FUNCTIONAL DISORDERS OF THE LIVER. 441 



their own products ; and the hepatic cells are driven to fresh 

 secretion. The purgatives which sweep away the old bile, 

 and so lead to the production of new bile, are called in- 

 direct cholagogues. Mercurials specially act upon the liver 

 in this way. 



(3) We believe that we can modify the metabolic processes 

 in the liver by specific hepatic stimulants and depressants, 

 irrespective of both the supply and the products. Thus, Phos- 

 phorus, Antimony, and Arsenic, increase the metabolic activity 

 of the liver, causing a greater production of urea, and the last 

 two a free flow of bile. Bicarbonate of Soda and Dilute 

 Nitrohydrochloric Acid have probably the same effect as 

 regards the glycogen and the bile. Chloride of Ammonium 

 remarkably increases the amount of urea, apparently by its own 

 decomposition, but still probably through the agency of the 

 liver cells. Iron increases the amount of urea. Amyl Nitrite 

 stimulates the glycogenic function. On the other hand, there 

 can be no question that the whole process of hepatic activity 

 may be remarkably reduced by means of Opium, and to a less 

 degree by Quinia and Alcohol. 



The direct effect of certain drugs upon the secretion of bile 

 is unquestionable. Podophyllin, Rhubarb, Aloes, Colocynth, 

 Colchicum, Jalap, Scammony, Ipecacuanha, Sulphate of Soda, 

 Phosphate of Soda, and Chloride of Ammonium, Nitro- 

 hydrochloric Acid, and (non-officinal) Euonymin and Iridin, 

 stimulate the liver substance and increase the amount of bile 

 secreted, and are therefore direct cholagogues. Mercurials, 

 including Calomel, as well as acids and such substances as 

 Guaiacum, Sarsaparilla, etc., possibly act less powerfully as 

 direct hepatic stimulants. Opium and Morphia reduce the 

 activity of the secretion. 



III. PATHOLOGICAL RELATIONS. 



The therapeutics of the liver will be best illustrated by a 

 study of the treatment of its functional disorders. The common 

 causes of derangement of the liver are to be found in the 

 materials supplied to it, namely, food and air, and especially in 

 the want of due proportion between the two. Most frequently 

 there is excess of food excess of rich food, especially of meat 

 and alcoholic drinks, causing also primary indigestion. On the 

 , other hand, there may be imperfect oxygenation of the blood 

 supplied through the hepatic artery, i.e. deficient respiration 

 and circulation, generally referable to sedentary or luxurious 

 habits, abstinence from muscular exercise, and confinement to 

 ill- ventilated hot atmospheres. Not uncommonly the two classes 



