446 . Disturbances of Digestion. 



Bile, peptones, ferments, various vegetable acids, gases, the in- 

 testinal putrefaction substances, various alkaloids and proteid 

 bodies are to be met; and are, it is true, largely carried out of the 

 system with the feces, but to a certain degree are also absorbed 

 by the portal venous radicles. The liver serves as a cleansing 

 apparatus, and frees the portal blood from these harmful ingre- 

 dients. As soon as the liver becomes affected by diseases which 

 reduce its antitoxic functional ability, these substances must 

 necessarily pass through the organ without being transformed and 

 gain entrance to the general circulation and be- changed possibly 

 by other tissues or be eliminated by the kidneys, lungs and per- 

 spiration. The kidne}'- is particularly capable of acting in place 

 of the liver in purifying the blood. It has been shown that th^ 

 urine in hepatic diseases and in conditions which cause an in- 

 creased albumen disintegration (whether in the liver itself or 

 elsewhere) acquires decidedly increased toxic properties and 

 contains instead of or along with urea large amounts of am- 

 moniacal compounds or acid bodies, as amido acids (leucin, 

 tvrosin), aromatic oxyacids. acetone and albumoses. Such ma- 

 terials are. however, injurious to the kidneys and for this reason 

 disease of the liver is frequently complicated by pathological 

 changes in the kidneys. In case of failure of the compensatory 

 function of the kidneys, and especially if poisonous substances no 

 longer neutralized by the liver parenchyma are passing into the 

 blood, there may ensue symptoms of general intoxication acting 

 particularly upon the central nervous system. These phenomena 

 may be met in varying grades of severity, as convulsive or stupor- 

 ous conditions of acute or protracted course, according to the 

 extent of destruction of liver cells, the increase of albuminous 

 ■disintegration in the liver and the access of infectious factors. 

 The most important poisonous material wdiicli occurs in case of 

 destruction of the hepatic function concerned in the transforma- 

 tion of albuminates into urea and uric acid, is carbamic acid : the 

 entrance of this material into the blood, as seen in animals de- 

 prived of the liver or having an Eck's fistula (Minkowski*), causes 

 very intense cerebral disturbances. 



Stagnation of bile, besides causing biliary staining of the liver 

 and the rest of the body structures, the so-called icterus (x. p. 

 212), is also responsible for cerebral toxic symptoms (spasms 

 and stupor), because of complex conditions of intoxication simi- 



♦ For details see Kitt, Pathol. Andtcnnie iler Haitstinc, II Aiifl. 1 Bd., p. 595. 



