128 THE TREATMENT OF DISEASES. 



injurious to those who are prone to liver disturbance. It has been found that the 

 injurious effect of alcoholic beverages upon the liver increases in a direct ratio to 

 the amount of sugar and spirit they contain. It would seem, indeed, that a mixture 

 of spirit and sugar produces injurious results, which would not be caused by taking 

 a much larger quantity of spirit or sugar alone. Practically, we know that the 

 alcoholic drinks which are most apt to disagree with the liver are malt liquors 

 of all sorts, but especially stout and the stronger forms of mild ale, port wine, 

 madeira, tokay, malaga, sweet champagne, dark sherries, liqueurs, and brandy; 

 whilst those least likely to derange the functions of that organ are claret, hock, 

 moselle, dry sherry, and gin or whisky, largely diluted. 



Derangements of the liver from excessive eating, or from any other error in diet, 

 usually first show themselves in middle life from thirty-five to forty-five. Young 

 people who take much exercise, and who are still growing, can eat more than they 

 actually require with comparative impunity. But by the age of forty the body is 

 fully developed, and most persons take less exercise than before, while at the same 

 time they often indulge more freely in the pleasures of the table. 



Insufficient muscular exercise in the open air may derange the functions of the 

 liver. It is well known that sedentary habits, and living in badly-ventilated rooms, 

 act on the body injuriously, and more especially on the liver. It is a common 

 observation that people who eat and drink too freely do not suffer from their livers 

 so long as they lead an active life in the open air ; but as soon as from change of 

 occupation or other causes they take to sedentary habits, without any corresponding 

 change in diet, derangement of the liver ensues. Every sportsman who has suffered 

 from biliousness knows the effect of a day's hunting or shooting in clearing his 

 complexion and relieving his symptoms. 



A high atmospheric temperature is especially favourable to the production of 

 disorders of the liver. We all know how frequently they occur in India and other 

 tropical climates, and in our own the liver more often becomes disordered in summer 

 than in winter. The draught, which is ^uitable in a cold or temperate climate, 

 produces in the tropics liver derangement. 



It is probable that many cases of liver disturbance are nervous in their origin. 

 We know that sudden fear, and other forms of severe mental emotion, may arrest 

 the secretion of the milk, and that, from the cessation of the secretion of saliva, the 

 tongue cleaves to the roof of the mouth. Prolonged mental anxiety, worry, and 

 incessant mental toil, interfere with the secretion of bile, and produce that chain 

 of symptoms to which we shall presently refer. Such results are all the more 

 likely to ensue if the diet has been such as to favour liver disturbance if, 

 for example, to drown grief the sufferer has indulged in stimulants. 



In considering the causes of derangement of the liver, it must not be forgotten 

 that there are constitutional peculiarities inherited or acquired in virtue of which 

 the liver is upset by things which, under ordinary circumstances, would be harmless. 

 Some -people are more prone to suffer from their livers than are others. An innate 

 weakness of the liver is often inherited. If an individual with this predisposition 

 take spirits, even in comparatively moderate quantities, he usually suffers very 

 quickly and also severely. Some people are always drinking, and apparently suffer 



