The oxalic acid found in certain calculi points in the same direction, as this acid, both in the body and in the laboratory, is found to result from the oxidation of uric acid (Wohler, Schenck, Hutchinson).
Degenerations of the Kidneys are to be largely traced to the same hepatic source. The uric acid diathesis, and the oxalic acid diathesis, both the result of imperfect liver function, are among the most frequent causes of irritation of the kidneys, by which channel they are eliminated from the body. Hence acute and chronic nephritis, as well as nephritic calculi result from morbid conditions which have their starting point in the imperfect function of the liver. Again fatty degeneration of the kidney is very liable to result from derangement of the glycogenic function of the liver, the tendency to the formation of fat and the constant irritation caused by the passage of the sugar contributing to the tissue degradation. In such cases albuminuria is a not uncommon accompaniment.
Derangements of the Digestive Organs may be said to be a necessary result of hepatic disorder. Excessive secretion of bile stimulates peristalsis and may induce diarrhœa, while diminished secretion tends to constipation, light colored, fœtid stools, intestinal fermentations and poisoning by the irritant products. A torpid hepatic circulation means congestion of the whole portal system, indigestions, colics, chronic muco-enteritis, intestinal hemorrhages, hemorrhoids, etc.
Derangements of the Nervous System. In this connection may be named the lameness of the right shoulder which accompanies certain disorders of the liver, the extreme dullness and depression that attends on others, the sluggish pulse that appears in certain types, the unsteadiness of gait (giddiness) in others, the muscular cramps, and irritability in still others. These appear to be due in some instances to the nervous sympathy of one part with another, whilst at other times they as manifestly depend on the circulation in the blood of partially oxidized and other morbid products of hepatic disorder which prove direct poisons to the nervous system.
Derangements of the circulation, like extreme rapidity, or slowness of the pulse, irregularities in rhythm and intermissions, may be charged more directly on the nervous affection, though primarily determined by hepatic disorder.
On the part of the Respiratory Organs, affections of a chronic type, like sore throat and bronchitis may often be traced to hepatic torpor or disorder.
Skin Diseases are notoriously liable to come from inactive or disordered liver, the irritant products circulating in the skin or sweating out through it, giving rise to more or less irritation. The result may be a simple pruritus, an urticaria, an eruption of papules, vesicles or even pustules. In any such cases it is proper to look for other indications of liver disease,—pale color and offensive odor of the fæces, muco-enteritis, indigestion, icterus or yellow patches on the mucous membranes, tenderness on percussion over the asternal ribs, muscular neuralgia, nervous disorder, the passage of bile, hæmoglobin, albumen, sugar or other abnormal elements in the urine, etc.
TREATMENT OF SECONDARY AND FUNCTIONAL DISEASES OF THE LIVER.
Diet. Many hepatic disorders, and especially those that are exclusively or mainly functional may be corrected by diet alone. Prominent among dietary influences is the abundant supply of water. The succulent grasses of spring and early summer constitute the ideal diet, hastening and increasing elimination, and lessening the density of the bile, even to the extent of dissolving biliary calculi and concretions. Upon dry winter feeding such calculi are common especially in ruminants, whereas after a month or two at pasture they are extremely rare. In winter the same good may be arrived at by the use of ensilage, brewer’s grains, roots, fruits, or even scalded hay or bran. The two extremes of highly albuminous and highly carbonaceous or saccharine food are to be avoided or used only in limited amounts. In the one class are clover, alfalfa, sainfoin, vetches, cowpea, lespedeza, especially in the form of hay, beans, peas, cotton seed, gluten-meal, rape and linseed cake. In the other are wheat, buckwheat, Indian corn, sorghum, sweet-corn and cornstalks. Some agents like beets which are rich in saccharine matter may be actually beneficial by reason of their laxative and cholagogue action. In the carnivora the food should be largely of simple mush of oatmeal, wheat seconds, or barley meal, skimmilk or buttermilk. If it is needful to tempt the appetite in a fleshfed animal this should not be done by rich, fat gravies, highly spiced animal food, or rich saccharine puddings, but rather by the addition of a little pure juice of lean meat, or some well skimmed beef tea.
It is as important to regulate the quantity as the quality of the food as the heavy feeder will over-charge the liver as much by an excess of otherwise wholesome food, as will the ordinary animal by the indigestible and unwholesome articles. As a rule the improved breeds of meat producing animals, have acquired such facility in fat production that much of the surplus is largely and profitably disposed of in this way, and in their short lives little obvious evil comes of the overfeeding, but in cases in which this outlet proves insufficient, as in horses and dogs that are highly fed on stimulating or saccharine diet, and which are kept for the natural term of their lives, with little exercise, the evil tends to reach a point of danger. Nursing mothers and dairy cows find a measure of safety in the free flow of milk and the yield of butter, but breeding cows that have been improved till they have no longer a capacity for milking, but must have their calves raised on the milk of other and milking strains are correspondingly liable to suffer.