BILIOUSNESS. 1 29 



but little from it, whilst others have only to take a glass or two of champagne to be 

 most frightfully upset. 



We must now consider the symptoms which we recognise as indicating that the 

 liver is out of order. In the first place, the tongue is usually covered with a thick 

 fur, sometimes whitish, but occasionally of a yellowish or brownish tint It is 

 commonly large, pale, and flabby, and indented by the teeth. Nevertheless, it is 

 well to remember that there may be considerable derangement of the functions of 

 the liver, and yet the tongue may be perfectly clean, or at most only slightly coated 

 in the morning. 



When the flow of bile is deficient, the appetite is often very bad, and there may 

 be a loathing of fat and of greasy articles of diet. Sometimes there is a loathing 

 of everything except alcohol, indulgence in which intensifies the mischief. In 

 exceptional cases the appetite may be excellent, even when the liver is performing 

 its work very badly, and the patient is often tempted to eat what he knows from 

 experience disagrees with him. Liver disturbance is often accompanied by a bitter 

 or metallic taste in the mouth, especially in the morning. " Hot coppers " is a 

 frequent complaint of those who have indulged too freely over-night. 



Flatulence, or wind, is another common symptom. It is one of the most frequent 

 results of a deficient flow of bile. From the absence of bile in the intestines, the 

 food undergoes fermentation, and a large quantity of gas is generated. Acidity is 

 another frequent source of trouble. Many articles of diet habitually disagree with 

 people who suffer from their livers, so that they get bilious. They awake in the 

 morning with a dry or clammy tongue, a bitter taste in the mouth, dull heavy 

 headache, giddiness, and cramps or pains in the knuckles. 



Functional derangement of the liver generally gives rise to disturbance of the 

 bowels in some form or other. Most commonly there is constipation. The bile acts 

 as a kind of natural purgative, and when it is secreted in diminished quantity there 

 is nothing to stimulate the bowels to action. The motions are either unusually pale, 

 or from long detention in the bowel become black and lumpy. The latter condition 

 is often associated with great depression of spirits the origin of the term melancholy. 

 Very often, instead of constipation, there is diarrhoea, or the two conditions may 

 alternate. It is probable that the retention of undigested food in the bowel, by 

 setting up irritation, is the cause of the diarrho3a. It may be taken as a rule, 

 that when little bile is secreted the stools are pale and unusually offensive, unless 

 they be long retained in the bowel, when they may be dark and lumpy ; and that 

 when there is an excessive secretion of bile an overflow of bile the motions are 

 relaxed and liquid. 



In exceptional cases, bleeding from the bowel occurs as the result of simple 

 derangement of the liver, without the existence of any actual permanent disease 

 of that organ. It is not common, but is most frequently met with in people beyond 

 the middle age. The attack is usually preceded by a feeling of oppression and 

 heaviness, by pain in the right shoulder, loss of appetite, nausea, and furred tongue. 

 It is often followed by a subsidence or cessation of the symptoms. Great relief is 

 usually afforded by a good purge, such as a calomel, or blue pill, and a saline 

 a j orient. 

 9 



