The Liver.

Its Functions, and the Treatment of its Diseases.

The Liver is really a part of the digestive apparatus, since it produces the bile, which is one of the digestive juices. It is the largest gland in the body, weighing, from 50 to 60 ounces avoirdupois, and is placed just below the diaphragm on the right side, extending also across the middle line of the body towards the left side. Its front border reaches just below the border of the chest when a person is sitting or standing, but when the person lies down the liver passes slightly up, so as to be completely under cover of the ribs, except for a small portion lying beyond the lower end of the breastbone. In women the liver is often permanently displaced and forced out of cover of the ribs through tight-lacing. This causes crowding in the abdomen and pelvic cavity, and may serve to displace other organs, notably the womb. When a small piece of liver is examined under a microscope it is found to consist mainly of a large number of many-sided cells, containing a large nucleus and a nucleolus. The cells of the liver take from the blood flowing past them certain materials from which they prepare the bile. This is discharged into the surrounding ducts, and then passes into larger ducts, which collect the bile from numerous lobules. These ducts unite with others from other parts of the liver until, in the end, two channels are formed, one of which carries all the bile formed by the right portion of the liver, and the other that formed by the left portion. These two channels come out from the substance of the liver, uniting into one main vessel—the hepatic duct which passes towards the small intestine. On the under-surface of the liver is the gall-bladder, in which the bile may be stored till needed for assisting digestion. From the gall-bladder the cystic duct joins the duct from the liver, and the common bile-duct is formed: reaching to the first part of the small intestine (called the "duodenum"), through the walls of which it passes, to open on the inner surface a few inches below the stomach. The bile, prepared in the depths of the liver by the liver cells, is conveyed out of the liver by the bile-ducts, and may pass straight down and into the small intestine, to mingle with the food therein. If, however, digestion is not going on, the mouth of the bile-duct is closed, and in that case the bile passes up the cystic duct and lodges in the gall-bladder till required.

The part the liver plays in the digestive process is, however, only one of its duties, and it is advisable to have a complete view of all the functions of the liver in order to estimate the great importance of that organ in the bodily economy. As we have seen, it secretes the bile, and therefore ranks—

(1) As a secretory organ, elaborating a fluid for use in the body. But the bile is not only a digestive fluid. It aids in the digestive process, and it also contains ingredients which are separated from the blood for the purpose of being cast out of the body, because their remaining in the blood would impair its quality. In respect of this the liver ranks—

(2) As an excretory organ, separating material of no use to the body, which is ultimately expelled as waste matter. This will be more easily understood by noting in detail the constituents of bile. It contains, roughly, 86 per cent. water and 14 per cent. solid matter. The solid matter consists of the bile salts, the glycocholate and taurocholate of soda, of colouring matters, of fats, and of inorganic salts, chiefly chloride of sodium (common salt), with a smaller quantity of phosphates, and traces of iron and manganese, also of a crystalline substance called cholesterin, a substance found in the brain, and very likely brought to the liver by the blood. There is also in bile a considerable quantity of mucus, obtained from the bile-ducts and gall-bladder.

Of these, the chief are the bile salts, and the colouring matters—the bile pigments. They do not exist already formed in the blood, as do the salts and the cholesterin, and must be formed from materials in the blood by the activity of the liver cells. Now, it is the bile salts that act on fats in the alimentary canal and aid in their emulsion and absorption. They appear to be themselves split up into other substances and absorbed, for they are not found in the faeces. The colouring matter of bile is derived from colouring matter of the blood. The pigment of human and carnivorous animals is bilirubin, of a golden red colour. In herbivorous animals it is green, biliverdin. The red pigment is readily converted by oxidation into green. These pigments are cast out in the faeces. Their presence in the blood gives rise to the yellowness in cases of jaundice.

(3) The third function of the liver is very different from those already considered. A French physiologist, Claude Bernard, was the first to point out that the liver formed a substance, like starch, which was readily converted into sugar. He named it glycogen; and it is also called animal starch. If an infusion of pieces of the liver of any animal be made, it will be found to be rich in sugar (grape sugar, or glucose.). But if the liver of an animal just killed be rapidly removed from the body and thrown into boiling water, an infusion does not contain sugar. It is opalescent, or even milky. By adding alcohol to it a white precipitate of glycogen falls. If to the opalescent infusion saliva (which converts starch into sugar) be added, the infusion clears up, and sugar may now be detected in it—the glycogen has been transformed. Moreover, if water be injected into the portal vein of the liver, removed from an animal, and the injection continued until the water issues from the hepatic vein, sugar will be found in abundance in the water. If the injection be continued until the liver is well washed out, the washings will at last contain no sugar; and if it be left for a few hours longer, then repeating the injections, sugar will again be found. It appears from such experiments, and many others, that the liver forms glycogen, which is stored up in its cells, and that it also contains a ferment capable of transforming the glycogen into sugar. The liver forms its glycogen chiefly from starch and sugar taken as food, these passing as sugar to the liver by the portal vein. So far as can be learned, the glycogen is gradually re-transformed into sugar and sent to the tissues, as their needs demand, supplying them with material for their energy and heat. Thus the liver has a great purpose to serve in the nutrition of the body. Its glycogenic function, as it is called, throws light on the disease called diabetes, in which sugar appears in the urine. Fats may be formed or arrested by the liver cells. When formed, the cells usually exhibit bright dots of oil-globules, which may so increase in number that the cells appear to contain nothing but fat. The liver of domestic animals, especially of those kept in confinement, tends to become very fatty. The luxury know as "pate de foi gras" is made of the fatty liver of Strasbourg geese. These birds are kept in close confinement and stuffed with rich food, so that the fatty degeneration speedily occurs.

To sum up—the liver aids in the process of digestion by secreting the bile, it separates certain waste substance from the blood, and it stores up in its cells substances which are destined to take part in the general nourishment of the body.

Congestion.

The liver is the largest organ in the body. Normally it contains nearly one-fourth of the total amount of blood in the body, and it can be readily understood that if these numerous blood-vessels become choked with blood instead of being ordinarily filled, the liver might contain an enormous amount of blood, and if it could be seen in that condition it would appear to be of a deep red colour, and feel hard through the amount of blood in it. The liver may be congested from various causes, for anything which prevents the blood from returning from the liver to the heart and lungs will produce an accumulation of blood and congestion in the liver. It may also result from much simpler causes, such as excessive eating, or the use of too rich foods; excess in alcoholic drinking; want of exercise and sedentary habits; ague may produce it, and many other causes, such as accidents, blows, &c.

The symptoms of congestion of the liver are weight and fulness in the region of the liver, on the right side, under the ribs and below the shoulder-blade. It becomes tender on pressure. This tenderness is often well shown by giving a smart push with the fingers to the front part of the belly, just behind the end of the breast-bone. In congestion of the liver there may be also some pain, especially in coughing and when lying on the right side. Added to this are symptoms of dyspepsia and a feeling of sickness, bad appetite, often dull headache, and mental depression. The urine is highly coloured, and there is costiveness. Sometimes there is yellowness of the skin, and jaundice, shown in the white of the eye.

Take a packet of Blood Purifying Herbs, and boil according to instructions, and give a small teacupful every 3 hours. Then as an outward application use hot fomentations of Knitbone or Comfrey Liquor, wrung out with hot flannels and placed over the region of the liver, and change them every time they become cool. A mixture of Marshmallows, Comfrey, and Ragwort may also be used for fomentation as above; or, instead of fomentations, a better way would be to rub with the 3rd Preparation of Lobelia (see article on "Lobelia") and then with Chickweed Ointment, and if the bowels be constipated give a small teacupful of Constipation Mixture every night and morning, made from the "Constipation Herbs" as recommended under "Constipation." If the above treatment be followed the patient will soon be in a state of convalescence, but it must always be understood that during the time of treatment the patient must be kept warm in bed, and even after convalescence the Blood Mixture preparation must continue to be given until a perfect state of health is restored. The patient must also be kept from all intoxicating drinks, wines, or ciders.

Abscess of the Liver.

In nearly all cases abscess of the liver is preceded by inflammation or congestion of that organ. There may be one or several points of ulceration, and they may discharge outwardly or through the stomach, bowels, or lungs, penetrating the diaphragm. The last method of discharge is the most favourable. It may last for many months, resembling consumption. Discharges into the abdominal cavity are usually fatal in a few days.

The symptoms of abscess of the liver are not very marked, but usually there are frequent chills, followed by fever, sharp pain, and disturbed sensations in the region of the liver, bowels, stomach, and under the right shoulder. There may be diarrhoea or dysentery and great debility; the patient may lie in bed for weeks or months.

Guard against blood-poisoning through suppuration, which might set in through bursting of the abscess. In order to do this plenty of Blood Purifying Mixture should be freely given, at least four times a day, and before meals also. Constipation Mixture every night and morning, besides the above. As an outward application the patient should be rubbed with Third Preparation and Chickweed Ointment on the right side, over the region of the liver, and no intoxicating drinks, wines, or ciders must be given. The diet must be light and easy to digest, such as Slippery Elm Food, Lentil Flour Food, &c, and there is no occasion whatever for anyone to undergo an operation. If the abscess should show a tendency to break on the outside, the outward application treatment will answer all that is required. Keep the sore well washed and clean three times a day with Knitbone, that is, Comfrey, Marshmallows, Ragwort, or Chickweed liquor, made hot. If the patient be very dry or thirsty he may be given plenty of hot tea, with a little milk, or plenty of hot water or hot milk, with a pinch of Composition Powder put into each cupful. If the patient will follow this treatment to the letter, and have patience and perseverance, it will neither disappoint him nor the practitioner. But always bear in mind that if the abscess has a tendency to burst, either inside or out, the nearer it is to bursting the greater will be the pain; but that is a good sign, and the pain will cease when opening takes place, but on no account must it be opened by artificial means.

Hobnail Liver.

The cause of this condition of the liver is most frequently excessive alcoholic drinking, though it may result from other causes, such as syphilis, consumption, malaria, &c. It may also be the result of chronic inflammation of the connective tissue of the entire organ. It is slow in developing, and gives rise to various functional disturbances. The symptoms are:—Indigestion, heartburn, sour belchings, coated tongue, constipation, and occasional vomiting. The liver gradually diminishes in size, and the skin becomes first pale and then decidedly sallow, a sort of creamy colour, and also dry and harsh. Strength and flesh are lost rapidly; the abdomen becomes distended, and dropsy is apparent. Difficulty in breathing, and palpitation and haemorrhages from the bowels occur in advanced cases.

The treatment should be the same as that for congestion of the liver, keeping off all intoxicating drinks, wines, or ciders, Also keep off all drugs or chemical preparations. The food must be light and nourishing. If the appetite be very poor, give plenty of Agrimony Tea; and if there be heartburn or sour belchings, give a Cayenne or Capsicum Pill before and after each meal. The patient should be kept warm and comfortable, and the treatment persevered with until a cure is made.

Hydatid Liver; Echinococcus Tumour.

This is a frightfully distressing malady, fortunately very rare in this country, though not infrequent in the far North. It is developed from embryos of the tape worm of the dog (Taenia echinococcus). It is supposed that the eggs of tape worms enter the stomach and bowels of human beings, and the embryos bore their way through the walls or muscular parts into, and embed themselves in, the liver and develop in various ways; and one or more may be present. The one known as Multiscular is supposed to reach or grow to a large size, possibly to eight inches in diameter.

It is supposed that little or no treatment can be found for this disease beyond sustaining the general health of the patient, but in all such cases there should be a general or regular treatment for worms, such as was laid down for consumption, when that disease was produced by worms. (See article on "Consumption," page 116.) If it is found that a tumour has formed through the worm, then besides the above treatment use that as laid down far abscess.

Inflammation of the Liver.

This may be caused through injuries or blows, accidents, congestion, or other drastic drying, caustic, corroding, and heating substances.

The symptoms are: Impairment of appetite, constipation, and bilious attacks; diarrhoea, tenderness and pain in the region of the liver, sometimes pleurisy pains in the chest, nausea and vomiting, and white, fur on the tongue. Attacks of this character may be frequent, and ushered In by chilliness and fever, chronic congestion, and possibly abscess is likely to follow.

The treatment in case of inflammation of the liver should be similar to that recommended for congestion of the liver.

Fatty Degeneration of the Liver.

The most common cause of fatty liver is over-indulgence in alcohol, fatty foods, or such as contain excessive quantities of starch or sugar, eaten by persons of an indolent nature, or inclined to obesity. But the condition may arise from consumption or wasting diseases, or heart or lung troubles, which prevent proper blood aeration. There are seldom any marked symptoms, though disturbances of digestion are common, and diarrhoea, with clay-coloured stools, and nausea and vomiting may set in. Fatty liver seldom proves fatal.

This disease of the liver should he treated similarly to that of waxy liver, but if there be lung affections give a Compound Lobelia Pill every two or three hours.

Lardaceous Liver, or Waxy Degeneration of the Liver.

This condition is always dependent on previous disease, such as syphilis, ulceration, and wasting diseases. The liver becomes increased in size and very dense in structure.

Some of the symptoms are:—Great paleness, diarrhoea, sickness and vomiting, indigestion, and progressive debility. The liver may be distinctly felt as enlarged, and the spleen is usually also enlarged, very often causing disagreeable sensations of fulness. Dropsy may be present, but jaundice is absent.

In the treatment of this disease nothing will be found better, than to give freely of the Blood Mixture Purifying Herbs and the Constipation Mixture as recommended in the article on "Constipation," p. 131; and rub as an outward application with Chickweed Ointment over the region of the liver, on the right side. This treatment will reduce the size and density of it, and prevent dropsy from setting in; and if there be sickness and vomiting, a Cayenne Pill, given before and after each meal, will stop it.

Wandering, or Floating, or Falling Liver.

The liver is held in its position by ligamentous attachment, which under certain conditions becomes elongated and allows the liver to fall down into the abdominal cavity. Women with lax tissues who have passed through frequent pregnancies are the persons most liable to such a condition, and men who suffer with excessive rupture on the right side.

In a falling down of the liver through relaxation of its ligaments the patient should be put to bed and be bound up with a warm woollen cloth, and mild astringent preparations given, such as may be made from Tormentil Root, Five-leaved Grass Root, Purple Loosestrife, Yarrow, Great Water Dock Root, Yellow Dock Root, &c.

Yellow Atrophy of the Liver.

When the liver gets to a state of yellow atrophy it is very difficult to treat, as it causes a rapid breaking down of the liver cells by fatty degeneration and consequent diminution in the size of the liver itself. Emotional and alcoholic excesses are the most frequent causes.

The symptoms are:—During the first few days or weeks there are considerable disturbances and irritation of the stomach and bowels, accompanied by jaundice; then nervous symptoms, delirium, convulsions, and stupor. The tongue and teeth become covered with dark substances, the bowels are inactive, and the urine very scanty. Dark matter may be vomited, and bleedings from the nose and bowels similar to dysentery are common. The temperature may fall below normal, breathing become difficult or irregular, and the heart's action greatly enfeebled; and in cases where the symptoms become very pronounced the invalid very rarely lasts over a week or two before death relieves the patient's suffering.

This state of disease of the liver should be treated by ah infusion of our Common Green Liver Wort and bruised lump Ginger, made as follows:—Take 1 oz. of the green leaves of Liverwort after they have been plucked from all dirt and soil and washed, and ½ oz. of lump Ginger, crushed. Place them in a pan and put one quart of cold water on them, and simmer gently on the fire down to one pint; then strain, and give a wineglassful every three hours. Besides the above, a preparation may be made as follows:—Take 1 oz. of Barberry Bark and one quart of new milk, and boil them for 10 minutes; then strain, and give a wine-glassful with each meal. The diet should be light and nourishing, such as Slippery Elm Food, Lentil Flour Food, or a food made as follows:—Take 2 ozs. of Marshmallow Root, in very fine powder; 2 ozs. of Slippery Elm Bark, in very fine powder; 1 oz. of Comfrey Root, in very fine powder; ½ oz. of best Composition Powder; 6 oz. of fine white sugar. Mix all together, and then put one tablespoonful of the mixture into a pint pot or bowl, pour on to it half-pint of boiling water; stir well, and then add the same quantity of milk; stir it up again, and drink it as a food.

Cancer of the Liver.

This may be treated as congestion of the liver. (This is advice from 1922. Do follow more modern regimes for cancer. -Henriette.)

Gallstones of the Liver.

These should he treated with Constipation Mixture as prescribed in the article on "Constipation."

Yellow Jaundice.

This can always be cured by using Barberry Bark boiled in milk, as was recommended in yellow atrophy of the liver, and taken before meals as prescribed.

Now it must always be borne in mind that the treatment here laid down for the various diseases of the liver is not only to assist in the dispersion of old, diseased, worn-out, and waste particles, but also to cause new tissue and cell formations to take the place of the old, and restore the parts affected to their normal condition, as all the separate ingredients mentioned in the making up of the different preparations named are not only depuratives but prophylactics, tissue nerve- and cell-formers, as well as having very great sanative qualities.

Common Plants and their Uses in Medicine was written by Richard Lawrence Hool, F.N.A.M.H., in 1922.