleaning, so to speak. Every canal and cavity of the body will become diseased, if the process of natural cleaning is interfered with; and, as the flow of bile is somewhat inhibited by the catarrhal thickening of the mucous membrane of the gall-duct, this favors the retention of gall in the gall-bladder, and this again favors concentration. The thinner fluid will find an exit through the gall-duct, while the heavier will be retained. This gives a start for the formation of gallstones. It is said that experimenters have succeeded in producing gallstones by injecting micro-organisms into the gall-bladder of animals. Another experiment has been successfully tried, within my professional experience--that of introducing a small bit of chewing gum into the male bladder, after which a stone as large as a hen's egg was taken out. It required only about three years for the stone to reach that size. Hence--this being positively true--chewing gum must be the cause of stone in the urinary bladder, if micro-organisms injected into the gall-bladder produce gallstones in that cavity.

   Without joking and without irony, any foreign substance finding lodgment, accidentally or otherwise, in closed cavities, especially the gall-bladder and the urinary bladder, has a tendency to become the nucleus around which stone forms into calculi of varying size. In some cases the gallbladder may be filled with one stone; in other cases there will be numerous stones. I have heard of as many as sixty to sixty-five being taken out of one gall-bladder.

   It stands to reason that the food and water which carry the greatest amount of mineral will be most favorable to the development of stones in the body.

   Symptoms.--In many cases there are no symptoms further than attacks of indigestion, and at times a slight jaundiced yellowness of the skin; but in many cases of fully developed stone in the gall-bladder there will be no decided symptoms whatever. To the educated eye, patients who have this disease will always present symptoms of deranged digestion.

   No one will develop gallstones and at the same time have the appearance of perfect health. The first symptom to arrest the attention of the patient is a feeling of fullness or weight, or a feeling of oppression, in the region over the stomach. The majority of cases will not be suspicious of anything wrong until they are taken with a pain so severe that it doubles them up. This they ascribe to indigestion. They will think that something they have eaten has thrown them into a colic. The disease is called gallstone colic. Previous to these attacks of severe pain there will be attacks of indigestion, weeks, and sometimes months, apart. When indigestion is accompanied by urticaria, or nettle-rash, it is well to be suspicious enough to investigate in the line of gallstones. It may be that the skin trouble has been produced by a sluggish state of the liver; but certainly, if there is much pain over the stomach, and a sensitiveness to pressure to the right of and a little above the umbilicus, the probabilities are that the disease is gallstones. Some cases will suffer very greatly, and remain sore for one or two days after they get over the gallstone colic. Patients recover from this affection, and sometimes run along for months--or, again, may not run along for more than a week--before they have another attack. It depends altogether upon how soon another stone will become lodged in the gall-duct. It is the passage of the gallstone from the gall-bladder into the duodenum that creates the suffering. These stones are usually rough and jagged, and cause great pain as they are forced through the passage.

   It is not necessary, in going over the symptoms, to take up the various complications, such as ulceration, suppuration, and the dangerous perforation that follows these complications; for such cases must be put into the hands of physicians. Nothing short of an operation will prevent death in case of peritonitis from perforation. In complete obstruction of the gall-duct it may be that surgery will be the only procedure which promises relief. Such extreme symptoms are exceptional and belong to the province of the surgical specialist.

   Treatment.--No treatment whatever should be given to gallstones--the patient must be treated. It matters not what the deviation is from the normal, he must be brought back. Hence, to treat a case of gallstone successfully, the patient must be examined, habits must be inquired into, and everything necessary to correct the eating and care of the body must be done.

   Constipation must be overcome by laxative foods. If the patient is suffering, and has been suffering a great deal, a fast must be insisted upon. No definite length of time can be given. It should, however, be prolonged until all pain and discomfort have passed away. During the fast, hot water should be taken freely--a pint every three hours, or even more. As soon as all discomfort has vanished, the patient should live for one week on fruit--any kind of fresh fruit--morning, noon, and night. No eating should be permitted between meals. Fruit must be eaten at the regular mealtime, and nothing at all between meals. The second week: fruit in the morning, and a combination salad, with one or two cooked, non-starchy vegetables, at noon. One of these vegetables should be spinach or onions, and they should be cooked properly--in very little water, so that there will be none to drain off. Spinach should be one of the raw vegetables in the salad. Lettuce, tomatoes, cucumbers, and spinach, with a small piece of onion for flavoring, makes a nice salad. Dress with salt, oil, and lemon juice. The evening meal should be one or two glasses of buttermilk. This should be the style of eating for the first month. The second month: fruit in the morning; toasted bread and fruit at noon, or rice dressed with salt only, and any kind of fresh, uncooked fruit; occasionally biscuit, butter, and honey, if so desired. If any drink is taken at the mealtime, it should be teakettle tea with the starch meal and fruit meal. Milk is not to be taken with meat.

   The dinners may be meat every other day, with two cooked, non-starchy vegetables and a combination salad. The alternate days have potatoes, navy beans, corn bread, or any of the decidedly starchy foods in place of meat. Patients must give their bodies thorough attention by way of bathing, dry towel rubbing, etc. A hot bath of three to five minutes' duration should be taken every morning, with a quick cold sponge bath, to be followed with dry towel rubbing, and then dry towel rubbing at night before going to bed. This should be done daily. The skin must be put into good condition, so as to prevent catching cold; for the gallstones depend upon catarrh of the gall-duct and gallbladder. Unless the constitutional derangement that should be known as catarrh is cured, it will be impossible to relieve the patient permanently of gallstone formation.

   Exercise regularly. Passive exercise should be practiced daily, besides being in the open air and sunshineeither walking, driving, or just enjoying the freedom of the out-of-doors. Old habits must be given up--such as eating between meals, eating candy, desserts, etc.

 

III. CIRRHOSIS OF THE LIVER

   Etiology.--This disease is the ending of a life of debauchery. It comes from indulging the senses by way of eating and drinking, and gratifying lust. Lust enters into this derangement as a factor by bringing on enervation and helping to derange digestion and nutrition. There are several leading etiological factors given by medical authorities: the toxic, coming from the use of alcoholics; the infectious, which is said to come from specific fevers, syphilis, etc.; a type that comes from the congestion following heart disease, known as cardiac liver; and one that comes from obstruction of the bile-duct. There is a vascular cirrhosis, which is brought on from irritation, engorgement, and the developing of new tissue because of an oversupply of nutritive material in the organ. There are many other etiological factors given, but I think it unnecessary to mention them. The causes most commonly met with are overeating and alcohol-drinking.

   Symptoms.--Like many other diseases of the liver, this disease often progresses to full development without presenting many symptoms--this is what authorities on the subject say. I, however, incline to the belief that the premonitory or primary symptoms have been present for years, but have been ignored or not even noticed. It would be impossible for anyone to tipple for years without showing symptoms of irritation of the stomach and tumefaction of the liver; so these symptoms are primary, and it should be the duty of every physician to inform victims of this derangement of what they are bringing upon themselves. Unfortunately the medical profession has never considered it its duty to take the attitude toward patients of being "my brother's keeper;" indeed, too many supposed-to-be teachers of health have encouraged these victims in taking into the system the material that builds disease. For years the blood vessels in the region of the stomach and liver have been engorged because of the irritation produced by alcoholics. The tongue is furred in the morning; the bowels are irregular. Sometimes there is vomiting or mucus. In alcohol gastritis great quantities of this mucus will be thrown out at times; even hemorrhage from the stomach is not uncommon. Occasionally the hemorrhage is profuse, and liable to recur so long as the habit of drinking is continued. Hemorrhage from the bowels may take place in this disease before there is any blood thrown out of the stomach. The bleeding is often from the veins in the esophagus, because of the disturbed portal circulation. Indeed, there is not very much difference, except in degree, between this state of the liver, caused by alcohol poisoning, and the chronic state brought on from years of imprudence in the eating of starch, sugar, and fat. The alcoholic variety is always more intense, there is greater enervation, and the circulatory system throughout the body is more involved than in those varieties produced by imprudence in eating. In advanced cases, patients become dropsical--show general dropsy. Ascites is common.

   Diagnosis.--With a dropsical state of the peritoneum, the well-marked history of alcoholism, light-colored feces from the bowels, and hemorrhage from the stomach and bowels, the diagnosis is made.

   Treatment.--There is not much to be done. Patients may be tapped and water taken off, which will give relief for a short time; but the water certainly will return. The time for curing the case has passed, perhaps many years ago. When the liver is so organically disorganized and the auxiliary organs of the body are so deranged as in these cases, there is nothing to be done, except whatever palliation may be required to give the patient temporary relief.

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