592 OF SECRETION AND EXCRETION. 



injurious. This is assuredly the case with regard to copper and certain other 

 mineral poisons ( 89) ; and it seems also to be true with respect to pus, which, 

 when taken up from ulcers in the intestinal walls, is stopped in the liver, and 

 not unfrequently gives rise to abscesses in its substance. 1 



631. When from any cause the secretion of Bile is suspended, the substances 

 at the expense of which it is formed accumulate in the Blood ; and their excre- 

 mentitious character is strikingly demonstrated by the disturbance of other 

 functions, especially those of the Nervous system, which then ensues. When 

 the suppression is complete, the patient suddenly becomes jaundiced, the powers 

 of that system are speedily lowered (almost as by a narcotic poison), and death 

 rapidly supervenes. 3 When the secretion is diminished, but not suspended, the 

 same symptoms present themselves in a less aggravated form. It is probable 

 that much of the disorder in the functions of the brain, which so constantly 

 accompanies deranged action of the digestive system, is due to the less severe 

 operation of the same cause ; namely, the partial retention within the blood of 

 certain constituents of the bile, which should have been eliminated from the 

 circulating fluid. Such an abnormal accumulation, which may depend either on 

 a deficiency in the functional activity of the liver, or on an excess of the excre- 

 mentitious matters brought to it for elimination, is habitual in some persons; 

 and it produces a degree of indisposition to bodily or mental exertion which it 

 is difficult to counteract. More, probably, is to be gained in such cases by the 

 regulation of the diet, especially the reduction of its hydrocarbonaceous compo- 

 nents, and by active exercise (which, by augmenting the respiration, will pro- 

 mote the elimination of any superfluity of this kind through the lungs), than by 

 continually inciting the liver to increased functional activity, by medicines which 

 have a special power of temporarily augmenting its energy. The reabsorption 

 of Bile into the blood, as seen in ordinary cases of jaundice dependent upon the 

 obstruction of the biliary ducts, does not act on the general system in a manner 

 nearly so injurious as the retention of the matters at the expense of which it is 

 formed has been shown to do; 3 in fact, much of the disturbance which then 

 ensues may be attributed to the disorder of the digestive function, which is 

 consequent upon the stoppage of the flow of bile into the intestinal canal ( 453, 

 454). And when it is further remembered that the greater part of the bile 

 which passes into the intestinal canal is ordinarily destined for re-absorption 

 ( 457), it seems fair to conclude that the matters which accumulate in the blood 



1 See Dr. G. Budd's "Treatise on Diseases of the Liver," 2d edit. Chap. ii. sect. 1. 



2 See Dr. Alison in "Ed. Med. & Surg. Journ.," vol. xliv. ; and Dr. Budd, Op. Cit, 

 Chap. iii. From the evidence collected by Dr. Budd, he is led to think it probable that 

 the cerebral symptoms are not due to the simple retention of the materials of Bile ; but 

 depend^ipon some metamorphosis which these undergo whilst circulating with the blood, 

 whereby a more noxious poison is generated. For the general symptoms of suppressed 

 secretion may have shown themselves for some time, before any serious disturbance occurs 

 in the cerebral functions ; and this may supervene very suddenly, and be fatal in a few 

 hours (p. 263). The analogy of Uraemia (g 637) seems to afford some confirmation to this 

 view ; but it must be borne in mind, as a possible explanation of the phenomena, and one 

 which has evidence in its favor, that the kidneys, by a vicarious action, remove the most 

 poisonous of the retained biliary matters ; and that it is only when they can no longer effect 

 this, that the results of the accumulation of these matters begin to show themselves in the 

 perversion of the functions of the nervous centres. 



3 Dr. Budd mentions several cases (Op. cit., pp. 209-227) in which the passage of bile 

 into the intestines was entirely prevented by the complete closure of the ductus communis, 

 and in which, nevertheless, life was prolonged for many months ; in one of these cases, the 

 jaundice first occurred in a woman four months pregnant, who nevertheless bore a living 

 child at the full period, and suckled it up to the time of her death, which happened when 

 the child was three months old. In all these cases, death seemed to result from gradual 

 exhaustion, consequent upon the imperfect assimilation of food, rather than from any 

 toxic agency ; and this even when the liver was in such a state of disorganization, that its 

 functional activity must have been suspended for some time before death. 



