Biliousness

“ These symptoms are commonly described as due to biliousness, and are provoked by excesses in diet, and not unfrequently by moderate indulgence in certain common articles of food, such as sweets, fruits, farinaceous foods, and the fermented preparations of alcohol.
Derangements of nutrition are shown by a disposition to erythematous and catarrhal affections of the skin and mucous membranes, to affections of the sebaceous glands, and to premature falling of the hair. There is often a more or less marked tendency to obesity. ”

“ After the stomach and the bowels have been thoroughly cleansed, if the patient is not able to exercise, artificial manipulation of the abdomen should be [808] administered for a period of half an hour three times a day. These suggestions may be repeated until the patient is relieved, when the diet for chronic indigestion may be followed in rather modified form, omitting the heavier vegetables, and increasing the lighter foods.
[809]
MENUS FOR BILIOUSNESS SPRING MENU
BILIOUSNESS—HEADACHE SLUGGISH LIVER
Supersecretion of bile by the liver is termed biliousness. ”

“ A woman will complain of being bilious; there may be a bitter taste in the mouth, a burning in the throat, frontal headache, nausea, and even vomiting, the urine high-colored, the bile abounding in the alvine dejections, and perhaps causing heat and a stinging sensation in the rectum; the tongue furred, a biliary tinge pervading the cutaneous surface." The propriety of ascribing the symptoms so graphically described in these words to excess, deficiency, or vitiation of the biliary secretion, in the entire absence of precise knowledge, may well be questioned. ”

“ How often, among the symptoms of that disease, do we see it ourselves, and find it confirmed by others, that the bile is unnatural, either in quantity or quality? Green bile is often found in the gall bladder and ducts, and the action of a brisk purgative, especially of calomel, will often dislodge morbid secretions from the liver, and from the bowels, and the consequence of such free evacuations, is seen in the restoration of the healthy functions of the liver, and along with it a frequent disappearance of that formidable array of symptoms which so closely simulate hydrocephalus. ”

“ Whereas, if the liver secretes more bile during the intervals of digestion than the wants of the system require; after the completion of each succeeding meal the excess of bile will remain behind in the gall-bladder, and, while becoming stored up with that subsequently secreted, of necessity, favour the increase or excite the formation of gall-stones in persons predisposed to them. There being nothing more conducive to the deposition of biliary calculi than a well-filled gall-bladder. ”

“ It will be remembered that I began by saying, that while some of the constituents of the bile are generated in the liver itself, there are others that exist, pre-formed in the blood.
If this view of the physiology of the biliary secretion be correct, it is perfectly evident that when the secretion of bile is arrested, those substances which the liver generates will be entirely wanting, while those which it merely excretes from the blood will accumulate there as soon as their excretion is prevented; just as urea accumulates in the circulation when its elimination by the kidneys is stopped. ”

“ For a bilious attack give the yolk of an egg beaten up well, and let the patient swallow it down in one mouthful and lie still awhile. The egg appears to collect all the bile together, and bring it away at once. It has an extraordinary effect, for hardly anything, save bile comes up. One wants an hour or two’s sleep after a bilious attack. Some people take a little spirits and water, but they do not agree with all, in many instances turning acid on the stomach, and laying the foundation for another headache. ”

“ I must here mention, that jaundice does not necessarily follow upon absence of the gall-bladder; just as in the horse, the deer, the rat, and other animals that possess no gall-bladders, the biliary function is perfectly well carried on, so it may be in the human subject, labouring under a congenital or accidental deficiency of the gall-bladder. In such cases, the hepatic ducts are pervious, and consequently the secreted bile finds no difficulty in reaching the intestines. ”

“ BILIOUS HEADACHE.—This is so-called because the bilious symptoms are the most prominent. It may be caused by violent anger, disputes, excessive eating causing congestion of the liver; abuse of spirits; some persons are of a bilious constitution and the least error in diet and habit produces such an attack. The pain may be violent or dull, the head may throb terribly; the whites of the eyes have a yellowish look, and the face may be of a dark brown hue, the patient may vomit bile. The vomiting causes more brain distress. The mouth is bitter, the tongue coated yellowish, the breath smells badly. ”

“ There is reason to believe, that the bile is most frequently returned into the circulation by the inverted motions of these hepatic glands, for the bile does not seem liable to be absorbed by the lymphatics, for it soaks through the gall-ducts, and is frequently found in the cellular membrane. This kind of jaundice is not generally attended with pain, neither at the extremity of the bile-duct, where it enters the duodenum, nor on the region of the gall-bladder. ”

“ As the secreting structure of the liver is continually lessened in extent by the atrophy, symptoms result from the necessary interference in the hepatic functions. These symptoms are concerned with the liver, with the nutrition of the tissues of the body, and with the kidneys. As regards the biliary function of the liver, the quantity of bile acids and pigment is reduced below the normal in proportion to the damage done to the organ. As a rule, there is little jaundice in sclerosis, and very little bile-pigment present in the urine. ”

“ A great variety is observed in the arrangement of the biliary ducts, through which, at the period of intestinal digestion, bile passes from the liver and gall-bladder into the intestine, while in the intervals of digestion the secretion is only carried from the liver to the bladder. The following main types of the biliary duct system may be recognized:
1. The hepatic duct joins the cystic to form the common bile-duct, entering the duodenum by passing obliquely through the intestinal wall (Fig. 242) . This form is encountered in man and in most mammals. ”

“ Hence an increased quantity of aliment requires a greater proportion of bile, to promote its digestion; and, accordingly as the stomach is more or less distended with food, it presses on the gall-bladder to obtain a proportionate quantity of bile, which is then mixed with the chyle, as before described.—See Chyle, and Liver.
Bile is a very important fluid in the animal economy, insomuch, that from an excessive secretion of it, the inhabitants of warm climates become liable to many tedious and often fatal diseases. ”

“ He proved that bile, which used to be considered an excretion, was really an important digestive secretion. He was not able to demonstrate the function of bile as completely as he had done for the gastric juice. The problem of intestinal digestion is much more complicated than that of stomach digestion, and involves a number of factors for which allowance has to be made if the value of any one of them is to be accurately determined. Even in our own day all of the physiological problems in the functions of biliary secretion are not solved. ”

“ If bile be administered, as I propose, at the end of stomachal digestion, it will, as in the healthy organism, act on the chyme at the proper moment, and thereby render it fit for absorption. In order still further to ensure the action of the bile being delayed until the food is in a condition favourable to its action, that is to say, until it is ready to pass from the stomach into the duodenum, I have had the bile, as above prepared, put into capsules,31 which are not readily acted on by the gastric juice. ”

“ By the administration of prepared bile in the manner here described, the physician is enabled to imitate nature, and [p. 131] supply an important element to the system; which, although incapable of curing the disease, can nevertheless ward off for a time the fatal termination.33
33 It is not alone in cases of jaundice that the prepared bile may be of service, but also in the various forms of duodenal dyspepsia, so common among the literary classes, consequent upon either a deficient quantity, or an abnormal quality of bile. ”

“ If the main hepatic duct or the common duct were obstructed, there would of course be paleness of the feces, as the bile would be prevented from entering the duodenum. But when a large amount of highly-colored bile is being secreted, as in relapsing fever, it seems clear that the obstruction of a certain number of minute ducts would cause sufficient resorption of the bile to induce jaundice of varying degrees of intensity, while at the same time allowing a flow of bile through the patulous ducts. ”

“ One of the effects of the bile in this operation is to extinguish acidity, whether proceeding from substances taken in, or generated in the stomach. The blood in all climates, and in all situations of life, is subject to have part of it thus corrupted, which, being separated from the common mass by the liver, is mingled and discharged with the common feces; but external heat continued for any length of time tends to augment this corruption of the fluids, and therefore to increase the secretion of bile ”

“ Causes.—The liver does not perform its function well, or there is a retention of bile in the bile ducts. Most of the symptoms do not depend directly upon the changes in the bile, but upon failure of proper digestion in the stomach and intestines. Certain poorly prepared foods or improper food for stomach digestion, quickly cause the development of active fermentation and its results irritate the stomach mucous membrane bringing about a faulty stomach secretion of mucus, which causes further trouble. It may end in a sick headache. ”

“ In case of jaundice, the bile, which is perhaps not at all absorbed in a state of health, is taken up in large quantities, and mingled with the mass of blood, which proves a seasonable relief in the state of accumulation and distension occasioned by the obstruction. This may happen in cases of fever, not indeed as a relief to nature, but from a depraved state of irritability in the lymphatics, induced by disease. Though no increased quantity of bile, therefore, is found in the gall bladder, there may have been an increased excretion of it, a preternatural absorption having been excited. ”

“ Whether the liver be enlarging or diminishing in size, its functions are impaired, or indeed entirely suspended. As the digestive canal receives the bile immediately on its production, it will be best to begin with the gastro-intestinal disorders which accompany occlusion of the bile-ducts. The appetite is either wanting entirely and food is loathed, or an excessive or canine appetite is experienced. The latter belongs rather to an early stage of the disorder, and comes on after the first disturbance of the stomach belonging to the immediate effects of the occlusion. ”

“ But if the atony arise from a hot intemperament, in process of time it appears more feculent and very fetid, the bile being high-coloured and thick. Wherefore, the substance of the liver being already melted, the whole body also is melted down; and there is fever, anorexia, and vomiting of bile. When the intemperament is cold, the discharges are neither constant nor many, for the affection is a chronic one; and for several days the discharges from the belly will be more abundant, but less fetid, like the lees of thick blood, approaching to black bile. ”

“ That the ready flow or free outlet of bile is the natural and proper medium of relief in such cases, every one has an opportunity to judge; for fits of anger are so common in Lima, that a day never passes without witnessing or hearing of their ill consequences; and the most familiar and immediate effect is a [87] bilious disorder of the bowels, or indigestion and subsequent vomiting,—just as the stomach happens to be occupied, or otherwise, during the period of mental perturbation. ”

“ The marks of a redundance of bile are, a sickness at stomach, a sense of scalding at the anus when the stools are passing, and the yellow or green colour of the stools themselves. It is apt also to excite symptoms of fever, such as a foul tongue, a hot and dry skin, with thirst. When collections of it are suspected in this disease, it is best to evacuate it by vomiting, for it is thereby prevented from irritating the bowels, and from arriving at the inflamed parts with, perhaps, increased acrimony, acquired in passing through the whole length of the intestines. ”

“ These cases show conclusively, that the matter of the black vomit, occurring in yellow fever, should not be regarded as altered bile; and that the supposition of its consisting of a secretion of the mucous membrane of the stomach, does not rest on a much more solid foundation. For bile can hardly be admitted to exude from the skin and serous membranes, and we cannot suppose, that fluids, similar in every respect, can be secreted from two surfaces, so very distinct in their organization, and in the nature of their ordinary products, as those of the mucous and serous membranes. ”

“ The patient dies of dropsy but not of "liver complaint."
Some people act as if they thought bile were a poison. On the contrary, it is a very useful digestant; it aids in keeping down the number of harmful bacteria and helps to carry the food from intestines to blood. Every day the liver manufactures at least a pint of this important fluid. The body uses what it needs and stores the surplus for reserve in the gall-bladder. The flow is continuous and, despite all appearances to the contrary, there is no such thing as a torpid or an over-active liver. ”