442 MATER i A MEDIC A AND THERAPEUTICS. 



of causes are combined, as is well seen in the disorders and dis- 

 eases of the liver so common in the tropics. 



Another way in which disorders of the liver originate is 

 through retention of the products. If the kidneys, lungs, or 

 bowels are inactive, the liver will be blocked, as it were, by 

 urea, uric acid, sugar, and bile ; and hepatic metabolism will 

 become feeble. This condition is generally referable to im- 

 paired muscular and circulatory activity ; to want of exercise, 

 air and light, which beget renal and intestinal torpidity: it 

 is the disorder of town life. In other cases debility of the liver 

 is distinctly inherited. 



In whatever way induced, derangement of the liver consists 

 in certain disturbances of the chemical processes within it, 

 which manifest themselves by altered composition of the ex- 

 cretions and many well-marked symptoms. The urine con- 

 tains an excess (rarely a deficiency) of urea, an excess of uric 

 acid, occasionally sugar, and even albuminous bodies, derived 

 probably from the liver ; whilst its reaction is disturbed, the 

 colouring matter is in excess, and leucin and tyrosin make their 

 appearance in it. The bile is altered in quantity and quality, 

 giving rise to diarrhoea or"co*hstipation with foul pale stools, to 

 inspissation of bile in the ducts and gall bladder, and the forma- 

 tion of gall stones. The general symptoms of biliary disorder 

 are referable to the circulation in the blood of an excessive 

 amount of the normal products urea, uric acid, etc., and of 

 imperfectly formed products allied to these. Such products of 

 disordered metabolism, though differing from the normal only 

 by a few atoms, or in the arrangement of their atoms, may be 

 highly deleterious in their action on the body. Entering the 

 blood by the hepatic veins, they disturb the nervous system, and 

 are the cause of the sleepiness, languor, irritability of temper, 

 the headache, and the general misery and melancholy, so familiar 

 in the " bilious." They enter the muscles and produce aching, 

 weariness, muscular debility, and trembling. Palpitation and 

 flushing indicate their action on the circulation, whilst the 

 general nutrition also suffers. If this condition persist, certain 

 chronic states of the system are induced, which are known as 

 gout and lithsemia. The heart and vessels become diseased, 

 as well as the skin and joints. Continued disturbance of the 

 reaction and constitution of the urine leads to a deposit in the 

 urinary passages of some of its salts in a solid form, constituting 

 gravel or calculus ; and structural disease of the kidneys may 

 ultimately result. 



Absorption of bile into the blood may occur in these cases, 

 but more so in actual plugging of the ducts, which leads to 

 jaundice. In either case, some or all of the constituents of the 



